A 38-year old Class C diabetic at 36w4d was taken for urgent c-section after non-stress testing revealed Category 3 fetal heart tones. At the time of delivery, a dusky umbilical cord suggestive of thrombosis was noted. Placental pathology revealed 40% occlusion of umbilical vein and chorangiosis. Chorangiosis is a vascular change of the placenta involving terminal chorionic villi, proposed to result from longstanding, low-grade hypoxia in placental tissue. It has been associated with diabetes, intrauterine growth restriction (IUGR), and hypertensive conditions. Clinical significance has not been studied extensively but case reports suggest correlation with increased fetal morbidity and mortality.METHODS:
We identified 56 cases of “chorangiosis” on placental pathology at Henry Ford Hospital from 2010–2015. We reviewed factors such as: maternal age, BMI, smoking status, maternal health conditions, antenatal fetal issues, gestational age, mode of delivery and fetal outcome.RESULTS:
Average age was 27.6 years; 20% of advanced maternal age. 16% of cases associated with hypertensive disorders, 11% with diabetes, 11% with IUGR and 45% associated with maternal obesity. 30% associated with current or former smokers. One resulted in neonatal death, 1 intrauterine fetal demise and 18% of deliveries were pre-term. 52% of deliveries were by cesarean section, with the most noted indication being abnormal fetal heart tones.CONCLUSION:
Chorangiosis may contribute to increased rates of cesarean section due to abnormal fetal heart tones from longstanding hypoxia coupled with the stress of labor. Further studies are needed to characterize the association of chorangiosis with subsequent infant health outcomes.