Prenatal Therapy of Large Placental Chorioangiomas: Case Report and Review of the Literature

Abstract

Objective To review techniques and outcomes of different prenatal treatments for large placental chorioangiomas. Study Design Presentation of a case of laparoscopic-assisted laser coagulation and a systematic review of the literature for articles related to intervention for placental chorioangioma. Results A total of 37 cases of definitive (n = 23) and supportive therapy (n = 14) were evaluated, including one case treated in our center. Approximately 35% of the patients had a spontaneous preterm delivery in definitive treatment group versus 36% in the supportive group. The infant survival rates were 65 and 71% in the two groups, respectively. We further compared the two types of laser ablation (fetoscopic [n = 10] and interstitial [n = 4]). Approximately 30% of the patients in the fetoscopic and 25% in interstitial group, had a spontaneous preterm delivery. Survival rates were 60 and 100% in fetoscopic and interstitial groups, respectively. Conclusion Laser ablation and embolization of chorioangiomas via minimally invasive approach may prevent or reverse fetal hydrops due to high cardiac states. However, further studies are needed to refine the appropriate selection criteria that will justify the risk of this invasive in utero therapy for chorioangiomas.

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

“…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.…”

“…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] .…”

Large Symptomatic Chorioangioma of Placenta; A Rare Complication of Pregnancy in Enugu, South East Nigeria

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Chorioangioma is the most common non trophoblastic tumour of the placenta which can result to severe pregnancy complications with attendant maternal and fetal morbidity and mortality [1]. Most cases of chorioangiomas are small, microscopic and of no clinical important [2,3]. We present the very fi rst case of large symptomatic chorioangioma managed successfully in University of Nigeria Teaching Hospital Enugu.The patient was referred to the University of Nigeria Teaching Hospital Enugu on account of suspected symptomatic chorioangioma, at a gestational age of 32 weeks.

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Giant chorioangioma treated with interstitial laser coagulation

“…Prenatal therapy may be performed when there are ultrasound features of fetal compromise and the gestation is not expected to survive. Therapeutic interventions include direct injection of various chemicals and laser coagulation of the tumor's feeding vessels, . We report a case of a large chorioangioma located close to the placental cord insertion site, treated using interstitial laser coagulation.…”

“…Injection of toxic substances for the treatment of chorioangioma carries the risk of potential fetal exposure, to which at least one neonatal death has been attributed. Laser photocoagulation can be performed either fetoscopically or using an ultrasound‐guided interstitial approach. Fetoscopy has a reported success rate of 60–80%; however, this technique may be difficult to perform in cases of anterior placenta, .…”