Giant Placental Chorioangioma with Intrauterine Fetal Death

Abstract

Chorioangioma of the placenta is a common benign vascular tumour of the placenta consisting of blood vessels and stroma. Most of these tumours are small and have no adverse impact on the fetus. Large tumours are associated with complications affecting mother and the fetus which may cause intrauterine fetal death. Chorioangiomas probably act as peripheral shunts between arteries and veins (arteriovenous shunts) leading to progressive heart failure of the fetus. Prenatal diagnosis is achieved by ultrasonography and Doppler studies will confirm the highly vascular nature of the mass.As the tumour is associated with unfavourable effects on the mother and fetus like polyhydramnios, prematurity, toxaemia, hydrops and fetal heart failure pregnancy needs to have regular surveillance to detect and manage complications early. A case of giant placental chorioangioma in a primigravida associated with intrauterine fetal death at 30 weeks of gestation is reported._______________________________________________________________________________________Keywords: Chorioangioma, hydrops fetalis; intrauterine fetal death; placental tumors._________________________________________________________________________________

Giant chorioangioma of placenta: a rare placental cause of polyhydramnios

“…Despite many identifiable causes, placental tumor as a cause of polyhrdramnios, though rare, is well documented in literature. [4][5][6] In the described case, chorioangioma was serendipitously diagnosed while searching for causes of hydramnios.…”

“…Giant chorioangiomas (> 4-5cms in diameter) with an approximate prevalence of around one in 9000 to one in 50,000 pregnancies, have been associated with many adverse maternal and fetal complications. [4][5][6]8 Maternal complications include polyhydramnios (observed in many cases of chorioangiomas), preeclampsia, antepartum haemorrhage (resulting from either placental abruption or from rupture of vascular pedicle of tumor). Polyhydramnios can increase the risk of malpresentation, cervical incompetence, preterm labor, abruption of placenta as a result of sudden fall of intrauterine pressure secondary to rupture of membranes and is associated with increased risk of caesarean sections.…”

“…Arteriovenous shunts in large tumors attribute to increased cardiac venous return, impairing fetal circulation and thereby leading to cardiac failure. [4][5][6] Complications related to labor include abruption, cord prolapse, fetal distress secondary to rupture of membranes in polyhydramnios, postpartum haemorrhage, retained placenta, sepsis etc.…”

Chorioangioma with pre-eclampsia and IUGR: a case report

“…2 Fetal complications include growth restriction, prematurity, cardiac failure, non-immune hydrops fetalis and stillbirths due to arteriovenous shunts in large chorioangiomas which impair the fetal circulation by increasing the venous return to the heart resulting in tachycardia, cardiomegaly and hypervolemia. 3,9 Neonatal complications include anaemia, thrombocytopenia, congenital anomalies or congestive cardiac failure. Perinatal mortality is high in large chorioangioma.…”

Corioangioma placentario gigante. Reporte de caso

“…Existen tres variedades histológicas de estas neoformaciones: A) celular: (inmaduro) formadas por células primitivas, presumiblemente endoteliales, arregladas de manera compacta; B) angioblástica: (vascular, maduro) compuestas por numerosos vasos sanguíneos, capilares; en algunas ocasiones pueden ser cavernosos en un estroma laxo; y, C) degenerativa: implica cambios mixoides, hialinización, necrosis o calcificaciones (7) . Dichos cambios son comunes en los grandes tumores, ya que tiene apariencia variable y transición diferente (8) .…”