title: Fetoscopic laser photocoagulation of feeding vessels to a large placental chorioangioma following fetal deterioration after amnioreduction.
abstract: Large placental chorioangiomas (>4 cm) can precipitate severe polyhydramnios, fetal anemia, growth restriction, high-output cardiac failure, hydrops, and fetal demise. We report a case of a large chorioangioma that was treated in a stepwise fashion with amnioreduction to ameliorate maternal discomfort, followed by fetoscopic laser ablation of the feeding vessels after rapid evolution of heart failure. Although amnioreduction was helpful in improving maternal symptoms, we suspect that the drop in intrauterine pressure from the amniotic fluid decompression may have resulted in increased tumor perfusion, thereby promoting fetal deterioration due to a 'steal' phenomenon. Close scrutiny of the fetal status via ultrasound is required, particularly if amnioreduction is necessary, and definitive treatment should be considered once early signs of heart failure develop. Fetoscopic laser ablation of the feeding vessels is a feasible definitive treatment of a large chorioangioma in cases in which perfusion of the tumor is via a superficial nonterminus umbilical artery. Future reports should describe the anatomy of the blood supply to the chorioangioma, in the hopes that further guidelines for surgical candidacy may be established.
authors.affiliation: Department of Obstetrics and Gynecology, Los Angeles County and University of Southern California Medical Center, Los Angeles, Calif., USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Jones
authors.forename: Katherine
authors.initials: K
authors.lastname: Tierney
authors.forename: Brendan H
authors.initials: BH
authors.lastname: Grubbs
authors.forename: Jay D
authors.initials: JD
authors.lastname: Pruetz
authors.forename: Jon
authors.initials: J
authors.lastname: Detterich
authors.forename: Ramen H
authors.initials: RH
authors.lastname: Chmait
mesh_terms: D000328:Adult; D016534:Cardiac Output, High / Q000209:etiology / Q000601:surgery; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D005316:Fetal Distress / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005332:Fetoscopy; D005865:Gestational Age; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D006391:Hemangioma / Q000098:blood supply / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008028:Light Coagulation; D050498:Live Birth; D010922:Placenta Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006831:Polyhydramnios / Q000209:etiology / Q000601:surgery; D011247:Pregnancy; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal / Q000379:methods