Chorioangioma

Chorioangioma

Chorioangioma is a rare, non-cancerous (benign) tumor that forms in the placenta—the organ that connects to the uterine wall during pregnancy to nourish the developing fetus. Chorioangiomas are vascular tumors, meaning they are composed of blood vessels, and they can vary in size and location within the placenta. While most cases of placental chorioangiomas do not lead to complications, larger tumors (especially those over 4 cm) can pose significant risks to both the mother and baby, particularly affecting fetal heart function and overall health.

Important Facts About Chorioangioma

  • Size and Location: The tumor may develop on the fetal side of the placenta, often near the umbilical cord insertion site. Chorioangiomas are typically diagnosed through ultrasound, but they can vary greatly in size—from small lesions that cause no symptoms to large masses that could disrupt the flow of blood and nutrients to the fetus.
  • Incidence: Chorioangiomas occur in approximately 1% of pregnancies. They are more commonly seen in pregnancies involving female fetuses or multiples (twins, triplets, etc.).
  • Benign Nature: Most chorioangiomas are benign and do not cause any issues during pregnancy. However, large tumors, especially those greater than 4 cm in size, may lead to serious complications.

How Does Chorioangioma Affect Pregnancy?

Chorioangiomas can affect both the fetus and the mother, particularly if the tumor is large. The main concern with large chorioangiomas is the increased blood flow (known as "shunting") to the tumor. This high volume of blood can strain the fetal heart, potentially leading to heart failure. Additionally, the tumor can cause a range of other complications, such as:

Fetal Risks:

  • Anemia: Reduced red blood cells, leading to insufficient oxygen supply.
  • Thrombocytopenia: Low platelet count, which can impair blood clotting.
  • Non-immune Hydrops: Fluid buildup in multiple areas of the baby's body.
  • Enlarged Heart (Cardiomegaly): The fetal heart may become enlarged as it works harder to pump blood.
  • Fetal Heart Failure: Caused by strain on the heart due to increased blood flow to the tumor.
  • Intrauterine Growth Restriction (IUGR): The fetus may not grow as expected due to the tumor's effect on nutrient and oxygen supply.
  • Fetal Stroke: A rare but possible complication from disturbed blood flow.
  • Umbilical Vein Thrombosis: A clot in the umbilical cord vein.
  • Fetal Death: In extreme cases, the fetus may not survive due to heart failure.

Maternal Risks:

  • Polyhydramnios: An excessive buildup of amniotic fluid in the uterus.
  • Preterm Labor and Delivery: Early labor or the need for premature delivery.
  • Preeclampsia: High blood pressure with potential damage to organs like the kidneys and liver.
  • Placental Abruption: Premature separation of the placenta from the uterine wall, causing bleeding and potential complications.
  • Malpresentation: Abnormal positioning of the baby at delivery.
  • Cesarean Delivery: Increased likelihood of needing a C-section.
  • Maternal Mirror Syndrome: A rare condition where the mother experiences symptoms mirroring those of the fetus, such as fluid retention and swelling.
  • Postpartum Hemorrhage: Excessive bleeding after delivery.

How is Chorioangioma Diagnosed?

Most chorioangiomas are discovered during routine prenatal ultrasounds, typically in the second trimester. A larger chorioangioma will appear as a solid mass on imaging, usually near the umbilical cord insertion site on the fetal side of the placenta. Small chorioangiomas that do not cause symptoms may go undetected during pregnancy, but some may only be discovered after birth when the placenta is evaluated. To confirm the diagnosis and rule out other conditions, further tests may be performed, such as:

Prenatal Care and Specialized Evaluation

If a chorioangioma is diagnosed or suspected, it is important to consult with a specialized fetal care team. Within the Fetal Center at Riley Children’s Health, a multidisciplinary team—including maternal-fetal medicine specialists, fetal imaging experts, fetal cardiologists, and neonatologists—will work together to evaluate the condition and plan appropriate care.

This comprehensive evaluation ensures that both you and your baby receive the most accurate diagnosis and tailored treatment plan.

Managing Chorioangioma During Pregnancy

If you are diagnosed with a chorioangioma, your healthcare team will monitor both you and your baby closely throughout the pregnancy. You may have frequent ultrasounds and fetal echocardiograms to assess fetal growth, heart function, and the tumor’s effect on the pregnancy.

In some cases, prenatal interventions may be necessary, particularly when the gestational age is less than 32 to 34 weeks, including:

  • Steroid Treatment: To help accelerate fetal lung development in case early delivery becomes necessary.
  • Amnioreduction: A procedure to reduce excess amniotic fluid, which can help reduce the risk of premature labor.
  • Fetal Blood Transfusions: To treat fetal anemia if necessary.
  • Laser Ablation: In rare cases, laser energy may be used to stop or reduce the blood flow to the chorioangioma, especially if the baby is at risk of heart failure.

Delivery considerations

If complications arise and the gestational age is beyond 32 to 34 weeks, early delivery may be required, especially if the baby is at risk of heart failure or other serious issues. Delivery should take place in a facility equipped to handle high-risk pregnancies, including access to a neonatal intensive care unit (NICU).

Treatment after birth

After delivery, the baby may require treatment for conditions such as severe anemia, thrombocytopenia, or non-immune hydrops. Some babies may need platelet or blood transfusions or support for breathing and fluid buildup. Postnatal Care:

  • Examination of the Placenta: To confirm the presence of the chorioangioma and ensure that the tumor is benign.
  • Close Monitoring: Babies born with complications from chorioangiomas will be monitored by a team of pediatric specialists, including neonatologists and cardiologists, to ensure their health and development.

Key Points to Remember

  • Chorioangioma is a rare, non-cancerous (benign) tumor that forms in the placenta—the organ that connects to the uterine wall during pregnancy to nourish the developing fetus.
  • Chorioangiomas can affect both the fetus and the mother, particularly if the tumor is large. The main concern with large chorioangiomas is the increased blood flow (known as "shunting") to the tumor. This high volume of blood can strain the fetal heart, potentially leading to heart failure.
  • Most placental chorioangiomas are discovered during routine prenatal ultrasounds, typically in the second trimester.
  • If you are diagnosed with a chorioangioma, your healthcare team will monitor both you and your baby closely throughout the pregnancy. You may have frequent ultrasounds and fetal echocardiograms to assess fetal growth, heart function, and the tumor’s effect on the pregnancy.

Locations

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

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Departments Treating This Condition