Call for Caution: Neonatal Portal Vein Thrombosis following Enbucrilate Embolization of Placental Chorioangioma

Voon, Hian Yan; Amin, Rafaie; Kok, Juan Loong; Tan, Kia Sing

doi:10.1159/000479105

Cited by 8 publications

(10 citation statements)

References 18 publications

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“…The search identified 322 articles, of which 68 were assessed in full text with respect to their eligibility for inclusion (Table S1) and 28 studies were included in the systematic review (Table S2, Figure 2) [1][2][3][4]6,7,9,10,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] . These 28 studies included 161 singleton pregnancies (144 from cohort studies and 17 from case reports) affected by placental chorioangioma without associated structural anomalies.…”

Section: General Characteristicsmentioning

confidence: 99%

“…These 28 studies included 161 singleton pregnancies (144 from cohort studies and 17 from case reports) affected by placental chorioangioma without associated structural anomalies. Of these studies, 11 were cohort studies [1][2][3][4]6,7,[19][20][21][22][23] , while 17 were case reports of pregnancies undergoing in-utero treatment of the chorioangioma (Table S2) 9,10,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] .…”

Section: General Characteristicsmentioning

confidence: 99%

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Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta‐analysis

Buca

Iacovella

Khalil

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To report the perinatal outcome of singleton pregnancies complicated by placental chorioangioma diagnosed on prenatal ultrasound. Methods MEDLINE, EMBASE, CINAHL and http://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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Section: General Characteristicsmentioning

confidence: 99%

Section: General Characteristicsmentioning

confidence: 99%

Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta‐analysis

Buca

Iacovella

Khalil

et al. 2020

Ultrasound in Obstet & Gyne

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“… 7 Embolization has been performed with liquid agents such as ethanol, cyanoacrylate, and enbucrilate. 8 9 10 Chorangiomas, however, may contain arteriovenous anastomoses, which can allow for passage of liquid or small particulate embolic agents through the tumor and back to the fetus. Voon et al recently reported a case of portal vein thrombosis in a newborn after use of the liquid embolic agent enbucrilate and advised caution with this material.…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Giant Placental Chorangioma by Microcoil Embolization

Emery

Orons

Bonadio

2018

AJP Rep

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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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“…Chorioangiomas are typically small masses without clinical consequences, however, large chorioangiomas, typically lesions larger than 4 cm, can cause hydramnios, arteriovenous (AV) shunting, and fetal red blood cell (RBC) sequestration. AV shunting and RBC sequestration can lead to fetal anemia, non-immune hydrops fetalis, fetal cardiomyopathy, intrauterine fetal growth restriction (IUGR), and even fetal demise [19][20][21][22]. Chorioangiomas are diagnosed via ultrasonography as well circumscribed solid or complex masses located on the fetal side of the placenta with turbulent hypervascular flow on Doppler-flow imaging.…”

Section: Part 1: Intrinsic Placental Abnormalitiesmentioning

confidence: 99%

“…Chorioangiomas are diagnosed via ultrasonography as well circumscribed solid or complex masses located on the fetal side of the placenta with turbulent hypervascular flow on Doppler-flow imaging. Management depends on the size of the mass, evidence of hydramnios, and evidence of fetal compromise, with management ranging from amnioreduction, percutaneous intrauterine transfusion, and embolization or laser coagulation of feeding vessels [20][21][22].…”

Section: Part 1: Intrinsic Placental Abnormalitiesmentioning

confidence: 99%

Placental Abnormalities

Juusela¹

2019

Complications of Pregnancy

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A detailed discussion of normal placental development and physiology is beyond the scope of this chapter and is discussed in other chapters. Instead, this chapter will focus on an overview of congenital placental abnormalities and the obstetrical complications that can arise. The goal of this chapter is to delineate the real-world implications of placental abnormalities and provide the reader with a basis for understanding the other chapters that will delve into microbiology, genomics, immunohistochemistry, and biochemistry of the placenta. The focus of this chapter will be on the developmental anomalies and this chapter will not discuss acquired anomalies (e.g., chorioamnionitis, amnion nodosum, metastatic tumors, and umbilical cord true knots). As the intention of this chapter is to focus on the etiopathogenesis of abnormal placentation, it is not intended to instruct the medical management of the described conditions, and therefore the discussions of management will be brief. The information provided is intended for general knowledge only and is not intended for use in diagnosing or treating a health problem or disease without consultation with a qualified healthcare provider. This chapter is not a substitute for professional medical advice, or treatment for specific medical conditions.

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Call for Caution: Neonatal Portal Vein Thrombosis following Enbucrilate Embolization of Placental Chorioangioma

Cited by 8 publications

References 18 publications

Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta‐analysis

Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta‐analysis

Successful Management of Giant Placental Chorangioma by Microcoil Embolization

Placental Abnormalities

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