Diagnosis and management of large placental chorioangiomas

Large chorioangiomas, benign vascular tumors of the placenta measuring ≥ 4 cm in greatest diameter, may pose significant risks to an ongoing pregnancy and warrant thorough sonographic evaluation to assess for evidence of fetal cardiac compromise and fetal anemia. Significant perinatal morbidity and mortality has been associated with large chorioangiomas. Key sonographic markers indicative of fetal compromise in the setting of a large chorioangioma include 1) polyhydramnios, 2) elevated middle cerebral artery (MCA) PSV (multiples of the median [MoM] ≥ 1.5), 3) increased combined cardiac output (CCO) and/or tricuspid regurgitation (TR) with or without evidence of fetal cardiomegaly, and 4) fetal hydrops. When fetal compromise is suspected in the setting of a large placental chorioangioma, referral to a fetal center with high-volume expertise in management of complex fetal care should be considered to evaluate for in-utero intervention candidacy. If in-utero fetal intervention is indicated, the placental location, the number and caliber of “feeder vessels” to the chorioangioma, and the proximity of the chorioangioma to the placental cord insertion guide the decision of surgical approach. Despite in-utero fetal intervention, perinatal morbidity and mortality remains high with 30–40 % resulting in perinatal death and about 50 % resulting in preterm birth.