As a predictor, this grading scale is not useful for neona tal outcome near term (Hill, 1983; McKenna, 2005; Montan, 1986). However, data from two small studies link grade 3 pla centa prior to 32 weeks with stillbirth and some other adverse pregnancy outcomes (Chen, 2011, 2015).
These benign tumors have components similar to blood vessels and stroma of the chorionic villus. lso called chorangiomas, these placental tumors occur with an incidence of approximately 1 percent (Guschmann, 2003). In some cases, fetal-to-maternal hemorrhage across tumor capillaries leads to elevated levels of maternal serum alpha-fetoprotein (MSAFP), prompting sonographic evaluation. heir characteristic sonographic appearance shows a well-circumscribed, rounded, predominantly hypoechoic lesion lying near the chorionic plate and protruding into the amnionic cavity (Fig. 6-4). Documenting increased blood low by color Doppler helps to distinguish these lesions from other placental masses such as hematoma, partial hydatidiform mole, teratoma, metastases, and leiomyoma (Prapas, 2000). Although rare, chorangiocarcinoma tumors clinically mirror chorangiomas (Huang, 2015).
Small chorioangiomas are usually asymptomatic. Large tumors, typically those measuring >4 em, can create signiicant arteriovenous shunting within the placenta to cause high-output heart failure, hydrops, and fetal death (l Wattar, 2014). Compression of fetal erythrocytes within tumor vessels can lead to hemolysis and microangiopathic anemia (Bauer, 1978). Hydramnios, pre term delivery, and fetal-growth restriction are other sequelae. Rare cases include tumor vessel rupture, hemorrhage, and fetal death (Batukan, 2001). At the other extreme, rare rumor infarction can lead to symptom reversal (Zalel, 2002).
FIGURE 6�4 Placental chorioangioma. A. Color Doppler imaging displays blood flow through a large chorioangioma with its border outlined by white arrows. B. Grossly, the chorioangioma is a round, well-circumcised mass protruding from the fetal surface.
Gray-scale and color Doppler interrogation of the placenta and amnionic fluid volume are used to identiy these tumors. Diagnostic tools that can airm associated fetomaternal hemorrhage include MSAFP level and Kleihauer-Betke stain. With fetal concern, echocardiography assesses cardiac function, whereas middle cerebral artery interrogation is used to identiy fetal anemia.
Several fetal therapies interfere with the vascular supply to the tumor and reverse fetal heart failure. At specialized perinatal centers, endoscopic laser ablation of feeder vessels to the tumor is most frequently used and is associated with favorable fetal outcomes (Hosseinzadeh, 2015). Of other therapy, fetal transfusion can treat serious anemia, amnioreduction can temporize hydramnios, and digoxin therapy can assist fetal heart failure.
Maternal malignant tumors rarely metastasize to the placenta. Of those that do, melanomas, leukemias and lymphomas, and breast cancer are the most common (Al-Adnani, 2007). Tumor cells usually are confined within the intervillous space. As a result, metastasis to the fetus is uncommon but is most often seen with melanoma (lexander, 2003).