Giant placental chorioangioma and intrapartum acute fetal distress: A case report

Abstract

Placental chorioangioma represents the most frequent benign non-trophoblastic tumor of the placenta. Most lesions are small and clinically silent, but giant chorioangiomas (4–5 cm), while uncommon, can be associated with serious complications. This report describes the case of a 27-year-old woman (gravida 2, para 1) with an uneventful pregnancy until 33 weeks, when an ultrasound identified a placental mass measuring 60 × 70 mm. At 36 weeks, she presented with spontaneous rupture of membranes and labor pains. During labor, the fetus developed acute distress, and an emergency cesarean section was performed. A female infant weighing 2360 g was delivered with Apgar scores of 7 and 9 at 1 and 5 min. Intraoperatively, a well-circumscribed placental tumor measuring 10 × 10 cm was observed. Histopathological analysis confirmed chorioangioma. Both mother and newborn were discharged in good health on postoperative day 5. Although often silent during pregnancy, giant placental chorioangiomas may precipitate acute intrapartum complications. Vigilant antenatal monitoring and timely intervention are crucial to optimize perinatal outcomes.

Highlights

• •Giant placental chorioangiomas are potentially serious lesions.
• •They may be clinically silent during pregnancy but go on to produce unexpected intrapartum complications.
• •Early detection, close antenatal surveillance, and prompt obstetric management are essential for improving perinatal outcomes for women with giant placental chorioangiomas.

1. Introduction

The placenta is a dynamic organ that regulates maternal–fetal nutrient transfer, gas exchange, endocrine support, and immunological balance. Structural or functional abnormalities of the placenta may profoundly affect maternal well-being and neonatal outcome [1]. Placental tumors encompass a group of rare entities. Among them, chorioangioma is the most prevalent benign vascular neoplasm, but its incidence in nevertheless low, with histological studies suggesting approximately 1% of pregnancies [2]. The incidence of the subset defined as giant chorioangioma (often exceeding 4–5 cm in diameter) is lower still but carries disproportionately high risks for adverse outcomes throughout gestation and delivery [2], [3].

The clinical significance of these large tumors stems from their distinct vascular architecture. They may establish abnormal direct connections between arterial and venous systems within the placenta [4], [5]. These abnormal arteriovenous connections create a functional vascular shunt, diverting blood flow and imposing a state of chronic volume overload on the fetal cardiovascular system. The ensuing fetal compensatory mechanisms can fail, leading to a well-documented cascade of complications: fetal anemia, progressive hydrops, significant growth restriction, and, in the most severe cases, intrauterine death [1], [4], [5]. Maternal morbidity, such as preeclampsia and mirror syndrome, is also heightened [1], [2].

The period of labor and delivery introduces additional acute risks. The physical mass of the tumor, combined with the forces of uterine contractions, may predispose to mechanical complications such as intrapartum placental dysfunction or abruption. This can manifest as unexpected acute fetal distress, as in the present case report. Furthermore, the abnormal placental implantation site and potential for uterine atony following delivery of a placenta with a large tumor substantially increase the risk of postpartum hemorrhage, a major contributor to maternal mortality [1], [6].

Consequently, while rare, giant chorioangiomas warrant a high index of clinical suspicion. Their management requires vigilant antenatal surveillance, preparedness for intrapartum emergencies, and a coordinated multidisciplinary approach to optimize safety for both mother and fetus.

This report describes a case in which a giant placental chorioangioma remained clinically silent until term but was associated with acute fetal distress during labor, underscoring the importance of vigilant monitoring and timely obstetric intervention.

2. Case Presentation

A 27-year-old woman (gravida 2, para 1), with a history of a cesarean section three years before the current pregnancy, was followed regularly during her second pregnancy. An ultrasound examination at 33 weeks demonstrated a heterogeneous placental mass measuring 60 × 70 mm. The lesion showed limited vascularity, and no fetal compromise was noted at that time. The pregnancy was managed expectantly with close surveillance, including serial ultrasound assessments to monitor fetal growth, amniotic fluid volume, and tumor characteristics (Table 1).

Table 1.

Monitoring indicators during pregnancy.

		33 weeks	34 weeks	35 weeks
Gravida	Proteinuria	Negative	Negative	Negative
	Blood pressure	Normal	Normal	Normal
	Edema	Negative	Negative	Negative
Fetus	Heart rate (beats per minute)	146	141	148
	Amniotic fluid	Normal	Normal	Normal
	Fetal weight (gram)	2152	2276	2310
	Placental tumors (mm)	60 × 70	72 × 79	80 × 86

At 36 weeks, the patient presented to the labor ward with painful contractions, spontaneous rupture of membranes, and blood‑tinged vaginal discharge. On admission, vital signs were stable. Vaginal examination revealed cervical dilatation of 2 cm, 70% effacement, and vertex presentation. The fetal heart rate was 146 beats per minute. Laboratory investigations, including complete blood count and coagulation profile, were unremarkable.

During labor progression, fetal heart rate monitoring demonstrated recurrent late decelerations with decreased variability. Amniotic fluid was noted to be meconium-stained, indicating acute fetal compromise. An emergency cesarean section was performed.

A live baby girl, weighing 2360 g, was born with a 1-min Apgar score of 7. The infant received oxygen therapy, warmth, and nasal suctioning. After 5 min, her Apgar score reached 9. Intraoperatively, a well-demarcated, lobulated placental tumor measuring 10 × 10 cm was identified (Fig. 1). The cut surface displayed a mixture of yellowish and hemorrhagic areas (Fig. 2). Histopathological examination of the placental mass revealed chorionic villi with proliferating capillaries showing marked vascular congestion and areas of hemorrhage. Foci of trophoblastic and syncytiotrophoblastic proliferation were observed, forming villous structures with fibrovascular cores. The trophoblastic cells demonstrated relatively uniform nuclei, with occasional nuclear atypia, but mitotic figures were absent. These features were consistent with placental chorioangioma (Fig. 3).

Fig. 1.

Gross image of the placenta at delivery showing a well-circumscribed, lobulated tumor measuring 10 × 10 cm (scale bar 1 cm).

Fig. 2.

Cut surface of the tumor showing a heterogeneous appearance with yellowish areas interspersed with reddish, congested vascular zones, consistent with chorioangioma (scale bar 1 cm).

Fig. 3.

Histopathological section of the placental tumor. Black arrow: example of congested chorionic villi. Blue arrowhead: example of areas of capillary proliferation. Asterisk (*): example of hemorrhagic areas. Trophoblastic and syncytiotrophoblastic cells form villous structures with fibrovascular stroma. No mitotic activity is observed (H&E stain, × 200). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

The postoperative course was uneventful. The mother received prophylactic antibiotics, analgesia, and standard uterotonic therapy. During the baby's hospital stay, no abnormalities were observed in the neonate. Both mother and neonate were discharged in good health on postoperative day 5.

After discharge from the hospital, the mother and baby were monitored for 7 weeks. The mother had no postoperative complications, her beta-HCG levels were negative from the second week, and the fetus was healthy.

3. Discussion

Placental chorioangioma is a benign vascular tumor [2], [3]. It can adversely affect the pregnancy through mechanisms of arteriovenous shunting, which impose increased cardiac output demands on the fetus and may result in high-output cardiac failure [4], [5]. This process can trigger polyhydramnios, fetal anemia, hydrops fetalis, growth restriction, or even intrauterine demise. Maternal complications such as preeclampsia, mirror syndrome, and postpartum hemorrhage have also been reported [2], [4].

Diagnosis is typically made prenatally by ultrasonography with color Doppler. Large, vascular placental masses with feeding vessels strongly suggest chorioangioma [5]. In the present case, the lesion demonstrated limited vascularity, which may account for the absence of antenatal complications such as polyhydramnios or hydrops. Nevertheless, the tumor enlarged to 10 cm by the time of delivery and ultimately might have contributed to the acute fetal distress during labor.

Management of giant chorioangiomas remains a subject of debate. Expectant management with intensive monitoring is acceptable in uncomplicated cases, whereas invasive interventions may be warranted when complications arise. Options include amnioreduction to relieve polyhydramnios, intrauterine transfusion for fetal anemia, or interventional procedures such as fetoscopic laser coagulation or radiofrequency ablation of feeding vessels [1], [5], [7]. Recent studies have emphasized that prognosis depends not only on tumor size but also on vascularity, gestational age at diagnosis, and availability of specialized fetal therapy [1], [3], [6].

This case is notable because the patient remained clinically stable late pre-term (36 weeks of gestation), when sudden intrapartum fetal distress developed. This underscores the unpredictable natural history of giant chorioangiomas. Even in the absence of overt antenatal complications, acute events may arise during labor, necessitating urgent obstetric intervention. The timely cesarean delivery in this case ensured favorable maternal and neonatal outcomes.

This case highlights the importance of close monitoring of pregnancy and early detection and management of abnormalities during labor in pregnant women with placental tumors. This helps ensure the safety of both mother and fetus during pregnancy, labor, and afterwards.

4. Conclusion

Giant placental chorioangiomas are rare but potentially serious lesions. Although they may be clinically silent during pregnancy, unexpected intrapartum complications such as acute fetal distress can occur. Early detection, close antenatal surveillance, and prompt obstetric management are essential for improving perinatal outcomes.

Contributors

Hung Nguyen Dao contributed to patient care, conception of the case report, acquiring and interpreting the data, drafting the manuscript and undertaking the literature review.

Trung Viet Nguyen contributed to patient care and drafting the manuscript.

Hieu Trung Mai contributed to patient care and drafting the manuscript.

Tien Viet Tran contributed to patient care and revising the article critically for important intellectual content.

Tien Minh Bui contributed to patient care, drafting the manuscript and revising the article critically for important intellectual content.

Kien Trung Nguyen contributed to patient care and drafting the manuscript.

Tuan Dinh Le contributed to patient care, acquiring and interpreting the data and revising the article critically for important intellectual content.

Nui Minh Nguyen to patient care and drafting the manuscript.

Son Tien Nguyen contributed to drafting the manuscript.

Hoa Trung Dinh contributed to interpreting the data and revising the article critically for important intellectual content.

Binh Van Nguyen contributed to drafting the manuscript and revising the article critically for important intellectual content.

All authors approved the final submitted manuscript.

Patient consent

Written informed consent was obtained from the patient for publication of the case report and accompanying images.

Provenance and peer review

This article was not commissioned and was peer reviewed.

Funding

No funding from an external source supported the publication of this case report.

Declaration of competing interest

The authors declare that they have no competing interest regarding the publication of this case report.