At what gestational age should patients with a placental chorangioma be delivered?

Timing of Delivery for Patients with Placental Chorangioma

Patients with placental chorangioma should be delivered at 34-36 weeks of gestation if stable, with earlier delivery indicated for maternal or fetal complications. 1

Delivery Timing Based on Clinical Presentation

• For stable patients with placental chorangioma without complications, delivery should be planned between 34-36 weeks of gestation 1
• Earlier delivery is indicated in cases with maternal or fetal compromise, including: 1
  • Persistent bleeding
  • Preeclampsia
  • Labor or rupture of membranes
  • Fetal compromise (abnormal Doppler studies, growth restriction)
  • Developing maternal comorbidities

Complications Associated with Placental Chorangioma

• Large placental chorangiomas (>5 cm) are associated with significant maternal and fetal complications: 2, 3
  • Polyhydramnios
  • Preterm labor
  • Postpartum hemorrhage
  • Fetal anemia
  • Fetal distress
  • Fetal hydrops
  • Potential perinatal death

Management Protocol

• Weekly antenatal monitoring should be implemented after diagnosis of placental chorangioma 2, 3
• Corticosteroids should be administered if delivery is anticipated before 37 weeks 1
• Multidisciplinary team involvement with maternal-fetal medicine specialists, anesthesiologists, and neonatologists is recommended 2
• For large chorangiomas with fetal compromise before viability, consider prenatal interventions such as laser coagulation of feeding vessels in specialized centers 4

Monitoring Parameters

• Serial ultrasound assessment of:
  • Tumor size and vascularity 5
  • Fetal growth 6
  • Amniotic fluid volume 2
  • Middle cerebral artery Doppler (to detect fetal anemia) 5
  • Umbilical artery Doppler 1

Delivery Considerations

• Mode of delivery should be individualized based on obstetric indications rather than the presence of chorangioma alone 2
• Preparation for potential postpartum hemorrhage is essential as placental chorangiomas are associated with uterine atony 2
• Blood products should be available for both mother and neonate due to risk of maternal hemorrhage and fetal anemia 2, 3

Special Considerations

• For extremely large chorangiomas (>10 cm) or those with significant fetal compromise, earlier delivery may be necessary, balancing prematurity risks against continued in-utero risks 2, 5
• In cases of severe fetal growth restriction with abnormal umbilical artery Doppler studies, delivery timing should follow protocols for growth restriction: 1
  • At 37 weeks for decreased diastolic flow without absent/reversed end-diastolic velocity
  • At 33-34 weeks for absent end-diastolic velocity
  • At 30-32 weeks for reversed end-diastolic velocity

Pitfalls to Avoid

• Delaying delivery beyond 36 weeks in cases of placental chorangioma increases risk of stillbirth 1
• Failing to prepare for potential neonatal complications, particularly anemia and thrombocytopenia 2
• Underestimating the risk of postpartum hemorrhage, which requires prophylactic management with uterotonic agents 2