Giant placenta chorioangioma with postpartum bleeding and uterine atony
Chorioangioma is the most commonly occurring vascular, non-malignant placental tumor in pregnancy, with a reported incidence of 1% in all examined placentas. Nonetheless, real tumor incidence remains unknown because of small specimen sizes, which contributes to a lack of detection throughout the entire gestational period. Prenatal detection and diagnosis may be possible with ultrasound screening; however, most placental chorioangioma diagnoses are postnatal, based upon histopathological studies. This article report the case of postnatal diagnosis and associated complications in a 35-year-old patient with a 6 cm × 4 cm × 4 cm placental chorioangioma.
Among the non-trophoblastic, benign placental tumors, the chorioangioma is the most common, accounting for 1% of the overall total (Yadav et al, 2017; Kurman et al, 2019). Although most chorioangiomas have no clinical repercussions, they may conjoin in the development of polyhydramnios, premature birth, preeclampsia, intrauterine growth restriction, platelet entrapment, arteriovenous short circuit, maternal mirror syndrome (maternal edema or pre-eclampsia with hydrops fetalis), stillbirth (Heerema-McKenney, 2019), non-reassuring fetal status, fetal anemia, cardiomegaly (Wu and Hu, 2016) and neonatal death; however, chorioangiomas rarely result in postpartum bleeding (Kramer et al, 2011). This article presents the case of a patient with postpartum uterine atony that required hysterectomy, with subsequent histopathological confirmation of a giant chorioangioma.
A 35-year-old patient was undergoing routine prenatal checkup at gestational week 35, with suspicion of preterm delivery as a result of advanced stage labor contractions. The patient had a history of three pregnancies, one live birth and one miscarriage. The patient suffered from hypertension (142/85 mmHg) linked to urine protein:creatinine ratio of 0.26, with no evidence of target organ damage. Following vaginal delivery, uterine examination revealed placental remnants suggestive of uterine wall infiltration with subsequent uterine atony and 1000 cc blood loss that triggered a code red alert. The patient did not respond to doses of oxytocin, methergine and tranexamic acid; because of the suspicion of placenta accreta, the patient underwent total abdominal hysterectomy. Table 1 contains the paraclinical case data.
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