Diffuse placental chorioangiomatosis causing multiple fetal cerebral embolism: a case report

Placental chorioangiomas are benign vascular tumors. Large chorioangiomas have been reported to cause several obstetric complications, including premature labor, placental abruption, polyhydramnios, fetal hydrops, fetal growth restriction, fetal hepatosplenomegaly, cardiomegaly, a congestive heart failure and fetal death. The clinical significance of small hemangiomas is less known.

Multiple small placental hemangiomas occupied 70% of the total placental volume. A shower of emboli in the fetal cerebral circulation occurred 1 week before the delivery, causing permanent brain damage. Workup failed to detect causes of the embolism other than dissemination from the placental hemangioma. The fetal heart rate tracing was reassuring a few days after the cerebral embolism.

Chorioangiomas can cause fetal cerebral ischemic stroke, which, in otherwise healthy neonates, should prompt examination of the placenta. The nonstress test is not an adequate method of monitoring gestations with placental chorioangiomas. Optimal management in the presence of placental hemangiomas without fetal compromise remains undetermined.