Significance of Placental Hemangioma

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A placental hemangioma or chorioangioma is associated with a high rate of maternal and fetal complications. It is the most common benign tumor of the placenta. The incidence of placental hemangioma is 1% or less. The diagnosis is sometimes made with ultrasound, but other conditions like fibroids and hematomas can mimic a hemangioma on ultrasound as well. Small hemangiomas are not clinically significant, but large hemangiomas (greater than 5 cm in diameter) are. Large hemangiomas can produce preterm labor, nonimmune hydrops fetalis (generalized swelling of the fetus due to cardiac failure), polyhydramnios (overabundance of amniotic fluid), fetal cardiac failure, oligohydramnios (too little amniotic fluid), and fetal anemia. The complications for the fetus revolve around arteriovenous shunts (where the artery communicates with the vein) that are created by the hemangioma. Hemangiomas occur after the first trimester as first trimester hemangiomas are unknown.

Hemangiomas usually occur close to the umbilical cord insertion site. There are cases where the hemangioma is located on the umbilical cord or on the membranes as well. The hemangioma will be on the surface of the placenta if it is located in the placenta.

Maternal complications include vaginal bleeding during the pregnancy, and postpartum hemorrhage (heavy vaginal bleeding following the birth of the infant). There is also a higher incidence of velamentous insertion of the umbilical cord with a hemangioma.

There is a routine prenatal panel which is done on all pregnant women looking at everything from a blood count to syphilis. In addition, there is a test known as an alphafetoprotein (AFP) which is offered as a voluntary test to pregnant women in the second trimester. This test looks for neural tube defects like spina bifida (which occurs when the bones of the spine don’t form around part of the baby’s spinal cord), and Down’s Syndrome. These conditions will give an elevated AFP value which will lead to further testing. Interestingly, the placental hemangioma will also provide an elevated AFP which is not associated with spina bifida or Down’s Syndrome.

Since placental hemangioma is a rare condition, not much is known about it.

Your provide will, of course, inform you if a placental hemangioma or chorioangioma is suspected on ultrasound.

Wishing you a safe and uncomplicated delivery, Pablo.

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