Peri- and postpartum outcome of a large placenta chorioangioma

Introduction Chorangiomas are the most common benign non-trophoblastic tumors of the placenta. The incidence is about 1% of all pregnancies. They occur more frequently in female fetuses (72.2%), maternal age over 30 years (46.3%), maternal hypertension (13.2%) or diabetes (6.4%). Most are small and of no clinical relevance. The larger ones (>4-5 cm) are rare and associated with maternal and fetal complications such as preeclampsia, prematurity, fetal anemia, thrombocytopenia, polyhydramnion, growth restriction, fetal heart failure/cardiomegaly, up to fetal hydrops and intrauterine fetal death. The diagnosis is made sonographically. They usually develop near the umbilical cord and can be easily distinguished from the rest of the placenta using Doppler sonography based on the high blood flow in the placental tumor [1] [2] [3] ([Abb. 1]).

Abb. 1  

The case Admission a 29-year-old IIIG/0P in the 34+0 weeks of gestation with thoracic complaints and unease for inpatient observation with normal lab readings. For further clarification, we performed an ECG and an echocardiogram – both normal. The sonography showed a timely developed fetus with normal fetal movements, polyhydramnion I° (max depot 9.5 cm), posterior wall placenta with the suspicion of a placenta chorangioma (9.3 x 6.3 cm) in the area of attachment of the umbilical cord. The fetus showed a mild pericardial effusion, tricuspid regurgitation and increased Vmax of the ACM by fetal anemia. The prim. caesarean section was indicated. Post partum transfer of the baby (weight 2485g, Apgar: 8/5/8, NA pH 7.33, BE -1.9) to the children's hospital. The echocardiogram showed a mild pericardial effusion, which receded over time. Due to fetal anemia/thrombocytopenia an erythrocyte and a platelet concentrate were transfused on the 1st day. The newborn was discharged from the children's hospital after a total of 4 weeks. The CNS sonography showed age-appropriate normal findings.

Histology Placenta with attached umbilical cord and membranes – 23.5 x 22.7 x 2.2 cm, weight 852.8 g. Central inserting umbilical cord. A chorangioma 12 x 9.5 x 3.4 cm with regressive changes.

Discussion Doppler sonography is the gold standard in diagnostics. The care of a patient with a proven placental chorioangioma is predominantly conservative. Based on the previous findings and the size of the chorangioma, the control intervals should be between 1-4. Weeks³. If there is sonographic evidence of fetal anemia, cardiac insufficiency or hydrops, delivery should be considered, if necessary after the induction of the antenatal lung maturity with corticosteroids.

Publication History

Article published online:
15 November 2023

• References

• 1 Fan M, Skupski DW.. Placental chorioangioma: literature review
• 2 Guschmann M. et al. Chorioangioma--new insights into a well-known problem. I. Results of a clinical and morphological study of 136 cases
• 3 Ziemann M. et al. Chorioangiom der Plazenta – eine seltene Ursache fetaler High-Output-Herzinsuffizienz