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

Abstract

We report a case of voluminous placental chorioangioma diagnosed by ultrasound and color Doppler imaging during the 20th week of pregnancy. The size of the tumor was enlarging progressively (up to 10 cm in the 32nd week), and during this time the signs of fetal intrauterine volume overload and blood cell consumption, such as cardiomegaly, umbilical vein dilation, hydramnios, anemia, and thrombocytopenia, were observed. In the 32nd week of pregnancy, the signs of uteroplacental insufficiency and fetal hypoxia appeared; therefore, the pregnancy was terminated by cesarean section, and a female infant weighing 1,870 g was delivered. She was discharged, fully recovered, after 48 days. Histopathological examination of the placental tumor showed a benign, vascular-type chorioangioma.

Natural history and pregnancy outcome in patients with placental chorioangioma

“…The functioning villi are then deprived of adequate blood flow and nutrient exchange. 7 This hypoxia is also thought to lead to oligohydramnion and increase the frequency of fetal deaths with large chorioangiomas.…”

Fetal intra‐abdominal umbilical vein varix: what is the clinical significance?

“…A total of 80 cases of prenatally diagnosed FIUV varix were identified in 20 reports1–20. Twelve (60%) of these reports were single case reports1, 4, 6, 9, 10, 13–18, 20 and the median sample size was two. In only two reports was the sample size 10 or more cases3, 12.…”

“…In one report, the ratio of the dilated FIUV to the non‐dilated portion of the intrahepatic umbilical vein was found to be 1.93 ± 0.363. There were no detailed descriptions of the FIUV varix in seven reports1, 7, 10, 14, 15, 19, 20. The umbilical portion of the left portal vein was also described as dilated in four cases5, 13; one of them was complicated with thrombosis and the other three had normal fetal outcome.…”

“…The gestational age at first diagnosis was available in 73 cases2–6, 8–10, 14–18, 20. The mean and median gestation at diagnosis was 28.0 and 29.0 weeks, respectively, with a range of 16.0–41.9 weeks.…”

Quantitative three‐dimensional power Doppler ultrasound predicts the outcome of placental chorioangioma

“…Large, clinically significant chorioangiomas occur much less frequently, with a reported incidence ranging from 1 in 3500 to 1 in 9000 births2. Because large chorioangiomas are thought to act as peripheral arteriovenous shunts resulting in cardiac overload, complications associated with them include congestive heart failure, polyhydramnios, hydrops fetalis, premature labor, maternal and fetal coagulopathies and hemolytic anemia3–9. To prevent fetal loss due to these complications, different interventions have been proposed, including intrauterine transfusion of anemic fetuses and fetoscopic surgery to fulgurate the feeding vessels2, 10.…”