Chorioangioma: Symptoms, Causes, Treatment

What are the symptoms of chorioangioma?

Chorioangioma is a benign vascular tumor of the placenta, which can vary in size and severity. While small chorioangiomas are often asymptomatic and may not cause any problems during pregnancy, larger or multiple tumors can lead to complications. The symptoms and complications associated with larger chorioangiomas include:

Polyhydramnios (excess amniotic fluid): This can cause abdominal discomfort and increase the risk of preterm labor.
Fetal growth restriction (FGR): The baby may not grow properly due to impaired blood flow or placental function.
Fetal anemia: Chorioangiomas can lead to red blood cell destruction or bleeding within the tumor, which may cause anemia in the baby.
Fetal heart failure: If the chorioangioma is large, it can place a strain on the baby’s heart, leading to heart failure (nonimmune hydrops fetalis), which can result in fluid buildup in tissues and organs.
Preterm labor: The excess amniotic fluid or other complications can increase the risk of early labor.
Placental abruption: In rare cases, the tumor can cause part of the placenta to separate from the uterine wall prematurely.
Pre-eclampsia: The mother may develop high blood pressure and protein in the urine, which can be dangerous if not managed.

Chorioangioma is often detected during routine ultrasound imaging, and close monitoring is usually recommended if a large tumor is present. In severe cases, interventions such as fetal blood transfusions or early delivery might be required.

What are the causes of chorioangioma?

The exact causes of chorioangioma are not well understood, but several factors are thought to contribute to the development of these benign placental tumors:

Abnormal placental blood vessel formation: Chorioangiomas are thought to arise from a malformation of the placenta’s blood vessels during early pregnancy. The exact trigger for this abnormal development remains unclear.
Genetic factors: While chorioangiomas are generally not inherited, some research suggests that genetic predispositions may play a role in their development, particularly in cases where there are multiple tumors or recurrent cases.
Maternal factors: Certain maternal conditions and factors may increase the likelihood of developing a chorioangioma, including:
Multiple pregnancies (e.g., twins or triplets)
Advanced maternal age
Hypertension during pregnancy (high blood pressure)
Diabetes
Placental stress or injury: There is some speculation that factors causing stress or injury to the placenta might increase the risk of abnormal placental development, including chorioangioma formation.

While the majority of chorioangiomas are small and cause no symptoms, larger ones may cause complications, particularly if they interfere with normal placental function. They are typically detected via routine ultrasound, and their cause is often not determined in individual cases.

What is the treatment for chorioangioma?

The treatment for chorioangioma depends on the size of the tumor and whether it is causing complications for the mother or fetus. Small, asymptomatic chorioangiomas often require no treatment and are simply monitored throughout the pregnancy. However, larger chorioangiomas can lead to complications that may require intervention. Treatment options include:

1. Close Monitoring

Regular ultrasound examinations to assess the size of the tumor and monitor fetal growth and amniotic fluid levels.
Fetal Doppler studies to evaluate blood flow and ensure the baby is not developing signs of heart failure (hydrops fetalis).
Frequent monitoring allows early detection of any developing complications.

2. Amnioreduction

In cases of polyhydramnios (excess amniotic fluid), an amnioreduction procedure may be performed to drain excess fluid and reduce the risk of preterm labor or placental abruption.

3. Fetal Blood Transfusion

If the baby develops fetal anemia, a fetal blood transfusion may be required. This is typically done via the umbilical vein under ultrasound guidance.

4. Laser or Radiofrequency Ablation

For larger, more symptomatic chorioangiomas, treatment may involve laser ablation or radiofrequency ablation to cut off the blood supply to the tumor. This procedure can help reduce the risk of complications like fetal heart failure.

5. Preterm Delivery

If complications such as fetal hydrops, severe fetal anemia, or placental insufficiency arise and the fetus is at risk, early delivery may be considered. Delivery timing depends on the gestational age and severity of complications.

6. Maternal Care

Monitoring the mother for signs of complications like pre-eclampsia or placental abruption is important, especially if the tumor is large or affecting placental function.

7. Steroids

In cases where early delivery is expected, corticosteroids may be administered to accelerate fetal lung maturation and improve the baby’s chances of survival if preterm delivery is required.

The management of chorioangioma typically involves a multidisciplinary team, including obstetricians, maternal-fetal medicine specialists, and neonatologists, to ensure the best outcome for both mother and baby.