A case report of placental hemangioma resulting in severe fetal distress

Abstract

A 30 year old female was admitted twice during her pregnancy for genital bleeding. An ultrasonography at 19 weeks gestation showed several nodules on the chorionic plate. Cardiotocography during labor at 37 weeks gestation indicated a non-reactive pattern. A 2230 g infant girl was delivered soon after rupture of membranes with asphyxia and hydrops fetalis. The placenta weighed 600 g with a maximal thickness of 6 cm. Nodules occupied about one-third of the placenta and were diagnosed as placental hemangiomas. Postnatal examination revealed that the infant had disseminated intravascular coagulation and cardiac failure. This baby recovered after treatment in the intensive care unit, and was discharged home on the 52nd day of life.

Fetal Anemia, Thrombocytopenia, Dilated Umbilical Vein, and Cardiomegaly due to a Voluminous Placental Chorioangioma

“…Japanese authors [34] presented a case in whom magnetic resonance imaging aided in confirming the antenatal diagnosis of a placental chorioangioma. Like the women studied by Ito et al [26], our patient had recurrent uterine bleeding early in pregnancy.…”

“…Cardiotocography [26], Doppler methods [12,23,25,35,36], and invasive sonographic methods (amniocentesis, cordocentesis, intraumbilical transfusion) play an important role in the longitudinal monitoring of placental tumors. An Italian study [37] recommends injection of alcohol to destroy the chorioangioma.…”

“…Cordocentesis demonstrated anemia and thrombocytopenia of the fetus. There are other pathological conditions that are linked with chorioangiomas cited in the literature: preeclampsia [2,12], retroplacental hematomas and abruptio placentae [2,4,5], placenta previa [5], premature rupture of membranes and prematurity [3,4,10,[14][15][16][17], intrauterine growth restriction [5,18,19], fetal malformations [2,18], nonimmune hydrops fetalis [12,[19][20][21][22][23], fetal coagulopathy [24][25][26], fetal congestive heart failure [16,22,26], and fetal hypoxia [18,26]. The fetal and neonatal mortality in connection with large placental chorioangiomas is high: 18-40% [2,27].…”

Large Placental Chorioangiomas as a Cause of Cardiac Failure in Two Fetuses

“…Most such tumors are not diag-nosed antenatally, and also lack clinical significance. We know of several published reports involving patients with large placental chorioangiomas that were visible external ly and were complicated by heart failure in the fetus [5,6,10,14].…”