Pathophysiology and treatment of fetal anemia due to placental chorioangioma

Abstract

Placental chorioangiomas occur in 1% of pregnancies. Large chorioangiomas may cause serious complications such as fetal anemia, hydrops and fetal death. In this case report, a pregnancy complicated by a large placental chorioangioma is described. Severe fetal anemia without the occurrence of hydrops fetalis was suspected using ultrasound and Doppler examinations. Successful intrauterine blood transfusion was performed, with an unusually large amount of blood needed to obtain an adequate rise in fetal hematocrit. Two weeks later, at 32 weeks, the infant was born in good condition. In pregnancies with large chorioangiomas, we advise regular ultrasound and Doppler examinations, with the aim of detecting fetal anemia before hydrops develops. When anemia is suspected, fetal blood sampling is indicated and intrauterine transfusion therapy may be beneficial to preserve fetal health until maturity is reached.

Large Placental Chorioangioma as a Cause of Sudden Intrauterine Fetal Death

“…Although not all fetuses are expected to be anemic, in cases of mild signs of fetal hydrops, a cordocentesis should be performed to determine the hematological status, because fetal anemia can be treated by intrauterine blood transfusion. Recently, 3 such cases have been reported [3,10,11]. We used Doppler ultrasound to monitor fetal circulation and fetal wellbeing, but despite the presence of the large chorioangioma, no signs of significant anemia or cardiac failure could be observed until 4 days before intrauterine death.…”

“…Large chorioangiomas, however, are less common, occurring in only 1/16,000 to 1/50,000 live births [1]. Small, single tumors do not significantly affect the fetus and pregnancy outcome, but large ones can cause polyhydramnios, premature onset of labor, fetal anemia, thrombocytopenia, fetomaternal hemorrhage, intrauterine growth retardation, congestive heart failure and fetal death [2][3][4].…”

Therapeutic management of fetal anemia: review of standard practice and alternative treatment options

“…Some centers continue to perform a combined approach incorporating both procedures so as to achieve a more stable fetal Hct and a more prolonged interval between transfusions. The main indication for IUT continues to be fetal anemia due to red cell alloimmunization, but successful use of this procedure has also been reported in pregnancies with parvovirus B19 infection, fetomaternal hemorrhage, placental chorioangiomas, and others [8,30,65,70,84] .…”

“…There are few reports of pregnancies with placenta chorioangiomas successfully managed with IUT therapy [30] ; moreover, the MCA Doppler assessment seems to be useful in the detection of fetal anemia in these cases [22] .…”

“…may also be implicated in HDFN. There are also non-immune etiologic factors of fetal anemia such as parvovirus B19 infection, fetomaternal hemorrhage, homozygous thalassemia, and placental chorioangioma [8,30,70,84] .…”