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Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta‐analysis

Buca, D; Iacovella, C; Khalil, A; Rizzo, G; Sirotkina, M; Makatsariya, A; Liberati, M; Silvi, C; Acharya, G; D'Antonio, F (2020) Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta‐analysis. Ultrasound Obstet Gynecol, 55 (4). pp. 441-449. ISSN 1469-0705 https://doi.org/10.1002/uog.20304
SGUL Authors: Khalil, Asma

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Abstract

Objective To report the perinatal outcome of singleton pregnancies complicated by placental chorioangioma diagnosed on prenatal ultrasound. Methods MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov databases were searched for studies reporting the outcome of pregnancies complicated by placental chorioangioma. Inclusion criteria were singleton pregnancy diagnosed with placental chorioangioma on prenatal ultrasound, with no other associated structural anomaly. The primary outcome was perinatal mortality. Secondary outcomes included associated non‐structural anomalies detected on prenatal ultrasound (including fetal hydrops, anemia, polyhydramnios, signs of hyperdynamic circulation and small‐for‐gestational‐age (SGA) fetus), SGA at birth, composite neonatal morbidity and preterm birth. Outcome was assessed separately in pregnancies undergoing and those not undergoing fetal therapy. Subanalyses were performed according to the presence of hydrops and the size of the tumor in all pregnancies diagnosed with chorioangioma. Random‐effects meta‐analyses of proportions were used to analyze the data. Results Twenty‐eight studies (161 pregnancies) were included. In pregnancies complicated by chorioangioma that did not undergo intervention, intrauterine death occurred in 8.2% (95% CI, 3.8–15.0%), while neonatal death and perinatal death occurred in 3.8% (95% CI, 1.0–8.1%) and 11.1% (95% CI, 5.0–19.4%), respectively. SGA at birth was present in 24.0% (95% CI, 13.5–36.5%) of cases, while preterm birth < 37 weeks complicated 34.1% (95% CI, 21.1–48.3%) of pregnancies. Composite neonatal morbidity occurred in 12.0% (95% CI, 4.5–22.3%) of cases. On ultrasound, signs of fetal hyperdynamic circulation were present in 21.0% (95% CI, 9.6–35.3%) of cases, while peak systolic velocity in the fetal middle cerebral artery was increased in 20.6% (95% CI, 10.9–32.3%). Subanalysis according to the size of chorioangioma, including both pregnancies that did and those that did not undergo intervention, showed a progressive increase in the occurrence of most of the outcomes explored with increasing size of the tumor. Furthermore, the prevalence of adverse perinatal outcome was high in pregnancies complicated by chorioangioma presenting with fetal hydrops. There was no randomized controlled trial comparing intervention vs expectant management in pregnancies complicated by chorioangioma with signs of fetal compromise (hydrops or hyperdynamic circulation). Overall, perinatal mortality occurred in 31.2% (95% CI, 18.1–46.1%) of fetuses undergoing in‐utero therapy, and 57.3% (95% CI, 39.2–74.4%) had resolution of hydrops or hyperdynamic circulation after treatment. Conclusions Placental chorioangioma is associated with adverse perinatal outcome. The size of the mass and presence of fetal hydrops are likely to be the main determinants of perinatal outcome in affected pregnancies.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Buca, D., Iacovella, C., Khalil, A., Rizzo, G., Sirotkina, M., Makatsariya, A., Liberati, M., Silvi, C., Acharya, G. and D'Antonio, F. (2020), Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta‐analysis. Ultrasound Obstet Gynecol, 55: 441-449, which has been published in final form at https://doi.org/10.1002/uog.20304. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Keywords: chorioangioma, fetal therapy, placental tumors, prenatal diagnosis, 1114 Paediatrics And Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
31 March 2020Published
29 April 2019Published Online
18 April 2019Accepted
Publisher License: Publisher's own licence
PubMed ID: 31034661
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110850
Publisher's version: https://doi.org/10.1002/uog.20304

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