Letters to the Editor

Indian Pediatrics 2001; 38: 112-113

Hydrops Fetalis in Placental Chorioangioma

Chorioangioma is the most common benign tumor of the placenta. The incidence appears to be about 1% most tumors being small ones(1). However, a large one complicated with hydrops fetalis is rare. We report one such case of chorioangioma which resulted in hydrops fetalis.

A 23-year-old unregistered primigravida mother with 34 weeks gestation delivered a male baby in Rajindra Hospital, Patiala. Apgar score at birth ws 5/10 at 1 minute and 7/10 at 5 minutes. Examination revealed a heart rate of 200 beats/min. Respiratory rate was 72/min with subcostal and intercostal retraction. His weight was 3000 g, length 46 cm and head circumferance 36.5 cm. Pallor was present along with peripheral cyanosis. There was edema over feet. Abdominal examination showed hepatic enlargement (4 cm) and a firm spleen palpable 4 cm below the left costal margin. Ascites was present. Cardiovascular system revealed tachycardia and short systolic murmur in left parasternal area while respiratory system was normal. The child developed petechial hemorrhages over the limbs and trunk 12 hours after birth. On investigation, hemoglobin was 9 g/dl, blood sugar was 156 mg/dl, blood urea 33 mg/dl, SGOT 225 IU/L and SGPT 103 IU/L. Serum electrolytes were nomral. C-reactive protein in blood was negative. This child was given restricted fluids, diuretics and antibiotics but the child expired within 16 hours of birth. Pathological examination of placenta showed a big solid mass attached just at point of insertion of umblical cord measuring 9 cm ´ 7 cm ´ 4 cm in size. Its cut surface was brown and congested. Microscopic examination of placenta revealed proliferation of multiple small capillaries lined by endothelial cells with their lumina filled with blood, consistent with choriohemangioma of placenta.

Clincally significant chorioangiomas, i.e., those greater than 4 cm in diameter, are associated with an overall fetal loss rate of approximately 40%(2). Various reported clinical complication of chorioangiomas are hydramnios, premature delivery, fetal conges-tive cardiac failure and fetal microangiopathic hemolytic anemia(1). Hydrops fetalis due to a large chorioangioma is a rare complication. Our Patient had hydrops fetalis associated with large placental chorioangioma. The clinical manifestation included edema, anemia, hepato-splenomegaly and coagulopathy. Placental chorioangioma can give rise to fetal cardiac failure due to hyperdynamic circulation and anemia can be either due to hemodilution or destruction of the red blood cells in the chorioangioma(3). Fluid restriction with diuretics and blood transfusion is the treatment of neonatal cardiac failure in such cases.

With the increasing use of ultrasound, prenatal diagnosis of these tumors is becoming more common(4). Management includes umblical blood sampling and intravascular transfusion for fetal anemia which temporarily corects the hydrops and significantly pro- longs the pregnancy(5). Ablation of the blood supply of plancental chorioangioma via operative fetoscopy is another manage- ment alternative in patients with large chorioangioma(2).

K.K. Locham,
Rajinder Garg,
Sanjiv Goel,
Department of Pediatrics,
Government Medical College,
Rajindra Hospital,
Patiala 147 001, India.
E-mail: [email protected]

1. Wallenburg HCS. Choriangioma of the placenta. Obstet Gynec Surv 1971; 26: 411-425.

2. Quintero RA, Reich H, Romero R, Johnson MP, Goncalves L, Evans MI. In: utero endo-scopic devascularization of a large choriangioma. Ultrasound Obstet Gynec 1996; 8: 48-52.

3. Montan S, Anandakumar C, Joseph R, Arulkumaran S, Ng SC, Ratnam SS. Fetal and neonatal hemodilution associated with multiple placental choriangioma: Case report. J Obstet Gynec Res 1996; 22: 43-46.

4. Makino Y, Horiuchi S, Sonoda M, Kobayashi H, Kaneoka T, Kawarabayashi T. A case of large placental choriangioma with non-immunological hydrops fetalis. J Perinat Med 1999; 27: 128-131.

5. Hirata GI, Masaki D, O’ Toole M, Medearis AL, Platt LD. Color flow mapping and Doppler velocimetry in the diagnosis and management of a placental choriangioma associated with nonimmune fetal hydrops. Obstet Gynec 1993; 81: 850-852.