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Zhao B, Yin L, Chu W, Wang F, Huo P, Gao J. Radio frequency ablation for the intrauterine treatment of giant placental chorioangioma associated with fetal compromise: A case report. Birth Defects Res 2023; 115:251-257. [PMID: 36259564 DOI: 10.1002/bdr2.2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/21/2022] [Accepted: 09/27/2022] [Indexed: 01/26/2023]
Abstract
Giant placental chorioangiomas associated with fetal hyperdynamic circulation complications are rare to see. Here, we summarized a case of giant placental chorioangioma associated with fetal anemia and heart failure treated by radiofrequency ablation (RFA) combined with cordocentesis and intrauterine transfusion. The sonographic appearance of the placental chorioangioma was atypical which was isoechoic with unclear boundary. RFA was performed successfully at 27 weeks of gestation, when the chorioangioma has increased to 17.0 × 10.6 × 12.3 cm3 . Unfortunately, intrauterine fetal demise was found on the first day after operation. After induction of labor, it was pathologically confirmed as placental chorioangioma.
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Affiliation(s)
- Bingyi Zhao
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Lu Yin
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wei Chu
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Fangna Wang
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Ping Huo
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jian Gao
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
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Turgut E, Atalay A, Sakcak B, Sahin D. Interstitial Laser Ablation of Feeding Vessels to a Large Placental Chorioangioma. Z Geburtshilfe Neonatol 2022; 226:274-277. [PMID: 35609870 DOI: 10.1055/a-1833-9554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chorioangioma is a vascular neoplasm of the placenta with the potential to cause heart failure, hydrops, and even death. CASE A 30-year-old patient was referred owing to a large placental chorioangioma and fetal hydrops at 28 weeks of gestation. The patient underwent ultrasound-guided interstitial laser ablation. Ten days later, fetal blood transfusion was performed and at 31 weeks of gestation, and the patient delivered a female infant by cesarean section. The newborn was discharged from the neonatal intensive care unit without any complication. CONCLUSION According to our case, large placental chorioangioma may have a favorable outcome with interstitial laser ablation and fetal transfusion.
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Affiliation(s)
- Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara City Hospital, Ankara, Turkey
| | - Aysegul Atalay
- Obstetric and Gynecology, Ankara City Hospital, Cankaya, Turkey
| | - Bedri Sakcak
- Obstetric and Gynecology, Ankara City Hospital, Cankaya, Turkey
| | - Dilek Sahin
- Perinatology, Ankara City Hospital, Cankaya, Turkey
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3
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Nawapun K, Hunsawongsakul D, Phithakwatchara N, Hanamornroongruang S, Viboonchart S, Jaingam S, Wataganara T. Ablative effect of the interstitial laser setting in the human placental model. J Obstet Gynaecol Res 2022; 48:1157-1164. [PMID: 35178830 DOI: 10.1111/jog.15190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
AIM To assess the impact of laser power and time on interstitial ablation generated by neodymium-doped yttrium aluminium garnet (Nd:YAG) and diode laser in the human placental model. METHODS The experiment was carried out in a simulation model of interstitial laser ablation on ex-vivo placental tissue. One-hundred and forty-four pieces of fresh placentae were interstitially ablated with Nd:YAG or diode laser at various power (15, 20, 25, 30 W)-time (5, 10, 15 s) combinations. The ablation tissues were evaluated using both sonographic and histopathologic measurements. RESULTS Laser generator, power, and time significantly affected the ablation size (p < 0.001). The coagulation zone continuously increased with extending time at the power of 15, 20, and 25 W. When adjusting to the power of 30 W, increased time from 10 to 15 s did not induce the larger coagulation diameter. The maximal diameter was obtained at the laser power of 20 W for 15 s. The ablation from the diode laser was greater than that from Nd:YAG laser. The sonographic evaluation overestimated the ablation size by an average of 24%. CONCLUSION Diode laser destroys greater tissue than Nd:YAG laser. Different power settings of interstitial laser ablation produce diverse patterns of correlation between laser time and coagulation size.
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Affiliation(s)
- Katika Nawapun
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Daungporn Hunsawongsakul
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Nisarat Phithakwatchara
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | | | - Sommai Viboonchart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Suparat Jaingam
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Tuangsit Wataganara
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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4
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Czeresnia RM, Trad ATA, Narang K, Wyatt M, Ruano R. Three-Dimensional Doppler Mapping of Placental Chorioangioma Prior to Fetoscopic Laser Ablation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:255-257. [PMID: 33749868 DOI: 10.1002/jum.15680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Ricardo Mamber Czeresnia
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ayssa Teles Abrao Trad
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kavita Narang
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michelle Wyatt
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Rodrigo Ruano
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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5
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Bouchghoul H, Benachi A, Senat MV. Prenatal Percutaneous Fetoscopic Laser Photocoagulation of Chorioangioma: Report of Two Cases and Review of the Literature. Fetal Diagn Ther 2021; 48:633-639. [PMID: 34496362 DOI: 10.1159/000517392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In Doppler flow diagnosis of a large placental chorioangioma with vascularization, there may be fetal consequences as cardiac output failure and polyhydramnios. Prenatal percutaneous fetoscopic laser photocoagulation of chorioangioma is a therapeutic option. First, we present 2 cases of chorioangioma treated by fetoscopic laser photocoagulation. Second, we conducted a narrative review to identify all reported cases of chorioangioma treated by fetoscopic laser photocoagulation. CASE PRESENTATION Case 1 presented a chorioangioma measuring 48 × 36 × 42 mm, and the Doppler flow study showed vascularization with a high flow rate. The fetus showed dilatation of the right cardiac chambers, moderate tricuspid insufficiency, normal Doppler indices, and polyhydramnios. Case 2 presented a chorioangioma measuring 58 × 36 × 31 mm associated with polyhydramnios and elevated peak systolic velocity of the middle cerebral artery at 49 cm/s, that is, 1.65 MoM. The procedure was performed at 22+2 and 23+5 WG for both cases. Photocoagulation of the chorioangioma vessels was performed first on the small superficial vessels (capillaries) and then on the feeding vessels (artery first and then vein), until complete cessation of blood flow on ultrasound. Successful devascularization was achieved when flow within the chorioangioma's feeding vessels was no longer visualized on intraoperative ultrasound examination using Doppler flow. The ultrasound follow-up showed complete cessation of blood flow in the chorioangioma, normalization of fetal signs, and normal fetal growth in both cases. In case 1, a 2,350-g boy was delivered vaginally after spontaneous labor at 33+6 WG. In case 2, a 2,700-g boy was delivered vaginally after spontaneous labor at 39+2 WG. Neonatal findings were normal, and the outcome at 1 year was normal for both children. CONCLUSION Prenatal percutaneous fetoscopic laser photocoagulation improves survival in large chorioangioma, despite a risk of fetal death in utero.
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Affiliation(s)
- Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.,Department of Gynecology-Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Alexandra Benachi
- Department of Gynecology-Obstetrics, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Marie-Victoire Senat
- Department of Gynecology-Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
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6
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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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7
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Abstract
AbstractChorioangiomas are benign tumors of the placenta, characterised by AV shunting within placenta leading to fetal anemia, cardiomegaly and hydrops. Maternal complications are also known as polyhydramnios, APH and Mirror syndrome. They are seen after 20 weeks, and most of them remain small and are asymptomatic. Large ones (> 4 cm) can create complications for the fetus and expectant mothers. The proximity of the chorioangioma to the placental cord insertion site and its size determines prognosis. Prenatal therapy in the form of interventions like direct injections of various chemicals and laser coagulation of the tumor’s feeding vessels are described in the literature. Conservative management may also be offered in certain circumstances. We report a case of large Chorioangioma managed conservatively. Early diagnosis was made, patient counseling followed by close surveillance with Doppler, MCA PSV was done for fetal wellbeing. The timely intervention led to good neonatal and maternal outcome aided with NICU management.
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8
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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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9
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Prenatal Embolisation of Giant Chorioangioma Using n-Butyl Cyanoacrylate: Technique, Clinical Course and Perinatal Outcome. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-019-00235-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Large placental chorioangioma: a potential effective in-utero treatment modality for radio frequency ablation. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2018-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Placenta chorioangiomas are common benign placental tumours. While microscopic chorioangiomas are frequent, macroscopic chorioangiomas of more than 5 cm are rare and often associated with fetal complications such as high output cardiac failure, fetal anaemia and stillbirth. Close monitoring and in-utero treatment are sometimes necessary to prevent adverse pregnancy outcome.
Case presentation
We present two cases of large placenta chorioangiomas with one case requiring surgical therapy with radiofrequency ablation (RFA) of tumour vessels, which resulted in a successful outcome of a live birth at term.
Conclusion
We conclude that RFA is an effective alternative treatment modality to fetoscopic laser therapy in utero for cases at risk of fetal cardiac failure and intrauterine demise in the presence of large chorioangiomas.
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11
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Das R. Chorioangioma of Placenta. Placenta 2018. [DOI: 10.5772/intechopen.79993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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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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13
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Nassr AA, Erfani H, Fisher JE, Ogunleye OK, Espinoza J, Belfort MA, Shamshirsaz AA. Fetal interventional procedures and surgeries: a practical approach. J Perinat Med 2018; 46:701-715. [PMID: 28599395 DOI: 10.1515/jpm-2017-0015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/19/2017] [Indexed: 12/25/2022]
Abstract
Abstract
The identification of congenital birth defects and fetal malformations continues to increase during the antenatal period with improved imaging techniques. Understanding of how to treat specific fetal conditions continues to improve outcomes from these treatment modalities. In an effort to further improvement in this field, we provide a review that begins with a brief background of fetal surgery including the history of fetal surgery, ethics surrounding fetal surgery, and considerations of how to treat the fetus during intervention. A synopsis of the most commonly encountered disease processes treated by fetal intervention/surgery including definitions, treatment modalities, and outcomes following fetal intervention/surgery is then provided. Within the sections describing each disease process, methodology is described that has helped with efficiency and success of procedures performed at our institution.
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Affiliation(s)
- Ahmed A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.,Women's Health Hospital, Assiut University, Assiut, Egypt
| | - Hadi Erfani
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - James E Fisher
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Oluseyi K Ogunleye
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Alireza A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, 6651 Main Street, Houston, TX 77030, USA,
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14
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Papaioannou GK, Evangelinakis N, Kourtis P, Konstantinidou A, Papantoniou N. Giant chorioangioma treated with interstitial laser coagulation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:280-281. [PMID: 29072331 DOI: 10.1002/uog.18941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/02/2017] [Accepted: 10/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
- G K Papaioannou
- 3rd Department of Obstetrics and Gynecology, General University Hospital "Attikon", Rimini 1, Chaidari, Athens, Greece
| | - N Evangelinakis
- 3rd Department of Obstetrics and Gynecology, General University Hospital "Attikon", Rimini 1, Chaidari, Athens, Greece
| | - P Kourtis
- Private Fetal Medicine Clinic, Athens, Greece
| | - A Konstantinidou
- Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - N Papantoniou
- 3rd Department of Obstetrics and Gynecology, General University Hospital "Attikon", Rimini 1, Chaidari, Athens, Greece
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15
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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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16
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Moaddab A, Nassr AA, Belfort MA, Shamshirsaz AA. Ethical issues in fetal therapy. Best Pract Res Clin Obstet Gynaecol 2017; 43:58-67. [PMID: 28268059 DOI: 10.1016/j.bpobgyn.2017.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 02/03/2023]
Abstract
The introduction of routine fetal ultrasound and the technical improvements in ultrasound equipment have greatly increased our ability to diagnose fetal anomalies. As a consequence, congenital anomalies are diagnosed today earlier and in a greater number of patients than ever before. The development of fetal intervention and fetal surgery techniques, improved anesthesia methodology, and sophisticated perinatal care at the limits of viability, have now made prenatal management of some birth defects or fetal malformations a reality. The increasing number of indications for fetal therapy and the apparent desire of parents to seek out these procedures have raised concern regarding the ethical issues related to the therapy. While fetal therapy may have a huge impact on the prenatal management of some congenital birth defects and/or fetal malformations, because of the invasive nature of these procedures, the lack of sufficient data regarding long-term outcomes, and the medical/ethical uncertainties associated with some of these interventions there is cause for concern. This chapter aims to highlight some of the most important ethical considerations pertaining to fetal therapy, and to provide a conceptual ethical framework for a decision-making process to help in the choice of management options.
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Affiliation(s)
- Amirhossein Moaddab
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States
| | - Ahmed A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States
| | - Alireza A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States.
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