Placental chorioangiomas are abnormal proliferations of chorionic tissue. They are often small and not associated with risk to the fetus. However, larger chorioangiomas, measuring greater than 4 cm, can have grave fetal consequences, including polyhydramnios, microangiopathic hemolytic fetal anemia, high-output cardiac failure resulting in nonimmune hydrops fetalis, and intrauterine growth restriction. Rates of intrauterine demise can approach 40%. 

Frequency

Chorioangiomas are identified in approximately 1 in 100 placentas. Fortunately, larger chorioangiomas occur less frequently with a reported incidence of 1: 3,500 to 1: 9,000.

Diagnosis + Evaluation

Chorioangiomas can be identified via prenatal ultrasound as a well-circumscribed placental mass that often projects into the amniotic cavity.  The mass can be hyperechoic, highly vascular, and well-circumscribed. The mass often is located in close proximity to the umbilical cord insertion site.  Feeding vessels to the chorioangioma may be superficial and or deep. The anatomy of the blood supply to the chorioangioma should also be recorded and monitored so that surgical candidacy may be established.

Management Options + Outcomes

One approach is a palliative strategy to ameliorate secondary symptoms. In the case of secondary polyhydramnios, amnioreduction can be advantageous to treat preterm labor and maternal discomfort. The obvious advantage of amnioreduction is that it is the least invasive prenatal treatment option.

Although considered more invasive and associated with higher procedure-related complications, definitive treatment with the goal to interrupt the blood supply to the chorioangioma can alternatively be employed. Ultrasound-guided percutaneous treatment options include alcohol injection, embolization, and interstitial laser therapy. Endoscopic methods include suture ligation and laser photocoagulation of the feeding vessels.

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References

*diagnostic information provided courtesy of Kathryn Jones a Katherine Tierney a Brendan H. Grubbs b Jay D. Pruetz c Jon Detterich c Ramen H. Chmait b 

a Department of Obstetrics and Gynecology, Los Angeles County and University of Southern California Medical Center, b Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and c Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, Calif. , USA