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Mestha A, Dhanaliwala A, Frangieh A, Mestha SM, Ramaiah SM. Giant Chorioangioma of the Placenta as a Cause of Maternal, Foetal, and Neonatal Complications. Cureus 2023; 15:e42430. [PMID: 37637612 PMCID: PMC10448837 DOI: 10.7759/cureus.42430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Chorioangioma is a benign placental neoplasm seen in about one percent of all pregnancies. The larger neoplasms generally cause severe foeto-maternal complications. We are reporting a case of a 33-year-old gravida three para two female who was incidentally diagnosed with chorioangioma at her routine 28-week antenatal follow-up. She delivered a preterm small-for-gestational-age female baby at 34 weeks with complications. Therefore, an early diagnosis warrants a close follow-up and timely intervention for a better outcome of the pregnancy.
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Affiliation(s)
- Akshata Mestha
- General Practice, Dubai Academic Health Corporation, Dubai, ARE
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Zou J, Ding W, Chen Q, Bai X, Li B. Safety of vaginal delivery in women with placental chorioangiomas diagnosed by prenatal ultrasound: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29672. [PMID: 35866806 PMCID: PMC9302376 DOI: 10.1097/md.0000000000029672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This study aimed to examine the maternal and neonatal outcomes in different mode of delivery in pregnant women with placental chorioangiomas, in order to determine the safety of vaginal delivery. We conducted a retrospective study of 54 women with placental chorioangioma diagnosed by prenatal ultrasound and subsequently proven histologically, excluding those who underwent cesarean section for obstetric indications. The mode of delivery was divided into a vaginal delivery group (23 women) and a cesarean section group (31 women). The indication of cesarean section group was only for placental chorioangioma, no other obstetric indications. The maternal characteristics, pregnancy outcomes and the color doppler imaging characteristics of placental chorioangioma of the 2 groups were compared, and the clinical characteristics of women in the vaginal delivery group were described in detail. The incidence of placental chorioangioma was nearly 0.43‰ in our study. There was no significant difference in the maternal characteristics and pregnancy outcomes between the 2 groups. 82.6% (19/23) of the women successfully delivered vaginally and 4 failed who turned to cesarean section in the vaginal delivery group; among them, 17 women had giant chorioangiomas (>4 cm in diameter). The direct cause of vaginal delivery failure was fetal distress, persistent occiput posterior fetal position and cephalopelvic disproportion. Pregnant women with placental chorioangiomas and no other obstetric indications for cesarean section may attempt a vaginal delivery, even with giant chorioangiomas. If there are risk factors of vaginal delivery failure, the progress of labor needs to be closely monitored.
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Affiliation(s)
- Jiashan Zou
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China
| | - Weimin Ding
- Zhejiang University School of Medicine, Hangzhou 310006, People’s Republic of China
| | - Qin Chen
- Department of Pathology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, People’s Republic of China
| | - Xiaoxia Bai
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China
| | - Baohua Li
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China
- *Correspondence: Baohua Li, Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China (e-mail: )
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Mo R. Successful expectant management of a giant chorioangioma. BMJ Case Rep 2021; 14:14/3/e239928. [PMID: 33722913 PMCID: PMC7959226 DOI: 10.1136/bcr-2020-239928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Giant chorioangiomas are benign placental tumours, which can have potential severe fetal consequences. Complications in pregnancy include polyhydramnios, fetal hydrops and growth restriction. Such pregnancies can carry a significant risk of poor perinatal outcome and require close monitoring. Therapeutic options include fetoscopic or interstitial vessel ablation, chemosclerosis and embolisation. Where there is no evidence of fetal compromise, such pregnancies can successfully be managed conservatively.
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Affiliation(s)
- Roxana Mo
- Department of O&G, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, Essex, UK
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Lakhno IV. Non-invasive fetal electrocardiography ameliorates fetal outcome in chorioangioma: A case report. J Neonatal Perinatal Med 2021; 14:149-152. [PMID: 32007964 DOI: 10.3233/npm-190329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chorioangioma is a rare vascular placental tumour. Large chorioangiomas are known to have many maternal and perinatal complications. The case of placental chorioangioma detected via ultrasound is presented. This paper is focused on non-invasive fetal electrocardiography (NI-FECG) clinical use for diagnosing fetal anemia in chorioangioma.A 22-year-old primigravida was admitted to the department of fetomaternal medicine at 30 weeks of gestation. She had threatened preterm labour, polyhydramnios, and breech presentation. The large echogenic mass of 77 mm×66 mm×83 mm, located in the uterine bottom, protruded into the amniotic cavity, and connected to the marginal sinus of the placenta was determined via ultrasound. The sinusoidal pattern of beat-to-beat variations was diagnosed via NI-FECG in spite of normal blood flow velocity in the fetal middle cerebral artery. Therefore, NI-FECG was superior in the detection of fetal anemia. The female baby weighing 1500 g and measuring 42 cm in length, with a head circumference of 30 cm and Apgar score 3⟶5, was delivered by caesarean section. The baby had severe anemia and respiratory distress syndrome.NI-FECG was a good option for the clinician for the timely and accurate diagnosis of fetal anemia and fetal compromise in placental chorioangioma.
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Affiliation(s)
- Igor V Lakhno
- Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
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Buca D, Iacovella C, Khalil A, Rizzo G, Sirotkina M, Makatsariya A, Liberati M, Silvi C, Acharya G, D'Antonio F. Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:441-449. [PMID: 31034661 DOI: 10.1002/uog.20304] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To report the perinatal outcome of singleton pregnancies complicated by placental chorioangioma diagnosed on prenatal ultrasound. METHODS MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov databases were searched for studies reporting the outcome of pregnancies complicated by placental chorioangioma. Inclusion criteria were singleton pregnancy diagnosed with placental chorioangioma on prenatal ultrasound, with no other associated structural anomaly. The primary outcome was perinatal mortality. Secondary outcomes included associated non-structural anomalies detected on prenatal ultrasound (including fetal hydrops, anemia, polyhydramnios, signs of hyperdynamic circulation and small-for-gestational-age (SGA) fetus), SGA at birth, composite neonatal morbidity and preterm birth. Outcome was assessed separately in pregnancies undergoing and those not undergoing fetal therapy. Subanalyses were performed according to the presence of hydrops and the size of the tumor in all pregnancies diagnosed with chorioangioma. Random-effects meta-analyses of proportions were used to analyze the data. RESULTS Twenty-eight studies (161 pregnancies) were included. In pregnancies complicated by chorioangioma that did not undergo intervention, intrauterine death occurred in 8.2% (95% CI, 3.8-15.0%), while neonatal death and perinatal death occurred in 3.8% (95% CI, 1.0-8.1%) and 11.1% (95% CI, 5.0-19.4%), respectively. SGA at birth was present in 24.0% (95% CI, 13.5-36.5%) of cases, while preterm birth < 37 weeks complicated 34.1% (95% CI, 21.1-48.3%) of pregnancies. Composite neonatal morbidity occurred in 12.0% (95% CI, 4.5-22.3%) of cases. On ultrasound, signs of fetal hyperdynamic circulation were present in 21.0% (95% CI, 9.6-35.3%) of cases, while peak systolic velocity in the fetal middle cerebral artery was increased in 20.6% (95% CI, 10.9-32.3%). Subanalysis according to the size of chorioangioma, including both pregnancies that did and those that did not undergo intervention, showed a progressive increase in the occurrence of most of the outcomes explored with increasing size of the tumor. Furthermore, the prevalence of adverse perinatal outcome was high in pregnancies complicated by chorioangioma presenting with fetal hydrops. There was no randomized controlled trial comparing intervention vs expectant management in pregnancies complicated by chorioangioma with signs of fetal compromise (hydrops or hyperdynamic circulation). Overall, perinatal mortality occurred in 31.2% (95% CI, 18.1-46.1%) of fetuses undergoing in-utero therapy, and 57.3% (95% CI, 39.2-74.4%) had resolution of hydrops or hyperdynamic circulation after treatment. CONCLUSIONS Placental chorioangioma is associated with adverse perinatal outcome. The size of the mass and presence of fetal hydrops are likely to be the main determinants of perinatal outcome in affected pregnancies. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Buca
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - C Iacovella
- Department of Gynecology and Obstetrics, Goethe University, Frankfurt, Germany
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - G Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Sirotkina
- Section of Perinatal Pathology, Department of Pathology, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Liberati
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - C Silvi
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
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Abstract
A pregnant woman was referred to our hospital due to fetal cardiomegaly. We recognised a dilated umbilical vein, which raised a suspicion of placental chorioangioma. A male neonate was delivered at 37 weeks of gestation. The cardiomegaly was gradually improved. Pathological examination identified five non-giant placental chorioangiomas. Multiple non-giant chorioangiomas may cause fetal complications despite the difficulty of prenatal diagnosis.
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Mack LM, Mastrobattista JM, Gandhi R, Castro EC, Burgess APH, Lee W. Characterization of Placental Microvasculature Using Superb Microvascular Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2485-2491. [PMID: 30620078 DOI: 10.1002/jum.14919] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/16/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
Superb Microvascular Imaging (SMI; Canon Medical Systems, Tustin, CA) uses clutter suppression to extract flow signals at rapid frame rates, which provides high-resolution vessel-branching details without the need for contrast agents. The potential diagnostic benefits of SMI, as described in other areas of medicine, requires further exploration during pregnancy. In this pictorial essay, we demonstrate the complementary use of SMI compared to conventional Doppler ultrasound and how it may improve our ability to characterize placental microvascular patterns without the need for ultrasound contrast agents.
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Affiliation(s)
- Lauren M Mack
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Joan M Mastrobattista
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Rajshi Gandhi
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Eumenia C Castro
- Department of Anatomic Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Angela P H Burgess
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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Nikolopoulos M, Otigbah C, Kalidindi M. Chorioangiomas in pregnancy - case report. J OBSTET GYNAECOL 2019; 39:1015-1016. [PMID: 31303120 DOI: 10.1080/01443615.2019.1576602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Manolis Nikolopoulos
- Department of Obstetrics and Gynaecology, Barking Havering and Redbridge University Teaching Hospitals, NHS Trust , Romford , UK
| | - Chineze Otigbah
- Department of Obstetrics and Gynaecology, Barking Havering and Redbridge University Teaching Hospitals, NHS Trust , Romford , UK
| | - Madhavi Kalidindi
- Department of Obstetrics and Gynaecology, Barking Havering and Redbridge University Teaching Hospitals, NHS Trust , Romford , UK
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Dong T, Sher D, Luo Q. Pregnancy complications and adverse outcomes in placental chorioangioma: a retrospective cohort analysis. J Matern Fetal Neonatal Med 2018; 33:2269-2273. [PMID: 30431372 DOI: 10.1080/14767058.2018.1548598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To measure the relative risk of pregnancy complications and adverse outcomes in women with placental chorioangioma, and postnatal developmental deficiencies in their offspring.Methods: We designed a retrospective cohort study using records from 140,387 pregnancies at our hospital between 1 January, 2008 and 1 July, 2017. Follow-up of children in the placental chorioangioma group was conducted by phone interview.Results: Placental chorioangioma was diagnosed in 56 patients (incidence = 0.04%). Fifty-one cases were detected during routine prenatal ultrasound. Placental chorioangioma patients were at increased risk for fetal loss or induced abortion (RR = 9.93, 95% CI [4.66, 21.20]), preterm birth (n = 13, RR = 2.45, 95% CI [1.52, 3.95]), birth by cesarean section (n = 45, RR = 1.62, 95% CI [1.42, 1.84]), and polyhydramnios (n = 9, RR = 9.98, 95% CI [5.48, 18.18]), but not fetal distress (n = 5, RR = 0.49, 95% CI [0.22, 1.15]) or preeclampsia (n = 5, RR = 1.61, 95% CI [0.70, 3.73]), although there was an increased risk for preeclampsia after controlling for preterm birth (n = 3, RR = 3.6, 95% CI [1.33, 9.74]). No developmental complications were reported in offspring.Conclusion: Placental chorioangioma increases the risk of fetal demise, pregnancy complications and adverse outcomes. In cases with mild complications or when early cesarean termination of pregnancy is feasible, the prognosis is excellent.
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Affiliation(s)
- Tian Dong
- Zhejiang University School of Medicine Women's Hospital, Hangzhou, China
| | - Daniel Sher
- Zhejiang University School of Medicine Women's Hospital, Hangzhou, China
| | - Qiong Luo
- Zhejiang University School of Medicine Women's Hospital, Hangzhou, China
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Emery SP, Orons PD, Bonadio JF. Successful Management of Giant Placental Chorangioma by Microcoil Embolization. AJP Rep 2018; 8:e230-e233. [PMID: 30345160 PMCID: PMC6188883 DOI: 10.1055/s-0038-1669944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/27/2018] [Indexed: 11/23/2022] Open
Abstract
Optimal prenatal management of giant placental chorangioma (also known as chorioangioma, angiomyxoma, fibroangiomyxoma, or fibroma) has yet to be determined. Interventions intended to devascularize the tumor such as interstitial laser, bipolar coagulation, fetoscopic laser photocoagulation, and chemical embolization have met mixed results. We report a minimally invasive, extra-amniotic approach, technically similar to cordocentesis, of microcoil embolization of the feeding vessel. These percutaneously placed microcoils initiate clot formation at the site of insertion and are unable to migrate through the tumor, thereby minimizing fetal harm by downstream embolic phenomena. Intervention at 26 and 22 weeks resulted in intraoperative fetal loss in the former and vaginal delivery at term of a healthy neonate in the latter. Preoperative, intraoperative, and placental findings are highlighted. The ease and safety of this procedure may alter the risk-benefit equation toward earlier intervention with potentially better clinical outcomes.
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Affiliation(s)
- Stephen P Emery
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Philip D Orons
- Department of Interventional Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jeffrey F Bonadio
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Sirotkina M, Douroudis K, Wahlgren CF, Westgren M, Papadogiannakis N. Exploring the association between chorangioma and infantile haemangioma in singleton and multiple pregnancies: a case-control study in a Swedish tertiary centre. BMJ Open 2017; 7:e015539. [PMID: 28871010 PMCID: PMC5588969 DOI: 10.1136/bmjopen-2016-015539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Placenta or placental chorangioma could be the origin site of infantile haemangioma since they share various histochemical and genetic characteristics with placental vascular tissue. The aim of the current study was to investigate the association between chorangiomas and infantile haemangiomas in singleton and multiple pregnancies. MATERIALS AND METHODS An informative questionnaire enquiring about the presence or not of infantile haemangioma and including illustrative photos of haemangioma was sent to 469 (153 cases with chorangioma and 316 controls) mothers of 323 singleton (104 cases and 219 controls) and 146 multiple (49 cases and 97 controls) liveborn neonates registered in Sweden. Overall, 310 mothers (66.1%) from 216 singleton and 94 multiple pregnancies (96 cases and 214 controls) provided feedback and their consent to participate in the current case-control study. RESULTS The incidence of infantile haemangioma showed no statistically significant differences between cases and controls (18.8% vs 18.2%) or between singleton and multiple pregnancies (18.9% vs 17.0%). The frequency of pre-eclampsia was significantly higher in cases with chorangioma compared with controls (41.7% vs 24.3%, OR=2.22, 95% CI 1.33 to 3.71, p=0.0022) and in singleton compared with multiple pregnancies (33.3% vs 21.3%, OR=1.85, 95% CI 1.04 to 3.26, p=0.034), whereas there were no significant differences in the incidence of infantile haemangioma in neonates of mothers with or without pre-eclampsia or in neonates of mothers with multiple compared with singleton pregnancies. CONCLUSION There was no association between placental chorangiomas and infantile haemangiomas. Multiple pregnancies or pre-eclampsia were not significantly related to higher incidence of infantile haemangioma.
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Affiliation(s)
- Meeli Sirotkina
- Section of Perinatal Pathology, Department of Pathology, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Konstantinos Douroudis
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Universitetet i Bergen, Bergen, Norway
| | - Carl-Fredrik Wahlgren
- Dermatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Magnus Westgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Section of Perinatal Pathology, Department of Pathology, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Perlman S, Messing B, Salem Y, Porat S, Achiron R, Gilboa Y. The added value of f-TAPSE in the surveillance of pregnancies complicated by fetal and placental tumors. Prenat Diagn 2017; 37:788-792. [DOI: 10.1002/pd.5087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/17/2017] [Accepted: 06/03/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Sharon Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel-Aviv University; Israel
| | - Baruch Messing
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel-Aviv University; Israel
| | - Yishay Salem
- Sackler School of Medicine; Tel-Aviv University; Israel
- Pediatric Cardiology Unit, Edmond and Lily Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
| | - Shiran Porat
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel-Aviv University; Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel-Aviv University; Israel
| | - Yinon Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel-Aviv University; Israel
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13
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Abdalla N, Piórkowski R, Stanirowski P, Pazura M, Cendrowski K, Sawicki W. Can ultrasound be helpful in selecting optimal management methods for pregnancies complicated by placental non-trophpblastic tumors? J Ultrason 2017; 17:116-122. [PMID: 28856020 PMCID: PMC5516082 DOI: 10.15557/jou.2017.0017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/04/2016] [Accepted: 10/09/2016] [Indexed: 12/21/2022] Open
Abstract
Placental chorioangioma is the most common subtype of non-trophoblastic placental tumors. Other subtypes are very rare and usually associated with an uneventful course of pregnancy. Most chorioangiomas are small and of no clinical significance. Giant chorioangiomas may be associated with serious fetal and maternal complications. So far, no established ultrasound guidelines are available for the management of placental non-trophoblastic tumors. This may be attributed to the rarity of the disease entity and its different clinical features and complications. In this article, the role of ultrasound findings such as the tumor’s size, vascularity, feeding vessels, amniotic fluid and location of the placenta in the diagnosis, treatment and follow up of these tumors is presented relying on up-todate literature review. Conservative management with serial ultrasound examinations can be an adequate method for monitoring small uncomplicated tumors. Ultrasound-guided procedures such as amnioreduction and cordocentesis can be used for amelioration of complications. Chorioangioma-specific treatment is reserved for complicated cases in the second trimester of pregnancy when prematurity is a matter of concern. Endoscopic laser ablation is indicated when the feeding vessel is superficial and small. Interstitial laser ablation is helpful when the placenta is located in the anterior uterine wall. Ligation of the feeding vessels is preferred when they are large. Alcohol injection should be performed away from the vasculature to prevent toxicity. Microcoils should be inserted as near as possible to the tumor to prevent collateral formation. Ultrasound is also a method of choice for monitoring the effectiveness of these procedures.
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Affiliation(s)
- Nabil Abdalla
- Department of Obstetrics, Gynecology and Gynecologic Oncology, 2nd Faculty of Medicine, Medical University of Warsaw, Poland
| | - Robert Piórkowski
- Department of Obstetrics, Gynecology and Gynecologic Oncology, 2nd Faculty of Medicine, Medical University of Warsaw, Poland
| | - Paweł Stanirowski
- Department of Obstetrics, Gynecology and Gynecologic Oncology, 2nd Faculty of Medicine, Medical University of Warsaw, Poland
| | - Monika Pazura
- Department of Obstetrics, Gynecology and Gynecologic Oncology, 2nd Faculty of Medicine, Medical University of Warsaw, Poland
| | - Krzysztof Cendrowski
- Department of Obstetrics, Gynecology and Gynecologic Oncology, 2nd Faculty of Medicine, Medical University of Warsaw, Poland
| | - Włodzimierz Sawicki
- Department of Obstetrics, Gynecology and Gynecologic Oncology, 2nd Faculty of Medicine, Medical University of Warsaw, Poland
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14
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Chorioangioma of Placenta: A Rare Case of Near-Miss Mortality. J Obstet Gynaecol India 2016; 67:224-226. [PMID: 28546672 DOI: 10.1007/s13224-016-0934-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022] Open
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