EP10.23: Exploring the prospects of antenatal micro‐coil embolisation of giant placental chorioangioma: a case report

Giant placental chorioangiomas (CA) which measure more than 4 cms are associated with adverse maternal, fetal and neonatal outcomes, with an estimated perinatal mortality of 30–40%. In this case report, we discuss a minimally invasive, percutaneous, extra-amniotic method of focal occlusion which was accomplished by micro coil embolization of the feeding vessel. A 34-year-old second gravida was diagnosed with giant chorioangioma in an anterior placenta at 28 weeks GA with associated polyhydramnios. Colour Doppler revealed large vascular channels around and within the tumour. Middle Cerebral Artery PSV was 1.7 MoM, suggestive of fetal anemia. The biggest challenge was the close proximity of feeder vessel to the umbilical cord insertion site. Under the aegis of interventional radiologist ultrasound guided microcoil embolisation was decided instead of other conventional methods. After informed consent, under monitored anesthesia and ultrasound guidance, the feeder vessel to the chorioangioma was targeted using 18G Chiba needle. After confirming the intravascular position of the needle, an 8mm Nestor fibred coil was deployed into the vessel. A 3mm coil was also deployed to occlude a small branch of the feeder vessel. Postcoil embolization Doppler confirmed no vascularity within the tumour. The fetal heart rate remained stable throughout the procedure without evidence of any deterioration. Post-procedure amniotic fluid index returned to normal (AFI- 11.4), fetal anemia was corrected with watchful expectancy alone. The baby's growth velocity continued to be normal and the Dopplers were optimal throughout the rest of her pregnancy. She delivered a live term healthy baby of weight 3650g by Caesarean Section. This case report allows exploring the prospects of this procedure in anterior, lateral and fundal placentae. Microcoil embolization could emerge as a minimally invasive, potentially safe and effective novel treatment option for symptomatic chorioangiomas.