A case of non-immun hydrops fetalis due to a giant chorioangioma

Chorioangiomas are found in approximately 0.5%–1.0% of placentas. Large (≥5 cm) or multiple chorioangiomas have been reported to occur at a rate of 1: 3500 to 1: 16,000 births. Most of them are small in size and have generally no clinical significance. However, large chorangiomas (>5 cm) are often associated with polyhydramnios, preterm labor, hydrops, fetal hemolytic anemia, fetal thrombocytopenia, cardiomegaly, intrauterine growth restriction, placental abruption and preeclampsia. Large hemangiomas probably act as arteriovenous shunts and cause complications. 29 year old G2P1 womean was referred to our clinic because of developing hydrops on her 27th week of pregnancy. Detailed sonographic examination was performed. Fetal biometry was consistent with gestational age. On sonographic examination, excessive accumulation of fluid in fetal abdomen, fetal thorax and fetal subcutaneous tissue, cardiomegaly, pericardial effusion and hepatosplenomegaly were observed. A well-defined echogenic mass measured 93 mm x 100 mm, different from the rest of the placenta was stated bulging on the fetal side, near the placenta. The anatomic sonogram of fetal heart and other fetal organs were normal. The peak systolic velocity in fetal aorta and pulmonary artery were high, suggesting hyperdynamic circulation. The peak systolic velocity in the fetal MCA was 72 cm/sec (2.04 MoM) suggesting fetal anemia. Diagnosis of hydrops fetalis and fetal anemia due to huge chorioangioma was made and intrauterin fetal transfusion was planned. Before fetal transfusion chordosynthesis was performed; fetal hematocryte was 24%. 32ml radiated CMV negative, 0 Rh negative eriythrocyte suspension was transfered. After transfusion fetal hematocryte was measured as 33% and fetus was monitorized with cardiotocogram. Six hours after transfusion recurrent late decelarations occured and the pregnancy was terminated via C/S. 1100 gr female baby was delivered. The 1st minute apgar score was 5 and the 5th minute apgar score was 2. Despite agressive cardiopulmonary resucitation the baby was dead 1 hour after birth. A lobular mass measuring 90 mm x 100 mm that attached to the fetal surface of placenta with a pedicle was noted. The diagnosis of chorioangioma was made with pathological examination. Chorioangioma is usually treated with expectant management, as the majority of tumors are asymptomatic and small. In situations in which maternal or fetal complications necessitate intervention, there are several possible treatments. However, most of these cases have a dismal poor  prognosis. Possible interventions include serial fetal transfusions, fetoscopic laser coagulation of vessels supplying the tumor, chemosclerosis with absolute alcohol, and endoscopic surgical devascularization. Large placental chorioangiomas are rare and the prognosis is bad when a big tumor causes fetal hemodynamic changes with NIHF. The overall prognosis is somewhat dependent on the presence and / or development of hydrops fetalis.

Keywords

Chorioangioma, fetal hydrops.