PLACENTAL CHORIOANGIOMA. ASPECTS OF ULTRASONIC ASSESSMENT OF THE FETUS HEMODYNAMICS

 

Normuradova N.M.1,2 , Yusupbayev R.B.2, Babakhanova A.M.2

Purpose. To demonstrate the possibilities of ultrasound diagnostics in assessing the hemodynamics of a fetus with chorionangioma in the placenta.

Material and methods. A clinical case of a patient with placental chorionangioma complicated by the development of cardiomegaly, hepatomegaly and edema in the fetus is presented.

Results. In a 29-year-old female patient at 26 weeks of gestation, a round tumor of 9x8 cm in size, and a live female fetus were detected in the uterine cavity in the placenta region. Fetal weight exceeded the standards, corresponded to 92 percentiles. Pronounced polyhydramnios was detected. The blood flow inside the tumor was of a low resistance, the rhythm frequency was similar to the rhythm in the umbilical artery. Despite the fact that the Doppler parameters of the umbilical cord artery and the middle cerebral artery had normal values and the resistance indices in the venous duct were reduced, the fetus had cardiomegaly (CFI 0.73) and hepatomegaly, and obtained data after the birth of the child indicated polycythemia.

Discussion. Arterio-arterial shunts between the vessels of the tumor and the placenta lead to hypervolemia and overload of the right heart of the fetus. Signs of hypervolemia are visualized by a pronounced expansion of the diameter of the umbilical cord vein, thickening of the umbilical cord, and an increase in the size of the liver. In the state of hypervolemia, the filtration of the kidneys increases, and as a result, pronounced polyhydramnios develops. Heart overload causes cardiomegaly. The next stages in the development of pathology are cardiac decompensation, the development of fetal edema, which often lead to perinatal death.

Conclusion. With chorionangioma of the placenta, along with pronounced polyhydramnios, an increase in the size of the liver and the diameter of the umbilical vein, with normal Doppler indices of the umbilical artery and middle cerebral artery, the fetus shows signs of increased preload to the heart: cardiomegaly (increased CFI) and a decrease in PI in the venous duct. The use of modern ultrasound technologies and knowledge of the mechanisms of the development of cardiac overload in the fetus with placental chorionangioma, contribute to the timely assessment of the condition of the fetus and the choice of optimal tactics for managing the pregnancy.

 

1-Tashkent Institute Postgraduate Medical Education.

2- Republican specialized scientific practice medical center of Obstetrician and Gynecology. Tashkent, Uzbekistan.

Keywords: placental chorionangioma, fetal cardiomegaly, cardiofemoral index, hepatomegaly, fetal edema.

 

Corresponding author:  Normuradova N.M., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Normuradova N.M., Yusupbayev R.B., Babakhanova A.M. Placental chorioangioma. Aspects of ultrasonic assessment of the fetus hemodynamics. REJR 2021; 11(2):143-152. DOI: 10.21569/2222-7415-2021-11-2-143-152.

Received:        21.09.20 Accepted:       09.09.21