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AJP Rep 2015; 05(02): e196-e202
DOI: 10.1055/s-0035-1558829
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Pardis Hosseinzadeh
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Alireza A. Shamshirsaz
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
3   Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Pouya Javadian
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Jimmy Espinoza
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
4   Division of Women's and Fetal Imaging, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Manisha Gandhi
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Rodrigo Ruano
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
3   Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Darrell L. Cass
2   Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Oluyinka A. Olutoye
2   Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Michael A. Belfort
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
3   Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
› Author Affiliations
Further Information

Publication History

11 May 2015

04 June 2015

Publication Date:
03 August 2015 (online)

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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.

Keywords

chorioangioma - laser ablation - nonimmune hydrops fetalis - systematic review

Note

This study did not receive any type of financial support from any institution. Authors do not have any conflict of interest to declare.


 

  • References

  • 1 Amer HZ, Heller DS. Chorangioma and related vascular lesions of the placenta—a review. Fetal Pediatr Pathol 2010; 29 (4) 199-206
    CrossrefPubMedGoogle Scholar
  • 2 Guschmann M, Henrich W, Dudenhausen JW. Chorioangiomas—new insights into a well-known problem. II. An immuno-histochemical investigation of 136 cases. J Perinat Med 2003; 31 (2) 170-175
    PubMedGoogle Scholar
  • 3 As AK, Hagen P, Webb JB, Wijesinghe D. Therapeutic amniodrainage in chorioangioma. J Obstet Gynaecol 1997; 17 (2) 169-170
    CrossrefPubMedGoogle Scholar
  • 4 Hamill N, Rijhsinghani A, Williamson RA, Grant S. Prenatal diagnosis and management of fetal anemia secondary to a large chorioangioma. Obstet Gynecol 2003; 102 (5 Pt 2) 1185-1188
    CrossrefPubMedGoogle Scholar
  • 5 Sepulveda W, Wong AE, Herrera L, Dezerega V, Devoto JC. Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment options. Prenat Diagn 2009; 29 (3) 201-206
    CrossrefPubMedGoogle Scholar
  • 6 Zanardini C, Papageorghiou A, Bhide A, Thilaganathan B. Giant placental chorioangioma: natural history and pregnancy outcome. Ultrasound Obstet Gynecol 2010; 35 (3) 332-336
    CrossrefPubMedGoogle Scholar
  • 7 Bhide A, Prefumo F, Sairam S, Carvalho J, Thilaganathan B. Ultrasound-guided interstitial laser therapy for the treatment of placental chorioangioma. Obstet Gynecol 2003; 102 (5 Pt 2) 1189-1191
    CrossrefPubMedGoogle Scholar
  • 8 Lau TK, Leung TY, Yu SC, To KF, Leung TN. Prenatal treatment of chorioangioma by microcoil embolisation. BJOG 2003; 110 (1) 70-73
    CrossrefPubMedGoogle Scholar
  • 9 Quarello E, Bernard JP, Leroy B, Ville Y. Prenatal laser treatment of a placental chorioangioma. Ultrasound Obstet Gynecol 2005; 25 (3) 299-301
    CrossrefPubMedGoogle Scholar
  • 10 Quintero RA, Reich H, Romero R, Johnson MP, Gonçalves L, Evans MI. In utero endoscopic devascularization of a large chorioangioma. Ultrasound Obstet Gynecol 1996; 8 (1) 48-52
    CrossrefPubMedGoogle Scholar
  • 11 Stroup DF, Berlin JA, Morton SC , et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283 (15) 2008-2012
    CrossrefPubMedGoogle Scholar
  • 12 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP ; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335 (7624) 806-808
    CrossrefPubMedGoogle Scholar
  • 13 Mielke G, Benda N. Cardiac output and central distribution of blood flow in the human fetus. Circulation 2001; 103 (12) 1662-1668
    CrossrefPubMedGoogle Scholar
  • 14 Shamshirsaz AA, Javadian P, Ruano R , et al. Comparison between laparoscopically assisted and standard fetoscopic laser ablation in patients with anterior and posterior placentation in twin-twin transfusion syndrome: a single center study. Prenat Diagn 2015; 35 (4) 376-381
    CrossrefPubMedGoogle Scholar
  • 15 Babic I, Tulbah M, Kurdi W. Antenatal embolization of a large placental chorioangioma: a case report. J Med Case Reports 2012; 6 (1) 183
    CrossrefPubMedGoogle Scholar
  • 16 Sepulveda W, Alcalde JL, Schnapp C, Bravo M. Perinatal outcome after prenatal diagnosis of placental chorioangioma. Obstet Gynecol 2003; 102 (5 Pt 1) 1028-1033
    CrossrefPubMedGoogle Scholar
  • 17 Sepulveda W, Aviles G, Carstens E, Corral E, Perez N. Prenatal diagnosis of solid placental masses: the value of color flow imaging. Ultrasound Obstet Gynecol 2000; 16 (6) 554-558
    CrossrefPubMedGoogle Scholar
  • 18 Wehrens XH, Offermans JPM, Snijders M, Peeters LL. Fetal cardiovascular response to large placental chorioangiomas. J Perinat Med 2004; 32 (2) 107-112
    PubMedGoogle Scholar
  • 19 Nicolini U, Zuliani G, Caravelli E, Fogliani R, Poblete A, Roberts A. Alcohol injection: a new method of treating placental chorioangiomas. Lancet 1999; 353 (9165) 1674-1675
    PubMedGoogle Scholar
  • 20 Jauniaux E, Kadri R, Donner C, Rodesch F. Not all chorioangiomas are associated with elevated maternal serum alpha-fetoprotein. Prenat Diagn 1992; 12 (1) 73-74
    CrossrefPubMedGoogle Scholar
  • 21 García-Díaz L, Carreto P, Costa-Pereira S, Antiñolo G. Prenatal management and perinatal outcome in giant placental chorioangioma complicated with hydrops fetalis, fetal anemia and maternal mirror syndrome. BMC Pregnancy Childbirth 2012; 12: 72
    CrossrefPubMedGoogle Scholar
  • 22 Lau TK, Yu SCH, Leung TY, To KF, Fung TY, Leung TN. Prenatal embolisation of a large chorioangioma using enbucrilate. BJOG 2005; 112 (7) 1002-1004
    CrossrefPubMedGoogle Scholar
  • 23 Wanapirak C, Tongsong T, Sirichotiyakul S, Chanprapaph P. Alcoholization: the choice of intrauterine treatment for chorioangioma. J Obstet Gynaecol Res 2002; 28 (2) 71-75
    CrossrefPubMedGoogle Scholar
  • 24 Al Wattar BH, Hillman SC, Marton T, Foster K, Kilby MD. Placenta chorioangioma: a rare case and systematic review of literature. J Matern Fetal Neonatal Med 2014; 27 (10) 1055-1063
    CrossrefPubMedGoogle Scholar
  • 25 Deren O, Ozyuncu O, Onderoglu LS, Durukan T. Alcohol injection for the intrauterine treatment of chorioangioma in a pregnancy with transfusion resistant fetal anemia: a case report. Fetal Diagn Ther 2007; 22 (3) 203-205
    CrossrefPubMedGoogle Scholar
  • 26 Mendez-Figueroa H, Papanna R, Popek EJ , et al. Endoscopic laser coagulation following amnioreduction for the management of a large placental chorioangioma. Prenat Diagn 2009; 29 (13) 1277-1278
    CrossrefPubMedGoogle Scholar
  • 27 Bermúdez C, Luengas O, Pérez-Wulff J , et al. Management of a placental chorioangioma with endoscopic devascularization and intrauterine transfusions. Ultrasound Obstet Gynecol 2007; 29 (1) 97-98
    CrossrefPubMedGoogle Scholar
  • 28 Bashiri A, Maymon E, Wiznitzer A, Maor E, Mazor M. Chorioangioma of the placenta in association with early severe polyhydramnios and elevated maternal serum HCG: a case report. Eur J Obstet Gynecol 1998; 79 (1) 103-105
    CrossrefPubMedGoogle Scholar
  • 29 Jauniaux E, Ogle R. Color Doppler imaging in the diagnosis and management of chorioangiomas. Ultrasound Obstet Gynecol 2000; 15 (6) 463-467
    CrossrefPubMedGoogle Scholar
  • 30 Haak MC, Oosterhof H, Mouw RJ, Oepkes D, Vandenbussche FP. Pathophysiology and treatment of fetal anemia due to placental chorioangioma. Ultrasound Obstet Gynecol 1999; 14 (1) 68-70
    CrossrefPubMedGoogle Scholar
  • 31 Escribano D, Galindo A, Arbués J, Puente JM, De la Fuente P. Prenatal management of placental chorioangioma: value of the middle cerebral artery peak systolic velocity. Fetal Diagn Ther 2006; 21 (6) 489-493
    CrossrefPubMedGoogle Scholar
  • 32 Wang LH, Tang JR, Teng RJ , et al. Hydrops fetalis due to placental chorioangioma: report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1997; 38 (2) 155-158
    PubMedGoogle Scholar
  • 33 Zalel Y, Weisz B, Gamzu R, Schiff E, Shalmon B, Achiron R. Chorioangiomas of the placenta: sonographic and Doppler flow characteristics. J Ultrasound Med 2002; 21 (8) 909-913
    PubMedGoogle Scholar
  • 34 Jones K, Tierney K, Grubbs BH, Pruetz JD, Detterich J, Chmait RH. Fetoscopic laser photocoagulation of feeding vessels to a large placental chorioangioma after fetal deterioration post amnioreduction. Fetal Diagn Ther 2012; 31 (3) 191-195
    CrossrefPubMedGoogle Scholar