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• W4384277402 abstract "There is a paucity in the literature regarding evidence-based guidelines for the management of large placental chorioangiomas (≥ 4cm diameter). The objective of this study is to describe different thermal techniques that may improve the efficiency of in utero intervention for chorioangiomas.This is a retrospective cohort study of 34 patients referred for the management of large placental chorioangiomas in a single center from January 2011 to December 2022, who were managed expectantly or with intervention. In utero intervention was performed when the fetus developed any signs of impending compromise including high combined cardiac output (CCO), worsening polyhydramnios, or abnormal fetal Doppler velocimetry findings. Interventions included radiofrequency ablation (RFA), interstitial laser surgery, single port FLP or two port fetoscopic laser photocoagulation (FLP). Treatment selection was dependent on the proximity of the tumor to the cord insertion and placental location. The two-port technique was performed in patients with a chorioangioma with large feeder vessels (≥ 3 mm) located in the posterior placenta, where one port was for the bipolar occlusion and coagulation of the feeder vessels and the second port for laser photocoagulation of these vessels downstream. Single port technique was used in chorioangioma with small feeder vessels (< 3 mm) located in the posterior placenta. Interstitial laser ablation or RFA was performed in cases of anterior placenta. Supportive treatments like amnioreduction and intrauterine transfusion (IUT) were additionally performed for worsening polyhydramnios and suspected fetal anemia based on middle cerebral artery Doppler flow studies respectively. Comparative statistics between expectant management vs. in-utero interventions were performed. Descriptive details are provided for patients who underwent in-utero intervention.Thirty-four large chorioangiomas were evaluated, 25 (73.5%) were managed expectantly and 9 (26.4%) underwent intervention. The presence of polyhydramnios was significantly higher in the intervention group compared to the expectant group (67% vs 8%, p value <0.001). The live birth among expectantly managed chorioangiomas was significantly higher compared to intervention group (96% vs 56%, p value=0.01). In the intervention group, elevated CCO was present in all cases and hydrops was present in (n=3) 34% of cases. One patient experienced fetal demise following IUT but prior to planned FLP. Among the remaining 8 patients, 4 underwent the two-port technique, 2 underwent a single-port FLP, and 2 underwent interstitial laser ablation/RFA. The overall survival rate for fetuses undergoing interventions was 62.3% (5/8). All 3 cases where hydrops was present at the time of intervention ended with fetal demise.Fetoscopic laser photocoagulation of feeder vessels is a therapeutic option for the management of large chorioangiomas. A two-port percutaneous fetoscopic technique appears to improve the efficiency of FLP when a large chorioangioma with large feeder vessels is located in the posterior placenta. We propose that in-utero interventions for large chorioangioma should be initiated prior to the development of fetal hydrops. This article is protected by copyright. All rights reserved." @default.
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• W4384277402 date "2023-07-13" @default.
• W4384277402 modified "2023-09-24" @default.
• W4384277402 title "Management of large placental chorioangiomas: novel approach for fetal intervention" @default.
• W4384277402 doi "https://doi.org/10.1002/uog.26307" @default.
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