Chorioangioma of placenta: a rare case of near-miss mortalit
Placental chorioangioma is a relatively rare condition that can result in serious prenatal complications and adverse pregnancy outcome. Published in the Journal of Obstetrics and Gynaecology of India, the authors report a rare case of placental chorangioma who presented with sudden maternal collapse.

A 23-year female G3 P2 L1 with 9 months amenorrhea came to the emergency with complaint of pain abdomen since 4 h.
She was hemodynamically stable with a pulse rate of 86 bpm, BP was 110/68 mmHg, afebrile, with 99 % SpO2 with normal respiratory and cardiovascular function. On per abdomen examination, her fundal height was 34 weeks with cephalic presentation. Uterus was irritable, and FHR showed deceleration up to 80 bpm lasting for 20 s in post-contraction phase. On P/V-cervical dilation 6 cm with fully effaced and vertex (−2) station with bag of membrane present.

As FHR was again dropping up to 60 bpm, ARM was done; liquor was meconium stained. Immediately after ARM, patient suddenly collapsed. Subsequently, her pulse was unrecordable. Patient became unconscious and unresponsive. Thinking it to be an embolic phenomenon patient was rushed to operation theater, resuscitation measures were started simultaneously in collaboration with anesthetist. Emergency LSCS was planned in view of fetal salvage. Patient was intubated, and inotrope noradrenaline infusion was started.

LSCS was commenced. On opening the abdomen, subcutaneous tissue was pale with no bleeding from any tissues. Uterus was also bluish and pale. A male baby of 1.4 kg with low Apgar score was delivered. Baby had no complications except hypoxia at birth. Subsequently, neonate was shifted to NICU. Uterus was flabby, so uterotonics were given to prevent postpartum hemorrhage. Actual assessment of hemostasis was not possible because patient was collapsed. Uterus was closed in single layer.

As patient improved, her vitals were recordable, but oozing also started from several sites at uterus stitch line. Bilateral uterine artery ligation was done. Resuscitative measures were continued, and abdomen was closed. At the end of closure, her pulse rate was 110 bpm BP was 120/84 mmHg and SpO2 100 %. She was shifted to ICU on noradrenaline infusion. She was kept intubated in ICU for 24 h. She was transfused 5 packed cells, 4 units of fresh-frozen plasma, 2 units of random donor plasma, and 800 mg i.v iron was given.

The placenta was sent for histopathological examination. The cut sections from the nodular masses revealed marked proliferation of capillaries and thin-walled vessels with area of hemorrhage and congestion suggestive of chorioangioma.

Key takeaways:-
-Chorioangioma is a rare but challenging condition. Antenatal diagnosis of such cases is a must to prevent and manage complications associated with it.

-Hence antenatal booking of every woman in early pregnancy should be encouraged.

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