Abstract

OBJECTIVES: To report perinatal outcome of singleton pregnancies complicated by placental choriangioma diagnosed on prenatal ultrasound. METHODS: Medline, Embase, Cinahl and Clinicaltrials.gov databases were searched. Inclusion criteria were singleton pregnancies complicated by placental chorioangioma with no other associated structural anomalies. Primary outcome was perinatal mortality; secondary outcomes included associated non-structural anomalies detected on prenatal ultrasound (including fetal hydrops, anemia, polyhydramnios or other signs of hyperdynamic circulation), small for gestational age (SGA) at birth, composite perinatal morbidity and preterm birth (PTB). Sub-analyses according to presence of hydrops, size of the tumor and outcome of pregnancies undergoing fetal therapy were also performed. Random effect meta-analyses of proportions were used to analyze the data. RESULTS: Twenty-eight studies (161 pregnancies) were included. In chorioangioma not undergoing intervention, IUD occurred in 8.2% (95% CI 3.8-14.0), while NND and PND in 3.8% (95% CI 1.0-8.1) and 11.1% (95% CI 5.0-19.4) of cases. SGA at birth was present in 24.0% (95% CI 13.5-36.5), of cases, while PTB <37 weeks complicated 34.1% (95% CI 21.1-48.3) of pregnancies. Finally, composite neonatal morbidity occurred in 12% (95% CI 4.5-22.3) of cases. On ultrasound, signs of fetal hyperdynamic circulation, were present in 21.0% (95% CI 9.6-35.3) of cases, while increased PSV in the MCA in 20.6% (95% CI 10.9-32.3). Sub-analysis according to the size of chorioangioma, showed a progressive increase in the occurrence of most of the outcomes explored with increasing size of the tumor. Furthermore, the prevalence of adverse perinatal outcome was high in pregnancies complicated by chorioangioma presenting with fetal hydrops. There was no randomized controlled trial comparing intervention vs expectant management in pregnancies complicated by chorioangioma with signs of fetal compromise (hydrops, hyperdynamic circulation). Overall, perinatal mortality occurred in 31.2% (95% CI 18.1-46.6) of fetuses undergoing in utero therapy and 57.3% (95% CI 39.2-74.4) had resolution of hydrops or hyperdynamic circulation, after treatment. CONCLUSION: Placental chorioangioma is associated with adverse perinatal outcome. The size of the mass and presence of fetal hydrops are likely to be the main determinants of perinatal outcome in these pregnancies. This article is protected by copyright. All rights reserved.