Prenatal treatment of chorioangioma by microcoil embolisation

Tze Kin Lau, Tak Yeung Leung, Simon C.H. Yu, Ka Fai To, Tse Ngong Leung

Case report

A 39 year old parous woman had a huge chorioangioma complicated by fetal anaemia. Her past obstetric history was unremarkable, with three normal vaginal deliveries at term. In her current pregnancy when she was first seen at 24 weeks of gestation, her fundal height was 28 cm. An ultrasound scan showed a placental tumour measuring10 cm in diameter protruding into the amniotic cavity. The placenta was anterior. The tumour was predominantly solid with multiple echo-free spaces. Colour Doppler examination revealed a vascular tumour, with a large feeding vessel measured 7.4 mm in diameter supplying the tumour. The feeding vessel bifurcated soon after its entry into the tumour (Fig. 1). Fetal measurements were on the third centile, and there was cardiomegaly with a cardiothoracic ratio of 0.62 (Fig. 2). The fetal morphology was otherwise normal. The liquor volume was also diminished, with only one identifiable pocket of 3.7 cm in diameter.

A diagnosis of chorioangioma with possible fetal anaemia was made. Cordocentesis was performed and confirmed fetal anaemia (haemoglobin concentration: 5.7 g/dL). Intrauterine transfusion was performed with 50 ml of irradiated Rhesus-positive maternal packed cells (haematocrit of 80%), and the haemoglobin level increased to 9.6 g/dL. The fetal karyotype was normal.

To prevent the recurrence of fetal anaemia due to chronic sequestration of fetal blood through the tumour, other treatment was considered to be necessary. Ultrasoundguided transcutaneous embolisation of the chorioangioma was performed two days later under local anaesthesia. Eight pieces of microcoil, including two 2-mm/3-mm coils, two 2-mm/5-mm coils and one 2-mm/6-mm coil, were inserted into the main and intratumoural branches and at the bifurcation of the main trunk of the feeding artery through a 15-cm-long, 20-gauge spinal needle. A significant reduction of blood flow was observed (Fig. 3) but the procedure was abandoned because of increasing discomfort felt by the woman due to prolonged sustained supine posture. The procedure lasted 45 minutes.

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