Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment options.
OBJECTIVE
To report three cases of large placental chorioangiomas managed with endoscopic laser coagulation of the feeding vessels, and review the literature regarding cases of chorioangioma treated with invasive techniques.


METHODS
Intrauterine endoscopic surgery was performed using a 2.5-mm fetoscope under epidural anesthesia. Coagulation of the feeding vessels was attempted with laser energy, and the operation was completed with amniodrainage.


RESULTS
The feeding vessels were successfully coagulated in one case, resulting in a term delivery. Histopathologic examination of the placenta confirmed a capillary chorioangioma with extensive necrosis. There were intraoperative complications in the other two cases, including bleeding at the site of coagulation requiring intrauterine transfusion in one, and incomplete vascular ablation in the other. In the former case the infant was born prematurely and developed chronic renal insufficiency. In the latter, the fetus died within the first week of the surgery.


CONCLUSIONS
There are limited interventions available for the management of large, symptomatic placental chorioangiomas. Although they can be treated with endoscopic laser coagulation of the feeding vessels, fetal bleeding, exsanguination, and death are potential complications of the procedure; therefore, this technique should be used with caution. The role of this treatment modality in the early devascularization of placental chorioangiomas prior to the development of significant complications warrants consideration.
Sepulveda
Waldo
W
Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile. fetalmed@yahoo.com
Wong
Amy E
AE
Herrera
Luis
L
Dezerega
Victor
V
Devoto
Juan C
JC
D004621:Embolization, Therapeutic; D005260:Female; D005332:Fetoscopy; D006391:Hemangioma / Q000098:blood supply* / Q000628:therapy*; D006801:Humans; D017075:Laser Coagulation; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000628:therapy*; D011262:Pregnancy Trimester, Second