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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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Choi HJ, Kim GJ. A giant symptomatic placental chorioangioma managed with a histoacryl injection. J Ultrasound 2020; 24:561-565. [PMID: 32372255 DOI: 10.1007/s40477-020-00470-x] [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: 12/20/2019] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
Abstract
Chorioangiomas are generally small and associated with favorable outcomes, but large tumors can cause serious fetal complications, such as polyhydramnios, fetal anemia, intrauterine growth restriction, cardiac failure, fetal hydrops, and intrauterine fetal death. Signs of fetal cardiac failure on ultrasonography are indications for urgent in utero interventions. We report a case of a giant chorioangioma causing fetal cardiac failure at 26+3 weeks' gestation, which was treated by embolization of the feeding vessels. We utilized a mixture of n-butyl cyanoacrylate (nBCA, Histoacryl®) and iodized oil (Lipiodol®) as an embolic agent. Fetal hydrops resolved in 4 weeks, and the cardiac size and function normalized 8 weeks after the embolization. A healthy male baby was born at the 37+5th gestational week by cesarean section.
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Affiliation(s)
- Hyun Jin Choi
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea
| | - Gwang Jun Kim
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea.
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3
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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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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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Hamouda S, Soussan J, Haumonté JB, Bretelle F. In utero embolization for placental chorioangioma and neonatal multifocal hemangiomatosis. J Gynecol Obstet Hum Reprod 2019; 48:689-694. [PMID: 31112760 DOI: 10.1016/j.jogoh.2019.05.011] [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: 02/01/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
Placental chorioangioma is a limited non trophoblastic vascular tumour that may causes fetal complications as well as post-natal ones. We reported in here the first case of an in utero embolization of chorioangioma diagnosed at 22 W G with a post-natal diagnosis of neonatal multifocal hemangioma with a good outcome. The chorioangioma was embolized using GLUBRAN 2 ® (cyanolacrylate) a biologic surgical glue at 26 W G. Premature rupture of membrane occurred at 28 W G. A cesarean section at 32 W G was performed for retro placental hematoma. The neonate was 1400 g healthy girl with an anemia (hemoglobin 9.7 g/dl). After one month of life, the child met a neonatal multifocal hemangioma (skin and liver were involved) with superficial erosion of skin hemangiomas that required post-natal transfusions. We propose a literature review related to the various technics of in utero treatment of placental chorioangioma and the links with neonatal multifocal hemangiomatosis as well. The girl is now 7 year old and has a normal neurodevelopmental outcome.
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Affiliation(s)
- Sophie Hamouda
- Department of Gynaecology and Obstetrics, Gynepole, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, France
| | - Jérome Soussan
- Department of Radiology, North University Hospital, Chemin des Bourrely, 13015 Marseille, France
| | | | - Florence Bretelle
- Department of Gynaecology and Obstetrics, Gynepole, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, France; Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
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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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Hosseinzadeh P, Shamshirsaz AA, Javadian P, Espinoza J, Gandhi M, Ruano R, Cass DL, Olutoye OA, Belfort MA. Prenatal Therapy of Large Placental Chorioangiomas: Case Report and Review of the Literature. AJP Rep 2015; 5:e196-202. [PMID: 26495184 PMCID: PMC4603846 DOI: 10.1055/s-0035-1558829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/04/2015] [Indexed: 11/04/2022] Open
Abstract
Objective To review techniques and outcomes of different prenatal treatments for large placental chorioangiomas. Study Design Presentation of a case of laparoscopic-assisted laser coagulation and a systematic review of the literature for articles related to intervention for placental chorioangioma. Results A total of 37 cases of definitive (n = 23) and supportive therapy (n = 14) were evaluated, including one case treated in our center. Approximately 35% of the patients had a spontaneous preterm delivery in definitive treatment group versus 36% in the supportive group. The infant survival rates were 65 and 71% in the two groups, respectively. We further compared the two types of laser ablation (fetoscopic [n = 10] and interstitial [n = 4]). Approximately 30% of the patients in the fetoscopic and 25% in interstitial group, had a spontaneous preterm delivery. Survival rates were 60 and 100% in fetoscopic and interstitial groups, respectively. Conclusion Laser ablation and embolization of chorioangiomas via minimally invasive approach may prevent or reverse fetal hydrops due to high cardiac states. However, further studies are needed to refine the appropriate selection criteria that will justify the risk of this invasive in utero therapy for chorioangiomas.
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Affiliation(s)
- Pardis Hosseinzadeh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Alireza A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas ; Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Pouya Javadian
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Jimmy Espinoza
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas ; Division of Women's and Fetal Imaging, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Manisha Gandhi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Rodrigo Ruano
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas ; Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Darrell L Cass
- Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Oluyinka A Olutoye
- Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Michael A Belfort
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas ; Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Mathis J, Raio L, Baud D. Fetal laser therapy: applications in the management of fetal pathologies. Prenat Diagn 2015; 35:623-36. [DOI: 10.1002/pd.4587] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/21/2015] [Accepted: 02/26/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Jérôme Mathis
- Swiss Fetal Laser Group; University Hospital of Bern, University Hospital of Lausanne CHUV; Lausanne Switzerland
| | - Luigi Raio
- Swiss Fetal Laser Group; University Hospital of Bern, University Hospital of Lausanne CHUV; Lausanne Switzerland
| | - David Baud
- Swiss Fetal Laser Group; University Hospital of Bern, University Hospital of Lausanne CHUV; Lausanne Switzerland
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Abdalla N, Bachanek M, Trojanowski S, Cendrowski K, Sawicki W. Placental tumor (chorioangioma) as a cause of polyhydramnios: a case report. Int J Womens Health 2014; 6:955-9. [PMID: 25429242 PMCID: PMC4242403 DOI: 10.2147/ijwh.s72178] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Placental chorioangioma is the most common type of placental tumor. It is usually symptomless and may be associated with serious maternal and fetal complication when it reaches a large size. We presented a case of an angiomatous type of placental hemangioma diagnosed in the second trimester of pregnancy in a patient with polyhydramnios. A normal volume of amniotic fluid was successfully achieved by three amnioreductions with conservative management. The size of the placental tumor remained the same from the time of diagnosis to the end of pregnancy. A term labor was uncomplicated and a healthy newborn was delivered. Macroscopic and microscopic examination of the placenta confirmed the diagnosis. Despite the rarity of placental tumors, they should be considered as differential diagnosis in cases of polyhydramnios.
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Affiliation(s)
- Nabil Abdalla
- Chair and Clinic of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Michal Bachanek
- Chair and Clinic of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Seweryn Trojanowski
- Chair and Clinic of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Cendrowski
- Chair and Clinic of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Wlodzimierz Sawicki
- Chair and Clinic of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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Color Doppler score: a new approach for monitoring a large placental chorioangioma. Case Rep Obstet Gynecol 2014; 2014:723429. [PMID: 25295202 PMCID: PMC4177183 DOI: 10.1155/2014/723429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 09/03/2014] [Indexed: 12/05/2022] Open
Abstract
We employed color Doppler score as an innovative approach for the prenatal diagnosis and monitoring of a large placental chorioangioma case diagnosed at 26 weeks and the subjective semiquantitative assessment of the vascularization. The blood flow was assessed by a color Doppler score based on the intensity of the color signal with the following value ranges: (1) no flow, (2) minimal flow, (3) moderate flow, and (4) high vascular flow. Weekly examinations were programmed. Initially, a color Doppler score 3 was assigned, remaining unchanged at the following two exams and decreasing to Score 2 in the following 2 exams and to Score 1 thereafter. The ultrasonographic scan showed an increase of the mass size at the second and third exams and was followed by an arrest of the growth persisting for the rest of the pregnancy. Some hyperechogenic spots inside the mass appeared at the end. Expectant management was opted for, and the delivery was at 39, 2 weeks and maternal and fetal outcomes were favourable. The color Doppler score employed for assessment of vascularization in successive examinations proved to be an important tool for the prediction of the chorioangioma involution, and this new approach of monitoring allowed effective surveillance and successful tailored management.
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