title: Giant chorioangiomas: perinatal outcomes and techniques in fetoscopic devascularization.
abstract: OBJECTIVE
  To evaluate the intrauterine management and perinatal outcome of pregnancies complicated by giant placental chorioangioma (>4 cm) and elaborate on various devascularization techniques.
  
  
  METHODS
  Retrospective review of 10 cases of giant placental chorioangioma evaluated between January 2005 and August 2012. Maternal demographics, prenatal imaging, response to fetoscopic treatment, obstetrical complications, and perinatal outcomes were evaluated.
  
  
  RESULTS
  Overall survival was 80%. Seven (70%) cases were associated with obstetrical complications, including polyhydramnios (n = 7), non-immune hydrops (n = 3), and high cardiac output state (n = 5). Five patients underwent fetoscopic devascularization at a mean gestational age of 24.03 weeks with 80% survival. The tumors were devascularized by bipolar coagulation (n = 1), combination of bipolar and diode laser (n = 2), bipolar and radiofrequency ablation (n = 1), and surgical clip application (n = 1). Postoperatively, all survivors had resolution of hydrops and high cardiac output states with survival beyond 60 days of life.
  
  
  CONCLUSIONS
  Fetoscopic devascularization is indicated for high cardiac output states or non-immune hydrops and may require multiple techniques including bipolar coagulation, clip application, and/or laser to interrupt arterial inflow and devascularize the mass.
authors.affiliation: Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Foong-Yen
authors.initials: FY
authors.lastname: Lim
authors.forename: Alan
authors.initials: A
authors.lastname: Coleman
authors.forename: William
authors.initials: W
authors.lastname: Polzin
authors.forename: Ronald
authors.initials: R
authors.lastname: Jaekle
authors.forename: Mounira
authors.initials: M
authors.lastname: Habli
authors.forename: James
authors.initials: J
authors.lastname: Van Hook
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.forename: Timothy
authors.initials: T
authors.lastname: Crombleholme
mesh_terms: D000328:Adult; D005260:Female; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006391:Hemangioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010922:Placenta Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging / Q000601:surgery*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal