Chorioangioma – What It Means for You and Your Baby
Overview
A chorioangioma is a non-cancerous tumor that forms in the placenta. It’s made up of extra blood vessels, and sometimes those vessels are connected to the baby through the umbilical cord. While small chorioangiomas are fairly common and usually don’t cause any issues, larger ones (over 4 cm) can lead to pregnancy complications.
These may include:
- Heart failure in the baby (hydrops fetalis)
- Poor growth
- Low red blood cells and platelets (a condition called Kasabach-Merritt Sequence)
- Preterm birth
- Stillbirth
What Causes These Problems?
- The baby’s heart may be forced to work too hard to pump blood through the tumor’s vessels, which can lead to heart failure.
- The tumor can also “steal” blood cells and platelets, causing anemia and bleeding problems in the baby.
Does It Always Need Treatment?
In most cases, no treatment is needed, and the baby continues to grow normally. However, if the chorioangioma is large and the baby shows signs of distress or complications, treatment may be recommended.
Possible Treatment Options
If the baby is at risk, doctors may consider:
- Intrauterine transfusion: Giving blood or platelets to the baby while still in the womb if signs of anemia or low platelets are seen.
- Amnioreduction: Removing extra amniotic fluid with a needle to reduce pressure in the womb and lower the risk of early labor.
Laser treatment of the tumor: A special camera and laser are used to block the blood flow to the tumor, helping to reduce its effects on the baby.
Chorioangioma is a placental tumor that is composed of an abnormal proliferation of vessels. These vessels may be connect to the baby via the umbilical cord. Although not uncommon (1% incidence), cases with chorioangiomas that measure greater than 4 cm in diameter are rare. Pregnancies with large chorioangiomas can be associated with pregnancy complications. These include hydrops fetalis (heart failure), growth restriction (poor growth of the baby), fetal/neonatal demise, and preterm birth. The cause of these pregnancy complications can be attributed to two factors. First, high-output cardiac failure may occur due to vascular steal from arteriovenous shunts in the tumor. Second, hemolytic anemia (low blood count) and severe thrombocytopenia (low platelet count), otherwise called Kasabach-Merritt Sequence, may develop.
Most pregnancies with a chorioangioma do not require treatment while the baby is in the womb. However, rarely, in cases of large chorioangiomas (defined as over 4 cm), the baby may be at risk. The following is a list of possible treatment options for pregnancies with large chorioangiomas and evidence of fetal compromise:
- Intrauterine transfusion. This may be necessary if there is ultrasound evidence of fetal anemia (low red blood cell count). Platelet transfusion may also be necessary.
- Amnioreduction. Amnioreduction is a procedure in which a needle is inserted into the amniotic cavity and the excess fluid is removed. The purpose of this procedure is to decompress the womb to prevent preterm delivery. This procedure may be necessary in cases with symptomatic polyhydramnios (excess amniotic fluid volume that is causing preterm contractions and/or a short cervix).
- Operative fetoscopy and laser ablation of chorioangioma feeding vessels. The procedure involves operative fetoscopy and laser occlusion of the feeding vessels to the tumor.
For further reading, please see the link below: