Maternal propranolol as a safe alternative to invasive fetal surgery in chorioangioma management

Chorioangiomas are associated with a significant risk of fetal demise due to high-output cardiac failure. Standard invasive treatment, including fetoscopic laser photocoagulation and intratumoral embolization, shows limited success and has high fetal mortality rates. The biological parallels between chorioangiomas and infantile hemangiomas suggest that these tumors may share common therapeutic targets. Propranolol is a proven therapy for infantile hemangiomas, therefore this established efficacy provides a strong rationale for its consideration in the management of symptomatic or rapidly growing placental chorioangiomas. We hypothesized that maternal oral propranolol administration could selectively target placental chorioangiomas while preserving overall placental function, thereby offering a potential off-label therapeutic use of the drug. We report a case series of four fetuses that presented to Leiden University Medical Center, Leiden, The Netherlands, between December 2023 and May 2025 with a large chorioangioma and signs of fetal decompensation, varying from hyperdynamic circulation to evolving hydrops, and were treated with maternal propranolol. In all four cases, the fetal condition improved significantly upon propranolol treatment, with normalization of cardiac function and resolution of hydrops, paralleled by tumor regression and thrombosis confirmed histologically. These findings support a shift in the clinical management of chorioangiomas to improve fetal outcomes while minimizing procedural risks. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.