Abstract
To our knowledge, this is the first report of a case of fetal anemia due to rupture of a vein on the surface of placental chorioangioma. A 29-year-old primigravida was referred to us for clinical follow-up and serial ultrasonographic (US) surveillance. The patient had a normal course until a placental mass was noted by obstetric US examination at 28 weeks. Routine obstetric US images demonstrated a 65×80-mm hypoechoic, circumscribed, and ovoid intraplacental mass that protruded into the amniotic cavity. Amniotic fluid pocket was measured as 87 mm, and power Doppler images demonstrated remarkable flow within the anechoic spaces in the placental mass. The diagnosis of chorioangioma and polyhydramnios were made, and the patient was admitted to our hospital. At admission, we did not find any apparent complications such as fetal anomaly, anemia, growth restriction, or placental abruption. Following examinations, the size of the mass gradually increased, and the middle cerebral artery-peak systolic velocity (MCA-PSV) MoMs were also increased. Furthermore, the sinusoidal pattern appeared on the fetal heart rate tracing. Then, emergency cesarean section was performed under the diagnosis of non-reassuring fetal status due to fetal anemia. At the operation, we found that amniotic fluid was bloody due to rupture of the placental mass. Neonatal hemoglobin and albumin were 8.3 g/dl and 1.5 mg/dl, respectively, and the platelet count was within the normal range (19.1×104/μl). The cause of fetal anemia was thought to be hemorrhage due to rupture of the placental mass. It has been suggested that we should pay attention to rupture of tumor vessels when we manage cases with chorioangioma complicated by polyhydramnios.
