A rare case of intra-uterine blood transfusion for fetal anemia caused by a giant placental chorioangioma
Author:
Raviv Shira1ORCID, Shrim Alon1, Eidel Julia2, Yinon Yoav3, Weiz Boaz3, Lipitz Shlomo3, Hallak Mordechai1, Gabbay-Benziv Rinat1ORCID
Affiliation:
1. Obsterics and Gynecology Department , Hillel Yaffe Medical Center, The Rappaport Faculty of Medicine, Technion , Hadera , Haifa , Israel 2. Pathology Department , Hillel Yaffe Medical Center, The Rappaport Faculty of Medicine, Technion , Hadera , Haifa , Israel 3. Tel Hashomer Medical Center, Sackler Faculty of Medicine , Ramat-Gan , Tel-Aviv , Israel
Abstract
Abstract
Objectives
Chorioangiomas (CAs) are the most frequent tumor-like-lesions of the placenta. Giant CAs (more than 4–5 cm in diameter) is rare and may result in severe maternal fetal complications.
Case presentation
A 38-year-old multigravida presented at 31 weeks’ gestation with contractions. Upon evaluation, contractions were spontaneously ceased, and the cervix was closed. Ultrasound examination revealed a single viable fetus, polyhydramnios and a 75 x 48 x 82 mm vascular lesion located on the placental surface near the cord insertion. Doppler assessment was suggestive of fetal anemia with middle cerebral artery-peak systolic velocity (MCA-PSV) 1.8 MoM’s. Fetal heart rate monitoring and biophysical scores were reassuring. Following betamethasone fetal cord sampling that revealed fetal hemoglobin level of 8.8 g/dL, 57 cc of blood was transfused resulting in final hemoglobin level of 14.3 g/dL measured prior to needle extraction. MCA-PSV was normalized immediately after the procedure, however aggravated at the following day with MCA-PSV 65 cm/s (1.46 MoM’s). No other intervention was taken and MCA-PSV continued to fluctuate from slight to severe anemia spontaneously over a period of two weeks. At 34 gestational weeks, the women delivered a healthy baby. Fetal hemoglobin level at delivery was 21 g/dL.
Conclusions
Fetal blood transfusion is a reasonable treatment for fetal anemia in cases of giant chorioangiomas. Following transfusion, MCA-PSV may act unexpectedly reflecting various mechanisms affecting the flow.
Publisher
Walter de Gruyter GmbH
Subject
Obstetrics and Gynecology,Embryology,Pediatrics, Perinatology and Child Health
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