Giant Chorioangioma Treated<i>In Utero</i>via Laser of Feeding Vessels with Subsequent Development of Multifocal Infantile Hemangiomas

Jhun, Katrina M.; Nassar, Paulo; Chen, Tina S.; Sardesai, Smeeta; Chmait, Ramen H.

doi:10.3109/15513815.2014.925018

Cited by 12 publications

(15 citation statements)

References 29 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

View full text Add to dashboard Cite

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“…The major fetal risks associated with chorioangiomas are non-immune hydrops, cardiomegaly, congestive cardiac failure, prematurity and sudden infant death [12][13][14][15]. These complications are mainly explained by the existence of shunts and bleeding between maternal and fetal circulation, microangiopathic hemolysis, as well as placental insufficiency caused by the growth of the tumor [7,8].…”

Section: Discussionmentioning

confidence: 99%

A giant chorioangioma of the placenta with favorable outcome: a rare case presentation with literature review

Beyazıt¹,

Göret²,

Pek³

et al. 2016

Med-Science

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Chorioangioma, or hemangioma of the placenta, is the most frequent non-trophoblastic tumor of the placenta consisting of blood vessels and stroma. A great proportion of these tumors are small and well delineated within the placental parenchyma and have no or minimal adverse impact on the fetus. Unfortunately, large tumor size is linked to serious complications such as fetal anemia, hydrops and intrauterine death. This is probably because of arteriovenous shunts leading to progressive heart failure of the fetus. With the increasing rates of antenatal screenings with ultrasonography, prenatal diagnosis of these tumors is widely achieved. Here we report a case of giant placental chorioangioma diagnosed in the second trimester of pregnancy. The size of the tumor minimally increased during follow-up and at term, uncomplicated labor was achieved. Macroscopic and histologic examination confirmed the diagnosis.

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“…Arteriovenous shunt of the blood and fetal hypoxia caused by unoxygenated blood that bypasses the maternal circulation through chorioangioma can cause high cardiac output and secondary fetal cardiomegaly (26) . Ultrasound features of heart failure include enlargement of the heart, decreased contractility and pericardial effusion, increased cardiothoracic ratio and developing fetal hydrops (8, 27) . Coincidental presence of congenital anomalies with placental chorioangioma have been reported (28) .…”

Section: Ultrasound Assessment Of the Fetusmentioning

confidence: 99%

“…Doppler ultrasound is used for evaluation of the blood flow in the feeding vessels and tumor itself. It can show the effectiveness of the procedure by showing the absent or decreased blood flow in the feeding vessels and the tumor (25, 27) . The mass may decrease in size, and can develop cystic appearance.…”

Section: Use Of Ultrasound To Monitor the Effect Of Treatment Of Chormentioning

confidence: 99%

Can ultrasound be helpful in selecting optimal management methods for pregnancies complicated by placental non-trophpblastic tumors?

et al. 2017

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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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Giant Chorioangioma TreatedIn Uterovia Laser of Feeding Vessels with Subsequent Development of Multifocal Infantile Hemangiomas

Cited by 12 publications

References 29 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

A giant chorioangioma of the placenta with favorable outcome: a rare case presentation with literature review

Can ultrasound be helpful in selecting optimal management methods for pregnancies complicated by placental non-trophpblastic tumors?

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