Objectives: Chorioangiomas are the most frequently occurring type of benign tumour
of the placenta. However, large chorioangiomas greater than 4 cm are rare and can
be more frequently associated with serious complications such as: polyhydramnios,
hydrops fetalis, fetal anaemia, intrauterine growth restriction, preterm birth, and
an increased risk of perinatal mortality. Importantly timely prenatal diagnosis with
close surveillance alongside potential intrauterine intervention can prove impactful
on pregnancy outcome and fetal survival. Case presentation: We present a case of a
36-year-old female referred to our tertiary fetal medicine unit at 28 weeks' gestation
with a large chorioangioma measuring 9.4x8.8x5.5 cm and ultrasonographic evidence
of severe fetal anaemia and fetal hydrops. The patient underwent an intrauterine transfusion
and in utero surgical therapy with radiofrequency ablation (RFA). Immediately following
the procedure, the fetus sustained a period of bradycardia, followed by asystole.
Delivery was expedited via emergency caesarean section. Careful planning and rapid
delivery after fetal intervention within the most appropriate surgical setting mitigated
risks for the baby and resulted in a positive outcome. The baby was discharged from
the neonatal unit on day 84 of life. Conclusions: Large placental chorioangiomas are
a rare occurrence, however, when associated with fetal complications present a high
incidence of adverse perinatal outcomes. In utero interventions require careful planning
and surgical expertise to ensure improved fetal and neonatal outcomes. To the best
of our knowledge this case is the first recorded instance of a successful postnatal
outcome following RFA for a large placental chorioangioma, whereby the fetus was complicated
by fetal hydrops.
