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 THE DOUBLE EDGED SWORD- A CASE OF PLACENTAL CHORIOANGIOMA

AIM:

To present a case of a large placental chorioangioma with polyhydramnios and fetal anemia without an adverse perinatal effect due to meticulous serial follow ups using ultrasound and timely delivery.

METHODS:

A 24 year old Gravida 3 Para 2 was referred to our centre at 23 weeks + 5 days with subamniotic hematoma measuring 5.4x5.3x4.2 cms on an obstetric ultrasound done outside due to acute abdominal pain. Ultrasound done at our centre at 24 weeks + 2 days revealed a subchorionic fibrin collection measuring 5.8 x 4.3 cms with satisfactory growth parameters and placenta in the right lateral wall.

Steroids covered at 28 weeks in view of anticipated preterm delivery. Follow up scan at 30 weeks diagnosed a large placental chorioangioma measuring 8.8 x 6.2 cms. The mass was seen within the substance of the placenta on the fetal side.  Colour Doppler revealed blood supply directly from the umbilical cord entering the mass and then proceeded to the fetus. A single large feeder was seen. Liquor was 26 cms-suggestive of polyhydramnios.

Serial monitoring of growth, liquor and fetal Doppler undertaken. Doppler at 32 weeks + 3 days showed MCA PSV to be greater than 1.5. MOM suggestive of fetal anemia. Baby was delivered as breech at 32 weeks + 3 days by caesarean section. Postnatal evaluation of baby showed adequate haemoglobin values eliminating the need for transfusion. Baby was discharged on post operative day 8.

CONCLUSION:

Histologic examination of the placenta confirmed diagnosis. Placental chorioangiomas tend to be associated with perinatal complications and adverse fetal outcomes. Early accurate diagnosis using ultrasound and follow ups can help facilitate an appropriate delivery plan to improve general obstetric and perinatal outcome.

REFERENCES:

Guschmann M, Henrich W, Entezami M, et al. Chorioangioma -