Placental chorioangioma and adverse fetal outcome: a case re
Published in the Journal of Clinical Gynecology and Obstetrics, the authors report a case of cellular chorioangioma larger than 5 cm and its unexpected evolution, associated with a dramatically rapid increasing of amniotic fluid volume and a poor fetal outcome.

A 28-year-old, gravida 2 para 0, at 21 + 4 weeks of gestation was admitted for general abdominal pain, uterine contractions and vaginal bleeding. Obstetric anamneses revealed a previous abortion at 22 weeks due to the presence of genetic disease osteogenesis imperfecta related. The woman underwent a previous morphological scan at 20 weeks and no abnormality of the placenta and of the fetus was detected.

Ultrasound revealed a single live fetus with regular biometry, with no evidence of structural abnormalities. Amniotic fluid appeared slightly increased AFI about 220 mm. Placenta was on the posterior wall and a well-defined echogenic mass size 45 × 44 mm, with no vascularization by Doppler, was seen on the fetal side. After three days of tocolytic treatment, abdominal discomfort and vaginal bleeding stopped.

The patient was discharged without signs of bleeding and uterine contractions, and she was recommended to perform a new US scan within one week, in order to check AFI and the placental mass. Just six days later, she had a new admission at 22 + 2 weeks for abdominal pain due to overdistended abdomen, moderate dyspnea, uterine contractions and vaginal bloody mucous discharge.

Ultrasound examination detected a slight but significative increase in both of placental mass 43 × 56 mm and of AFI 280 mm. Cervical tunneling was documented by TV scan. The patient once again was treated with tocolytic drugs, bed rest, but there was not an effective control of sintomatology. There was a dramatically rapid and unexpected evolution of the clinical condition within 72 h of admission: abdomen became overdistended up to xiphisternum, preterm labour was starting with regular, painful, valid uterine contractions.

Dyspnea became so important that the patient showed discomfort for supine position and could sleep just in a seated position. For this reason, a therapeutic amniocentesis was performed with the reduction of more than 500 mL of amniotic fluid. Just few hours later, the patient delivered a male fetus (600 g, Apgar 0/0).

Histopathological examination of products of conception observed the placental disc 170 × 150 × 40 mm. The fetal side showed a brownish mass, size 60 × 50 mm, and it is close to cord insertion. Cut section presented a red-brown surface and cotyledons partially fragmented on the maternal side. No fetal anomaly was detected. This hypoechoic placental tumor was identified as a cellular type of chorioangioma.

Key takeaways:-
- Ultrasound examination with color Doppler helps in timely diagnosis, and it is recommended during the follow-up.

- However, the progression of this tumor is often unpredictable.

- The authors suggest a close observation of placental mass, especially if it is larger than 4 cm, even when the Doppler scan does not show a vascularization of itself.

- A regular monitoring could be useful to treat clinical complications immediately, and to achieve better outcomes in complicated pregnancies.

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