PFM.55 Antenatal diagnosis of placental chorangioma: implications for clinical management

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Abstract

Introduction

Chorangiomas (placental haemangiomas) are rarely diagnosed antenatally but have been associated with cardiac failure and poor outcome. The aim of this study was to review cases of antenatally diagnosed placental chorangiomas within in a large tertiary level unit.

Methods

Retrospective cohort study

Results

Between January 2004 and March 2013, over 67,000 infants delivered in Mount Sinai, of which seven had an antenatal diagnosis of chorangioma. None of the pregnancies had a raised serum AFP. Three cases were diagnosed at the time of the routine anatomy ultrasound, and the remaining four cases were diagnosed between 22 and 26 weeks gestation. The choramgiomas ranged in size from “multiple small lesions” to large (10 × 8 cm). One case with a large chorangioma, scalp oedema and cardiomegaly presented initially with preterm rupture of membranes. Following discussion with the parents the fetus underwent fetal blood sampling (Hb 83g/l) and intrauterine transfusion. Five minutes following the procedure the infant became bradycardiac, and was delivered by emergency caesarean section at 29 weeks gestation, but died in the resuscitation room.

Results

Six other pregnancies were monitored closelybut all delivered uneventfully. One large chorangioma (7 × 5 cm) occurred near the cord root of twin A of a DCDA twin pregnancy; both infants delivered at 36 weeks gestation. Two cases returned to their referring hospital for delivery after intense monitoring.

Conclusion

Placental chorangioma is an uncommon antenatal diagnosis and can largely be managed with a conservatively, though recourse to laser ablation of feeding vessels or fetal blood sampling may be required.

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