114: Giant placental chorioangioma: techniques in fetoscopic devascularization and outcomes

in fetoscopic devascularization and outcomes Foong-Yen Lim, William Polzin, Ronald Jaekle, Mounira Habli, David Lewis, James Van Hook, Timothy Crombleholme Cincinnati Children’s Hospital Medical Center, Fetal Care Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, Good Samaritan Hospital, Obstetrics and Gynecology, Cincinnati, OH, University of Cincinnati, Obstetrics and Gynecology, Cincinnati, OH, University of Cincinnati, Obstetrics and Gynecology, Cincinnati, OH, University of Cincinnati, Obstetrics and Gynecology, Cincinnati, OH OBJECTIVE: To evaluate the intrauterine management and perinatal outcome of pregnancies complicated by giant placental chorioangioma ( 4cm). STUDY DESIGN: Retrospective review of 8 cases of giant placental chorioangioma referred to a single center between May 2006 and December 2010. Information on maternal demographics, prenatal imaging (ultrasound, fetal MRI, echocardiography), response to fetoscopic treatment for high cardiac output state or non-immune hydrops, obstetrical complications, and perinatal outcome were evaluated. RESULTS: All 8 cases were isolated, had an average tumor size of 8.3cm (range 5.1-12.5cm). Mean gestational age at evaluation and delivery was 23.5 weeks and 35.5 weeks, respectively. Overall survival was 75%. Six (75%) cases were associated with obstetrical complications, including polyhydramnios (n 6), non-immune hydrops (n 3), high cardiac output state (n 5). Five patients had fetoscopic devascularization of the chorioangiomas: all 5 were contiguous with the placental cord insertion (PCI) at mean gestational age of 23.9 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). Post-operatively, hydrops resolved in 2 of 2 and cardiac output normalized in 4 of 4, and all were liveborn at mean gestational age of 35.4 weeks. The three cases managed non-operatively had mild polyhydramnios persisted in one, and stillbirth occurred at 30 weeks gestation in one, with 66% survival. Mean gestational age at delivery was 35.6 weeks. CONCLUSION: Giant placental chorioangioma is associated with obstetrical complications particularly when contiguous with the PCI. Fetoscopic devascularization is indicated for high cardiac output or non-immune hydrops, which may require multiple techniques including bipolar coagulation or clip application to interrupt arterial inflow and laser to coagulate surface collateral vessels.