Chorangiosis and chorangioma in three cohorts of placentas from Nepal, Tibet, and Japan

Abstract

It has been reported that both chorangiosis and chorangioma are increased in placentas at high altitudes. In this study, 1.14% of 2448 Japanese placentas obtained at 30-300 m had chorangiosis or chorangioma, compared with 3.24% of the Nepalese placentas (1300-3000 m) and 9.09% of the Tibetan samples (3800-4200 m). The incidence of both pathologies was significantly higher in the Himalayan groups than those of the Japanese group (P < 0.05). Obstetric complications of the 28 Japanese placentas with chorangiosis and chorangioma included Caesarean section 16 (57.1%), abruptio placentae 2 (7.14%), intrauterine growth retardation 3 (10.7%), intrauterine fetal death 4 (14.2%) and placenta praevia 4 (14.2%). Four infants (14.2%) had Apgar scores ranging from 0 to 3. Among 48 Himalayan placentas with chorangiosis and chorangioma, incidence of marked subchorionic fibrin was significantly higher (25%) than in the Japanese group (3.57%) (P < 0.05). The incidence of abnormal insertion of the cord was significantly higher (14.2%) in the Japanese group than in the Himalayan group (5%) (P < 0.05). There was no significant difference in the frequencies of intervillous thrombosis and infarction between the two groups. These findings suggest that the incidence of pathological change such as chorangiosis and chorangioma may be increased in placentas at Himalayan altitudes.

Incidence and clinicopathologic correlation of fetal vessel thrombosis in mono- and dichorionic twin placentas

“…This hypothesis is based on a higher incidence of chorangiosis in placentas delivered at high altitude, patients with anemia, smokers, and placentas with cord anomalies. [20][21][22] However, study by Ogino and Redline 23 has found no significant association of chorangiosis with small placental size, accelerated villous maturation, or IUGR, suggesting that any effects of hypoxia in chorangiosis must be late in onset or occur in a background of adequate uteroplacental blood flow. This hypothesis serves as a possible explanation for our finding, considering that the effect of chorangiosis would be late onset and, therefore, unlikely to cause significant fetal thrombosis.…”

Fetal Anemia, Thrombocytopenia, Dilated Umbilical Vein, and Cardiomegaly due to a Voluminous Placental Chorioangioma

“…They are usually diagnosed only by chance without any clinical significance for mother or fetus [2,4]. Multiple and recurrent chorioangiomas occur more often in connection with altitudes above sea level (upregulation of vascular endothelial growth factors) [5,13,14] and chorioangiosis of newborns of these pregnancies [13,15]. There is no association with diabetes mellitus [13].…”

“…Cordocentesis demonstrated anemia and thrombocytopenia of the fetus. There are other pathological conditions that are linked with chorioangiomas cited in the literature: preeclampsia [2,12], retroplacental hematomas and abruptio placentae [2,4,5], placenta previa [5], premature rupture of membranes and prematurity [3,4,10,[14][15][16][17], intrauterine growth restriction [5,18,19], fetal malformations [2,18], nonimmune hydrops fetalis [12,[19][20][21][22][23], fetal coagulopathy [24][25][26], fetal congestive heart failure [16,22,26], and fetal hypoxia [18,26]. The fetal and neonatal mortality in connection with large placental chorioangiomas is high: 18-40% [2,27].…”

“…The size of the tumor can cause several serious fetal impairments: cardiomegaly, anemia, and nonimmune hydrops fetalis. Untreated, chorioangiomas may lead to intrauterine fetal death [5,6]. Some authors showed a causal relationship between placental hemangiomas and preeclampsia in the mother [2].…”

Severe Transient Cardiac Failure Caused by Placental Chorangiosis

“…Incidences of 3 and 9% have been reported for Nepalese (1,300-4,200 m altitude) and Tibetan (3,800-4,200 m) placentas [2] . The pathogenesis is unclear, although chronic hypoxia may be a contributing factor, because chorangiomas are frequently observed in women living in high altitudes [3] .…”