Transient hydrops fetalis after interstitial laser coagulation and amnioreduction for treating placental chorioangioma

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Large chorioangioma may lead to poor pregnancy outcomes. Current management includes invasive and less invasive procedure such as amnioreduction, interstitial laser coagulation (ILC) and fetoscopic laser ablation. We reported a unique case with transient fetal hydrops after ILC and amnioreduction. However, patient could continue pregnancy until term gestation without maternal and neonatal complications. Case presentation: A 38-year-old, parous woman presented with abdominal distension at 22 +6 WG and transabdominal ultrasound revealed a placental chorioangioma estimating 7.9x5.6x5.4 cm with polyhydramnios and peritumoral hypervascularization. Borderline fetal cardiomegaly, increased combined cardiac output and slightly increased peak systolic velocity of middle cerebral artery were also demonstrated. After extensive counseling, ILC together with amnioreduction was performed at 23 WG. The feeding vessel was completely occluded. Two days after procedure, the fetus developed holosystolic tricuspid regurgitation, starry sky liver and fetal hydrops (scalp edema, pericardial effusion, pleural effusion, and ascites). However, fetal hydrops and tricuspid regurgitation were resolved at 26 WG. The remaining pregnancy was unremarkable. Conclusions: Herein, we reported the first case of transient hydrops fetalis developed after successful treatment of large placental chorioangioma by ILC and amnioreduction. Placental chorioangioma Transient fetal hydrops Interstitial laser coagulation Amnioreduction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Placental chorioangioma is found 0.5-1.0% of pregnancies considered the most common placental tumor nevertheless the large chorioangioma is reported solely at 1/8,000 to 1/50,000 of pregnancies[ 1 ]. The size of chorioangioma is associated with adverse maternal and neonatal outcomes. The chorioangioma larger than 4–5 centimeters in diameter can generate poor maternal and fetal outcome such as polyhydramnios, nonimmune hydrops fetalis, fetal heart failure, fetal anemia, fetal growth restriction, preterm delivery, perinatal death and maternal preeclampsia [ 2 – 6 ]. Several mechanisms responsible for such complications include; 1) the arteriovenous shunt leading to hemodynamic change, thus, resulting in fetal hemodynamic decompensation [ 7 – 10 ]; 2) fetal hemolytic anemia which is a result of red cell sequestration within the tumor [ 11 – 13 ] and; 3) nonimmune fetal hydrops that may be a consequence of fetal anemia or feto-maternal hemorrhage. Prenatal diagnosis of chorioangioma can be performed by the use of transabdominal ultrasound. Ultrasonographic features is a single heterogenous round placental mass on the fetal surface of the placenta located near the cord insertion. Color Doppler imaging may show hypervascularization within the mass in some cases. However, some cases with avascular placental tumor have been reported [ 1 ]. The management of this condition depends on the size of placental tumor. Specifically, chorioangioma without fetal hemodynamic derangement (called uncomplicated chorioangioma) can manage expectantly by regular ultrasound for signs of fetal hydrops, fetal anemia and polyhydramnios[ 1 , 14 ]. While, in large chorioangioma with fetal hemodynamic disturbance (complicated chorioangioma) requires a definite treatment by devascularization of the feeding vessel. Various technique of devascularization of feeding vessels have been used including ILC [ 15 – 18 ], fetoscopic laser ablation[ 13 , 16 , 19 – 22 ], fetoscopic suture ligation[ 23 ], fetoscopic surgical clip application[ 9 ], alcohol injection[ 1 , 7 , 24 – 26 ], microcoil embolization[ 27 ] and chemical embolization[ 28 , 29 ]. To date, the treatments of chorangioma are mainly based on evidence provided by case reports or case series. We reported a pregnancy with large chorioangioma with successful treatment by ILC. This case is unique presentation as transient fetal hydrops developed after the procedure with successful pregnancy outcome. Case Presentation After the patient gave her consent for this case report. We report the successful management of a large chorioangioma by ILC concomitant with amnioreduction and a unique post-procedure fetal presentation. A 38-year-old gravida 3, para 1011 woman presented with abdominal distension and abdominal discomfort. Her antenatal care was unremarkable. Her previous pregnancies had a first trimester miscarriage and a term spontaneous vaginal delivery. She started her antenatal care at 11 + 3 weeks of gestation (WG). Her antenatal laboratory tests and aneuploidy screening by the non-invasive prenatal test (NIPT) were unremarkable. At 22 + 1 WG, her ultrasound screening revealed a large placental mass without fetal structural abnormality. Trans-abdominal ultrasound revealed a 7.9x5.6x5.4 cm well-defined heteroechoic mass at fetal side of the placenta and the mass was located 2 cm away from the placental cord insertion (shown in Figure. 1). Doppler studies demonstrated the low resistant peritumoral feeding vessels suspected the arteriovenous shunt (shown in Figure. 2). Moreover, polyhydramnios was diagnosed (deepest vertical pocket at 9.7 cm and amniotic fluid index at 27.6 cm). She was diagnosed with a large chorioangioma. Fetal ultrasonographic surveillance showed no structural fetal anomalies, no cardiomegaly (cardiothoracic area ratio at 0.35), no fetal hydrops, peaked systolic velocity of middle cerebral artery (MCA PSV) at 1.63 MoM, normal end diastolic velocity (EDV) of umbilical artery (UA), normal ductus venosus (DV) flow and slightly increased combined cardiac output (CCO) at 700 ml/kg/min. Hydrops fetalis did not appear but the signs of fetal hemodynamic disturbances were detected by the ultrasonographic features of polyhydramnios and increased fetal cardiac output. Accordingly, we discussed the prognosis, course of disease and the management options including expectant management, amnioreduction or definite therapy by ILC. The procedure related risk was also explained. Finally, she opted for definite treatment by ILC on the following day. Procedure After giving informed consent, she underwent ILC and amnioreduction under local anesthesia. Neither a pre-operative antibiotic nor a tocolytic drug was prescribed. The procedure was initially performed by the evaluation of the placental location, deep vertical pocket of amniotic fluid, location of the large chorioangioma and its feeding vessels. The feeding vessels were thoroughly identified using color Doppler ultrasound. The puncture site at left upper quadrant area was injected with 10 ml of 1% lidocaine with adrenaline. An 18-gauge spinal needle was inserted into the placenta under continuous sonographic guidance and the tip of the needle was pointed adjacent to the feeding vessels. A 400-micron laser fiber and Nd-YAG laser with fibertom system (Dornier MedTech GmbH, Wessling, Germany) was prepared. The laser fiber was inserted through the spinal needle and the tip of laser fiber was placed adjacent to the target vessels (shown in Figure. 3). Then, the intermittent laser coagulation at 20 watt was applied to the target vessels. After the completion of coagulation, the absence of flow in the peritumoral vessels was confirmed (shown in Figure. 3) and the fetal heart rate was 150 beat per minute. The amnioreduction was done and the deep vertical pocket at 4.5 cm was achieved after the removal of amniotic fluid 1,600 ml. No immediate maternal and fetal complications were observed. Post-operative findings One day post-operation, the fetus developed mild cardiomegaly as demonstrated by cardiothoracic area ratio (CTAR) at 0.35, mild tricuspid regurgitation (TR), mild mitral regurgitation (MR) and starry sky liver appearance suggesting the fetal blood volume overload [ 30 ]. However, there was no reperfusion of the placental mass or significant change in the placental mass size. Normal amniotic fluid volume, normal MCA PSV, normal EDV of UA Doppler and slightly increased CCO at 543.6 mL/kg/min were demonstrated. Interestingly, the presence of fetal hydrops including pleural effusion, pericardial effusion and minimal ascites was observed on the postoperative day 2 and the TR was increased from mild to moderate degree. We regularly evaluated maternal symptoms and the signs of fetal hydrops, the chorioangioma size, amniotic fluid volume, fetal cardiac size, fetal cardiac function, Doppler studies of MCA, UMA and DV. One week later, ultrasonographic signs of fetal hydrops was improved. Specifically, there was no fluid accumulation in the pleural and abdominal spaces, decreased degree of scalp edema and decreased amount of pericardial effusion (shown in Figure. 4). A follow up fetal echocardiography revealed mild cardiomegaly (CTAR at 0.41), normal cardiac contractility, and holosystolic TR. Three weeks after the procedure, signs of fetal hydrops were completely resolved. Subsequent antenatal visits were unremarkable. The placental mass was slightly decreased in size measuring 6.7x5.8x5 cm at 34 WG. In addition, the fetal size normally correlated with gestational age along the follow-up period. At 38 WG, she delivered an appropriate for gestational age female newborn without complication. The gross examination of placenta revealed a tan yellowish white mass measuring 8x6x4.5 cm at margin 4 cm from cord insertion (shown in Figure. 5). Serial cut sections through the placental disc showed normal spongy, moist and brownish red tissue. Cut surface of the mass showed a homogenous pale tan with cauterization lesion 0.5 cm in diameter at rim of the mass (shown in Figure. 5). The placental histologic findings revealed the tumor necrosis surrounding by the infarcted villi (shown in Figure. 6). Discussion A large chorioangioma is significant affect fetal hemodynamics leading to poor pregnancy outcomes and the larger the size of placental tumor, the greater the risk of adverse neonatal outcome[10]. Our case presented with maternal abdominal distension, polyhydramnios and high fetal cardiac output indicating the presence of fetal hemodynamics disturbance. Despite no conclusive evidence regarding the optimal management of the complicated chorioangioma, several successful therapeutic interventions for interruption of vascular flow to the placental mass have been reported[13, 15-20, 22]. Optimal management depends on the location of chorioangioma and the placenta, and the availability of equipment as well as operator experience. We, therefore, performed ILC as a definite treatment for this patient because the placenta was located at anterior uterine wall and the AV shunt could be easily accessed under sonographic guidance with Doppler mode. However, if the AV shunt locates superficially at fetal side of the placental surface, the fetoscopic assisted laser coagulation for direct visualization of AV shunt might be necessary for the proper assessment of the target vessels. Several techniques and laser power for coagulation the target vessel have been used [15-18]. Table 1 summarized previous studies reporting ILC for the treatment of chorioangioma. Almost 50% of studies revealed the unsuccessful interruption of feeding vessels with the first ILC and, therefore, the second ILC is required. Herein, we presented a successful management of placental chorioangioma with the use of ILC and amnioreduction. Our case was successfully managed with good maternal and neonatal outcome without subsequent procedure needed. Interestingly, we found the abnormal findings including the starry sky liver, cardiomegaly and tricuspid regurgitation indicating the presence of right-side cardiac failure at 1 day after operation. Our findings about transient hydrops fetalis with good pregnancy outcome after ILC are unique since there is no previous report of the development of hydrops fetalis after ILC. There are only 2 previous reports demonstrating hydrops fetalis developed after amnioreduction in pregnant women with large chorioangioma [21, 22]. Both cases subsequently required definite treatment by fetoscopic laser coagulation of feeding vessels. The former case was a pregnant woman at 25 WG with a solid placental tumor measuring 8.0x7.5x8 cm, polyhydramnios and increased combined cardiac output[21]. One day after amnioreduction of 1,800 mL, the fetal condition had deteriorated demonstrated by frank fetal hydrops, fetal anemia, severe right ventricular systolic dysfunction, moderate tricuspid, and mitral regurgitation with reversed flow in the A-wave of the DV. The patient underwent fetoscopic laser occlusion of feeding vessels and intrauterine transfusion thereafter. Unfortunately, a fetal demise was noted on the following day. The latter case was 25 WG pregnant women with a 5.6-cm of placental chorioangioma, polyhydramnios and increased combined cardiac output. An amnioreduction of 1,010 mL was performed at 26 WG due to maternal discomfort [22]. One week later, a follow up ultrasound revealed the presence of a small fetal pericardial effusion, enlarged right heart with decreased contractility, abnormal fetal Dopplers significant for pulsatile flow in the UV, reversed arterial systolic flow in the DV, and elevated MCA PSV. Repeat fetal echocardiography revealed findings consistent with fetal heart failure. At 27 WG, successful fetoscopic laser occlusion of feeding vessels was performed without any complication. Fetal Doppler values and fetal cardiac function parameters were return to normal 2 and 5 weeks after fetoscopic laser occlusion, respectively. The patient had term normal spontaneous vaginal delivery without any complications. The mechanism underlying the post-procedural deterioration of fetal condition after amnioreduction might be due to [21] a drop in intrauterine pressure leading to a sudden expansion in the size of the chorioangioma and increased perfusion of the placental vascular bed or frank hemorrhage into the tumor mass resulting in fetal anemia and fetal hydrops. Additionally, the findings of fetal hemodynamic change after amnioreduction have been widely reported in twin-to-twin transfusion syndrome (TTTS) [31-33]. An increase of placental thickness after amnioreduction can cause a rapid transfer of blood from recipient twin to the placenta referred to the ‘steal’ phenomenon but this phenomenon was described only in the recipient twin[32]. On the contrary, the donor twin developed transient hydrops fetalis due to volume overload following amnioreduction was observed [31]. Though, Mendez-Figueroa et al have suggested that amnioreduction should be performed following vascular occlusion of feeding vessels to reduce the risk of fetal deterioration in treatment of placental chorioangioma. Our cases report disclosed the fact that transient fetal hydrops might be found even the amnioreduction performed after complete vascular occlusion of the feeding vessels. We contemplated that fetal hemodynamic disturbance might be caused by either an amnioreduction or a vascular occlusion procedure itself as described in TTTS [34, 35]. The relative hypervolemia and transient fetal circulatory adaptation have been substantial noted after fetoscopic laser coagulation of the vascular anastomoses [34]. Unsurprisingly, transient fetal hydrops of our case might indicate the transitory fetal hemodynamic alteration without influence on perinatal outcome. Conclusion We reported the first case of transient hydrops fetalis developed after successful treatment of a large placental chorioangioma by ILC and amnioreduction without impacting perinatal outcomes. This case highlights that even after successful interstitial laser coagulation, transient hydrops may occur, but does not always predict poor prognosis, underscoring the importance of close monitoring, appropriate counseling, and further study of fetal cardiovascular adaptation. Abbreviations AV shunt, Arteriovenous shunt CCO, Combined cardiac output CTAR, Cardiothoracic area ratio DV, Ductus venosus EDV, End diastolic velocity ILC, Interstitial laser coagulation MCA PSV, Peaked systolic velocity of middle cerebral artery MR, mitral regurgitation Nd-YAG laser, neodymium-doped yttrium aluminum garnet laser NIPT, Non-invasive prenatal test TR, Tricuspid regurgitation TTTS, Twin-to-twin transfusion syndrome UA, Umbilical artery WG, Weeks of gestation Declarations Acknowledgments We thank Dr. Wichaporn Laksana, M.D. (Sichon Hospital, Nakhon Si Thammarat, Thailand), for the collection of the placenta. Authors’ contributions N.C. conducted the literature reviews and designed the study. N.C. and S.B. analyzed the relevant information and composed the initial draft. A.S. performed placental examination. S.B., W.D., and A.S. revised the manuscript. Funding This study did not receive any funding. Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study protocol was reviewed and approved by Human Research Ethics Committee, Faculty of Medicine Ramathibodi Hospital, Mahidol University, approval number COA. MURA2022/417. Consent for publication The patient provided the written informed consent for publication of this case report and any accompanying images. Competing interests The authors declare that they have no competing interests. References Jauniaux E, Ogle R. Color Doppler imaging in the diagnosis and management of chorioangiomas. Ultrasound Obstet Gynecol. 2000;15(6):463-7. Hadi HA, Finley J, Strickland D. Placental chorioangioma: prenatal diagnosis and clinical significance. Am J Perinatol. 1993;10(2):146-9. Wallenburg HC. Chorioangioma of the placenta. 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A rare case of a giant placental chorioangioma with favorable outcome. Pan Afr Med J. 2020;36:214. Bhide A, Prefumo F, Sairam S, Carvalho J, Thilaganathan B. Ultrasound-guided interstitial laser therapy for the treatment of placental chorioangioma. Obstet Gynecol. 2003;102(5 Pt 2):1189-91. Zanardini C, Papageorghiou A, Bhide A, Thilaganathan B. Giant placental chorioangioma: natural history and pregnancy outcome. Ultrasound Obstet Gynecol. 2010;35(3):332-6. Papaioannou GK, Evangelinakis N, Kourtis P, Konstantinidou A, Papantoniou N. Giant chorioangioma treated with interstitial laser coagulation. Ultrasound Obstet Gynecol. 2018;52(2):280-1. Turgut E, Atalay A, Sakcak B, Sahin D. Interstitial Laser Ablation of Feeding Vessels to a Large Placental Chorioangioma. Z Geburtshilfe Neonatol. 2022;226(4):274-7. Quarello E, Bernard JP, Leroy B, Ville Y. Prenatal laser treatment of a placental chorioangioma. Ultrasound Obstet Gynecol. 2005;25(3):299-301. 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Alcohol injection: a new method of treating placental chorioangiomas. Lancet. 1999;353(9165):1674-5. Wanapirak C, Tongsong T, Sirichotiyakul S, Chanprapaph P. Alcoholization: the choice of intrauterine treatment for chorioangioma. J Obstet Gynaecol Res. 2002;28(2):71-5. Deren O, Ozyuncu O, Onderoglu LS, Durukan T. Alcohol injection for the intrauterine treatment of chorioangioma in a pregnancy with transfusion resistant fetal anemia: a case report. Fetal Diagn Ther. 2007;22(3):203-5. Lau TK, Leung TY, Yu SC, To KF, Leung TN. Prenatal treatment of chorioangioma by microcoil embolisation. Bjog. 2003;110(1):70-3. Lau TK, Yu SC, Leung TY, To KF, Fung TY, Leung TN. Prenatal embolisation of a large chorioangioma using enbucrilate. Bjog. 2005;112(7):1002-4. Babic I, Tulbah M, Kurdi W. Antenatal embolization of a large placental chorioangioma: a case report. J Med Case Rep. 2012;6:183. Segev Y, Goldberg Y, Riskin-Mashiah S, Berdicef M, Lavie O, Auslender R. Starry sky pattern of fetal liver sonogram as first sign of twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2012;39(6):723-5. Morine M, Maeda K, Higashino K, Miura N, Kinoshita T, Endo S, et al. Transient hydrops fetalis of the donor fetus in twin-twin transfusion syndrome after therapeutic amnioreduction. Ultrasound Obstet Gynecol. 2003;22(2):182-5. Rodeck CH, Weisz B, Peebles DM, Jauniaux E. Hypothesis: the placental 'steal' phenomenon - a possible hazard of amnioreduction. Fetal Diagn Ther. 2006;21(3):302-6. Kosinska-Kaczynska K, Lipa M, Szymusik I, Bomba-Opon D, Brawura-Biskupski-Samaha R, Kozlowski S, et al. Sudden Fetal Hematologic Changes as a Complication of Amnioreduction in Twin-Twin Transfusion Syndrome. Fetal Diagnosis and Therapy. 2018;44(4):311-4. Gratacós E, Van Schoubroeck D, Carreras E, Devlieger R, Roma E, Cabero L, et al. Transient hydropic signs in the donor fetus after fetoscopic laser coagulation in severe twin-twin transfusion syndrome: incidence and clinical relevance. Ultrasound Obstet Gynecol. 2002;19(5):449-53. Gratacós E, Van Schoubroeck D, Carreras E, Devlieger R, Roma E, Cabero L, et al. Impact of laser coagulation in severe twin–twin transfusion syndrome on fetal Doppler indices and venous blood flow volume. Ultrasound in Obstetrics & Gynecology. 2002;20(2):125-30. Table Table 1. The available reports of the chorioangioma treated by interstitial photocoagulation. Author, year Case no. GA at procedure, WG Tumor size, mm Pre-operative findings Interstitial laser coagulation Post-operative finding Complications Outcomes Note Bhide 2003 [15] 1 24 53x45x44 Mild cardiomegaly, dilated umbilical vein, MCA PSV>95 th centile 17-gauge needle, a 400-um laser fiber, Nd-YAG initial power at 5 W increasing to 20 W Increasing echogenicity inside the placenta mass, revascularization of the chorioangioma No Unsuccessful interruption of feeding vessels 1 26 ø 60 Fetal hyperdynamic circulation 17-gauge needle, a 400-um laser fiber, Nd-YAG initial power at 5 W increasing to 20 W Resolved fetal hyperdynamic circulation, the fetal cardiomegaly and dilated umbilical vein persisted No Elective cesarean section at 32 WG due to increased UA PI and DV PI, livebirth Zanardini 2010 [16] 2 25 +4 Mean ø 45 Moderate cardiomegaly, MCA PSV>95 th centile Not stated Not stated Not stated Unsuccessful interruption of feeding vessels 2 26 +4 Not stated Not stated Not stated Not stated Not stated Live birth at 32 +3 WG 3 32 +3 Mean ø 35 Mild cardiomegaly, MCA PSV>95 th centile Not stated Not stated Not stated Live birth at 39 +1 WG 4 29 +2 Mean ø 54 Mild cardiomegaly, MCA PSV>95 th centile Not stated Not stated Not stated Unsuccessful interruption of feeding vessels Amnioreduction at 28 +6 WG, IUT at 29 WG 4 30 +4 Not stated Not stated Not stated Not stated Not stated Live birth at 37 +3 WG Papaioannou 2018 [17] 5 24 Maximum ø 140 Mild cardiomegaly, MCA PSV>1.5 SD above the mean 17-guage needle, 1.07-mm non-contact laser fiber, laser power 30-40 W Not stated No Emergency cesarean section at 31 WG due to fetal distress Turgut 2022 [18] 6 28 83x80x80 Fetal hydrops, polyhydramnios, MCA PSV 1.65 MoM 18-guage needle, 0.5-mm laser fiber, diode laser power at 40 W High MCA PSV persisted, no vascular flow inside the mass No Live birth at 31 WG IUT at 10 days after procedure Our case study 7 23 79x56x54 Mild cardiomegaly, MCA PSV at 1.63 MoM, high CCO, polyhydramnios 17-gauge needle, a 400-um laser fiber, Nd-YAG laser power at 20 W Resolved fetal hyperdynamic circulation, normal MCA PSV Transient fetal hydrops Live birth at 38 WG Amnioreduction 1,600 ml after IUT Abbreviations: GA, gestational age; WG, weeks of gestation; MCA, middle cerebral artery; PSV, peak systolic velocity;W, watt; ø, diameter; UA, umbilical artery; PI, pulsatility index; DV, ductus venosus; IUT, intrauterine blood transfusion; SD, standard deviation; MoM, multiple of median, CCO, combined cardiac output Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Dec, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 12 Sep, 2025 Reviews received at journal 11 Sep, 2025 Reviews received at journal 07 Sep, 2025 Reviewers agreed at journal 04 Sep, 2025 Reviewers agreed at journal 02 Sep, 2025 Reviewers invited by journal 02 Sep, 2025 Editor assigned by journal 01 Sep, 2025 Editor invited by journal 01 Sep, 2025 Submission checks completed at journal 31 Aug, 2025 First submitted to journal 31 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7482135","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":510404542,"identity":"efcc5d91-71c9-478c-8a0e-cfc5fe7d65fa","order_by":0,"name":"Nareenun Chansriniyom","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Nareenun","middleName":"","lastName":"Chansriniyom","suffix":""},{"id":510404543,"identity":"a3fd76a9-4af7-483f-ae16-a9b21f007a57","order_by":1,"name":"Wirada Dulyaphat","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Wirada","middleName":"","lastName":"Dulyaphat","suffix":""},{"id":510404545,"identity":"e5ebeeb2-76b4-40ab-b35a-5c00e8f2c625","order_by":2,"name":"Arunee Singhsnaeh","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Arunee","middleName":"","lastName":"Singhsnaeh","suffix":""},{"id":510404547,"identity":"9ffbcab1-9fc7-418d-ad18-4fe206102d7f","order_by":3,"name":"Sommart Bumrungphuet","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBADxgYG5mNgFhs7UarBBFsaA0MCUAsz8Vp4zMBaGAhp0W0/+/zhz7bDsv3sZ749+PhjmzwfMwPjh485uLWYnUk3bOZtO2w8syd3u+GMhNuGbcwMzJIzt+HRciCNsZlx2+HEDTd4t0nzJNxmBGphY+bFp+X8M8bGn2AtPM9AWuwJa7mRxtjAC9HCBtKSSISWZ4yzef+lA/2SZiY5I+12chszYzN+v5xPY/j444w1MMQOP5P4YHPbdn5788EPH/FowQbAETUKRsEoGAWjgBIAANhvUjy+jO/xAAAAAElFTkSuQmCC","orcid":"","institution":"Mahidol University","correspondingAuthor":true,"prefix":"","firstName":"Sommart","middleName":"","lastName":"Bumrungphuet","suffix":""}],"badges":[],"createdAt":"2025-08-28 16:23:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7482135/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7482135/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-025-08304-6","type":"published","date":"2025-12-01T15:57:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90886855,"identity":"c3b83e15-940b-4f2f-8d84-55f99cde311d","added_by":"auto","created_at":"2025-09-09 10:16:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":234424,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative ultrasound findings of the placental chorioangioma.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7482135/v1/0c6c2f041e16e6d4e963a8ea.png"},{"id":90884399,"identity":"4c943671-5ce7-4e4c-b2c3-52269e8210c8","added_by":"auto","created_at":"2025-09-09 10:00:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":163570,"visible":true,"origin":"","legend":"\u003cp\u003eDoppler ultrasound demonstrated the peritumeral feeding vessels with low resistance.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7482135/v1/5237b2727ae5d4c10c68d0bf.png"},{"id":90884406,"identity":"9cb0ca91-d5ad-4440-819a-81e8c5af15ed","added_by":"auto","created_at":"2025-09-09 10:00:28","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":567778,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative ultrasound findings. \u003cstrong\u003ea\u003c/strong\u003e Two-dimensional ultrasound during the procedure demonstrating laser fiber tip (arrowhead) and target vessel (arrow). \u003cstrong\u003eb\u003c/strong\u003eDoppler ultrasound showing the absent flow of target vessel after coagulation.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7482135/v1/6212bc61d53f8fcdb3638ce1.png"},{"id":90884410,"identity":"57bff2c9-0b9a-4b80-90d4-e2b386ff4f16","added_by":"auto","created_at":"2025-09-09 10:00:28","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1386175,"visible":true,"origin":"","legend":"\u003cp\u003eSerial ultrasound findings after procedure. \u003cstrong\u003ea\u003c/strong\u003e Scalp edema. \u003cstrong\u003eb\u003c/strong\u003e Fetal cardiomegaly and minimal pericardial effusion.\u003cstrong\u003e c\u003c/strong\u003e Resolution of scalp edema. \u003cstrong\u003ed\u003c/strong\u003e Resolution of cardiomegaly and pericardial effusion.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7482135/v1/da7dd270f57ced2437177540.png"},{"id":90884408,"identity":"4e2db29b-8e72-4e6d-8717-906692bdae2c","added_by":"auto","created_at":"2025-09-09 10:00:28","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":756560,"visible":true,"origin":"","legend":"\u003cp\u003eThe gross examination of the placenta. \u003cstrong\u003ea\u003c/strong\u003e Fetal surface of the chorionic plate. \u003cstrong\u003eb\u003c/strong\u003eMaternal surface of the chorionic plate. \u003cstrong\u003ec\u003c/strong\u003e Serial cut surface of the chorionic plate and placental mass.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7482135/v1/bc4bc6b14823fafb0dbab45b.png"},{"id":90886856,"identity":"57e829f4-bfc8-4ed1-b369-b612600c300f","added_by":"auto","created_at":"2025-09-09 10:16:28","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1083067,"visible":true,"origin":"","legend":"\u003cp\u003eHistologic findings of the tumor. \u003cstrong\u003ea\u003c/strong\u003e The infarcted villi (arrow) and normal villi (arrowhead) surrounding the necrotic tumor (ghost cell); 2X. \u003cstrong\u003eb\u003c/strong\u003eCoagulative necrosis of the tumor presenting as ghost cell; 4X.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7482135/v1/dd98d313ad444a555444c8bb.png"},{"id":97723988,"identity":"6954af57-1031-4ced-9137-a0426e5b9dc2","added_by":"auto","created_at":"2025-12-08 16:10:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4825853,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7482135/v1/abd69188-0bbf-4695-9b63-0060acfb12bb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transient hydrops fetalis after interstitial laser coagulation and amnioreduction for treating placental chorioangioma","fulltext":[{"header":"Background","content":"\u003cp\u003ePlacental chorioangioma is found 0.5-1.0% of pregnancies considered the most common placental tumor nevertheless the large chorioangioma is reported solely at 1/8,000 to 1/50,000 of pregnancies[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The size of chorioangioma is associated with adverse maternal and neonatal outcomes. The chorioangioma larger than 4\u0026ndash;5 centimeters in diameter can generate poor maternal and fetal outcome such as polyhydramnios, nonimmune hydrops fetalis, fetal heart failure, fetal anemia, fetal growth restriction, preterm delivery, perinatal death and maternal preeclampsia [\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Several mechanisms responsible for such complications include; 1) the arteriovenous shunt leading to hemodynamic change, thus, resulting in fetal hemodynamic decompensation [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; 2) fetal hemolytic anemia which is a result of red cell sequestration within the tumor [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and; 3) nonimmune fetal hydrops that may be a consequence of fetal anemia or feto-maternal hemorrhage.\u003c/p\u003e\u003cp\u003ePrenatal diagnosis of chorioangioma can be performed by the use of transabdominal ultrasound. Ultrasonographic features is a single heterogenous round placental mass on the fetal surface of the placenta located near the cord insertion. Color Doppler imaging may show hypervascularization within the mass in some cases. However, some cases with avascular placental tumor have been reported [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The management of this condition depends on the size of placental tumor. Specifically, chorioangioma without fetal hemodynamic derangement (called uncomplicated chorioangioma) can manage expectantly by regular ultrasound for signs of fetal hydrops, fetal anemia and polyhydramnios[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. While, in large chorioangioma with fetal hemodynamic disturbance (complicated chorioangioma) requires a definite treatment by devascularization of the feeding vessel.\u003c/p\u003e\u003cp\u003eVarious technique of devascularization of feeding vessels have been used including ILC [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], fetoscopic laser ablation[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], fetoscopic suture ligation[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], fetoscopic surgical clip application[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], alcohol injection[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], microcoil embolization[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and chemical embolization[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. To date, the treatments of chorangioma are mainly based on evidence provided by case reports or case series.\u003c/p\u003e\u003cp\u003eWe reported a pregnancy with large chorioangioma with successful treatment by ILC. This case is unique presentation as transient fetal hydrops developed after the procedure with successful pregnancy outcome.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003e After the patient gave her consent for this case report. We report the successful management of a large chorioangioma by ILC concomitant with amnioreduction and a unique post-procedure fetal presentation.\u003c/p\u003e\u003cp\u003eA 38-year-old gravida 3, para 1011 woman presented with abdominal distension and abdominal discomfort. Her antenatal care was unremarkable. Her previous pregnancies had a first trimester miscarriage and a term spontaneous vaginal delivery. She started her antenatal care at 11\u003csup\u003e+\u0026thinsp;3\u003c/sup\u003e weeks of gestation (WG). Her antenatal laboratory tests and aneuploidy screening by the non-invasive prenatal test (NIPT) were unremarkable. At 22\u003csup\u003e+\u0026thinsp;1\u003c/sup\u003e WG, her ultrasound screening revealed a large placental mass without fetal structural abnormality. Trans-abdominal ultrasound revealed a 7.9x5.6x5.4 cm well-defined heteroechoic mass at fetal side of the placenta and the mass was located 2 cm away from the placental cord insertion (shown in Figure. 1). Doppler studies demonstrated the low resistant peritumoral feeding vessels suspected the arteriovenous shunt (shown in Figure. 2). Moreover, polyhydramnios was diagnosed (deepest vertical pocket at 9.7 cm and amniotic fluid index at 27.6 cm). She was diagnosed with a large chorioangioma. Fetal ultrasonographic surveillance showed no structural fetal anomalies, no cardiomegaly (cardiothoracic area ratio at 0.35), no fetal hydrops, peaked systolic velocity of middle cerebral artery (MCA PSV) at 1.63 MoM, normal end diastolic velocity (EDV) of umbilical artery (UA), normal ductus venosus (DV) flow and slightly increased combined cardiac output (CCO) at 700 ml/kg/min.\u003c/p\u003e\u003cp\u003eHydrops fetalis did not appear but the signs of fetal hemodynamic disturbances were detected by the ultrasonographic features of polyhydramnios and increased fetal cardiac output. Accordingly, we discussed the prognosis, course of disease and the management options including expectant management, amnioreduction or definite therapy by ILC. The procedure related risk was also explained. Finally, she opted for definite treatment by ILC on the following day.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eProcedure\u003c/h2\u003e\u003cp\u003eAfter giving informed consent, she underwent ILC and amnioreduction under local anesthesia. Neither a pre-operative antibiotic nor a tocolytic drug was prescribed. The procedure was initially performed by the evaluation of the placental location, deep vertical pocket of amniotic fluid, location of the large chorioangioma and its feeding vessels. The feeding vessels were thoroughly identified using color Doppler ultrasound. The puncture site at left upper quadrant area was injected with 10 ml of 1% lidocaine with adrenaline. An 18-gauge spinal needle was inserted into the placenta under continuous sonographic guidance and the tip of the needle was pointed adjacent to the feeding vessels. A 400-micron laser fiber and Nd-YAG laser with fibertom system (Dornier MedTech GmbH, Wessling, Germany) was prepared. The laser fiber was inserted through the spinal needle and the tip of laser fiber was placed adjacent to the target vessels (shown in Figure. 3). Then, the intermittent laser coagulation at 20 watt was applied to the target vessels. After the completion of coagulation, the absence of flow in the peritumoral vessels was confirmed (shown in Figure. 3) and the fetal heart rate was 150 beat per minute. The amnioreduction was done and the deep vertical pocket at 4.5 cm was achieved after the removal of amniotic fluid 1,600 ml. No immediate maternal and fetal complications were observed.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePost-operative findings\u003c/h3\u003e\n\u003cp\u003eOne day post-operation, the fetus developed mild cardiomegaly as demonstrated by cardiothoracic area ratio (CTAR) at 0.35, mild tricuspid regurgitation (TR), mild mitral regurgitation (MR) and starry sky liver appearance suggesting the fetal blood volume overload [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, there was no reperfusion of the placental mass or significant change in the placental mass size. Normal amniotic fluid volume, normal MCA PSV, normal EDV of UA Doppler and slightly increased CCO at 543.6 mL/kg/min were demonstrated. Interestingly, the presence of fetal hydrops including pleural effusion, pericardial effusion and minimal ascites was observed on the postoperative day 2 and the TR was increased from mild to moderate degree. We regularly evaluated maternal symptoms and the signs of fetal hydrops, the chorioangioma size, amniotic fluid volume, fetal cardiac size, fetal cardiac function, Doppler studies of MCA, UMA and DV. One week later, ultrasonographic signs of fetal hydrops was improved. Specifically, there was no fluid accumulation in the pleural and abdominal spaces, decreased degree of scalp edema and decreased amount of pericardial effusion (shown in Figure. 4). A follow up fetal echocardiography revealed mild cardiomegaly (CTAR at 0.41), normal cardiac contractility, and holosystolic TR. Three weeks after the procedure, signs of fetal hydrops were completely resolved. Subsequent antenatal visits were unremarkable. The placental mass was slightly decreased in size measuring 6.7x5.8x5 cm at 34 WG. In addition, the fetal size normally correlated with gestational age along the follow-up period. At 38 WG, she delivered an appropriate for gestational age female newborn without complication. The gross examination of placenta revealed a tan yellowish white mass measuring 8x6x4.5 cm at margin 4 cm from cord insertion (shown in Figure. 5). Serial cut sections through the placental disc showed normal spongy, moist and brownish red tissue. Cut surface of the mass showed a homogenous pale tan with cauterization lesion 0.5 cm in diameter at rim of the mass (shown in Figure. 5). The placental histologic findings revealed the tumor necrosis surrounding by the infarcted villi (shown in Figure. 6).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eA large chorioangioma is significant affect fetal hemodynamics leading to poor pregnancy outcomes and the larger the size of placental tumor, the greater the risk of adverse neonatal outcome[10]. Our case presented with maternal abdominal distension, polyhydramnios and high fetal cardiac output indicating the presence of fetal hemodynamics disturbance. Despite no conclusive evidence regarding the optimal management of the complicated chorioangioma, several successful therapeutic interventions for interruption of vascular flow to the placental mass have been reported[13, 15-20, 22]. Optimal management depends on the location of chorioangioma and the placenta, and the availability of equipment as well as operator experience. We, therefore, performed ILC as a definite treatment for this patient because the placenta was located at anterior uterine wall and the AV shunt could be easily accessed under sonographic guidance with Doppler mode. However, if the AV shunt locates superficially at fetal side of the placental surface, the fetoscopic assisted laser coagulation for direct visualization of AV shunt might be necessary for the proper assessment of the target vessels. Several techniques and laser power for coagulation the target vessel have been used [15-18]. Table 1 summarized previous studies reporting ILC for the treatment of chorioangioma. Almost 50% of studies revealed the unsuccessful interruption of feeding vessels with the first ILC and, therefore, the second ILC is required. Herein, we presented a successful management of placental chorioangioma with the use of ILC and amnioreduction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur case was successfully managed with good maternal and neonatal outcome without subsequent procedure needed. \u0026nbsp;Interestingly, we found the abnormal findings including the starry sky liver, cardiomegaly and tricuspid regurgitation indicating the presence of right-side cardiac failure at 1 day after operation. Our findings about transient hydrops fetalis with good pregnancy outcome after ILC are unique since there is no previous report of the development of hydrops fetalis after ILC. \u0026nbsp; There are only 2 previous reports demonstrating hydrops fetalis developed after amnioreduction in pregnant women with large chorioangioma [21, 22]. Both cases subsequently required definite treatment by fetoscopic laser coagulation of feeding vessels. The former case was a pregnant woman at 25 WG with a solid placental tumor measuring 8.0x7.5x8 cm, polyhydramnios and increased combined cardiac output[21]. One day after amnioreduction of 1,800 mL, the fetal condition had deteriorated demonstrated by frank fetal hydrops, fetal anemia, severe right ventricular systolic dysfunction, moderate tricuspid, and mitral regurgitation with reversed flow in the A-wave of the DV. The patient underwent fetoscopic laser occlusion of feeding vessels and intrauterine transfusion thereafter. \u0026nbsp; Unfortunately, a fetal demise was noted on the following day. The latter case was 25 WG pregnant women with a 5.6-cm of placental chorioangioma, polyhydramnios and increased combined cardiac output. An amnioreduction of 1,010 mL was performed at 26 WG due to maternal discomfort [22]. One week later, a follow up ultrasound revealed the presence of a small fetal pericardial effusion, enlarged right heart with decreased contractility, abnormal fetal Dopplers significant for pulsatile flow in the UV, reversed arterial systolic flow in the DV, and elevated MCA PSV. Repeat fetal echocardiography revealed findings consistent with fetal heart failure. At 27 WG, successful fetoscopic laser occlusion of feeding vessels was performed without any complication. Fetal Doppler values and fetal cardiac function parameters were return to normal 2 and 5 weeks after fetoscopic laser occlusion, respectively. \u0026nbsp; The patient had term normal spontaneous vaginal delivery without any complications. The mechanism underlying the post-procedural deterioration of fetal condition after amnioreduction might be due to \u0026nbsp;[21] \u0026nbsp; a drop in intrauterine pressure leading to a sudden expansion in the size of the chorioangioma and increased perfusion of the placental vascular bed or frank hemorrhage into the tumor mass resulting in fetal anemia and fetal hydrops. Additionally, the findings of fetal hemodynamic change after amnioreduction have been widely reported in twin-to-twin transfusion syndrome (TTTS) [31-33]. An increase of placental thickness after amnioreduction can cause a rapid transfer of blood from recipient twin to the placenta referred to the ‘steal’ phenomenon but this phenomenon was described only in the recipient twin[32]. On the contrary, the donor twin developed transient hydrops fetalis due to volume overload following amnioreduction was observed [31]. Though, Mendez-Figueroa et al have suggested that amnioreduction should be performed following vascular occlusion of feeding vessels to reduce the risk of fetal deterioration in treatment of placental chorioangioma. Our cases report disclosed the fact that transient fetal hydrops might be found even the amnioreduction performed after complete vascular occlusion of the feeding vessels. We contemplated that fetal hemodynamic disturbance might be caused by either an amnioreduction or a vascular occlusion procedure itself as described in TTTS [34, 35]. The relative hypervolemia and transient fetal circulatory adaptation have been substantial noted after fetoscopic laser coagulation of the vascular anastomoses [34]. Unsurprisingly, transient fetal hydrops of our case might indicate the transitory fetal hemodynamic alteration without influence on perinatal outcome.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe reported the first case of transient hydrops fetalis developed after successful treatment of a large placental chorioangioma by ILC and amnioreduction without impacting perinatal outcomes. This case highlights that even after successful interstitial laser coagulation, transient hydrops may occur, but does not always predict poor prognosis, underscoring the importance of close monitoring, appropriate counseling, and further study of fetal cardiovascular adaptation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAV shunt, Arteriovenous shunt\u003c/p\u003e\n\u003cp\u003eCCO, Combined cardiac output\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCTAR, Cardiothoracic area ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDV, Ductus venosus\u003c/p\u003e\n\u003cp\u003eEDV, End diastolic velocity\u003c/p\u003e\n\u003cp\u003eILC, Interstitial laser coagulation\u003c/p\u003e\n\u003cp\u003eMCA PSV, Peaked systolic velocity of middle cerebral artery\u003c/p\u003e\n\u003cp\u003eMR, mitral regurgitation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNd-YAG laser, neodymium-doped yttrium aluminum garnet laser\u003c/p\u003e\n\u003cp\u003eNIPT, Non-invasive prenatal test\u003c/p\u003e\n\u003cp\u003eTR, Tricuspid regurgitation\u003c/p\u003e\n\u003cp\u003eTTTS, Twin-to-twin transfusion syndrome\u003c/p\u003e\n\u003cp\u003eUA, Umbilical artery\u003c/p\u003e\n\u003cp\u003eWG, Weeks of gestation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Dr. Wichaporn Laksana, M.D. (Sichon Hospital, Nakhon Si Thammarat, Thailand), for the collection of the placenta.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN.C. conducted the literature reviews and designed the study. N.C. and S.B. analyzed the relevant information and composed the initial draft. A.S. performed placental examination. \u0026nbsp;S.B., W.D., and A.S. revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study protocol was reviewed and approved by Human Research Ethics Committee, Faculty of Medicine Ramathibodi Hospital, Mahidol University, approval number COA. MURA2022/417.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient provided the written informed consent for publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJauniaux E, Ogle R. Color Doppler imaging in the diagnosis and management of chorioangiomas. Ultrasound Obstet Gynecol. 2000;15(6):463-7.\u003c/li\u003e\n\u003cli\u003eHadi HA, Finley J, Strickland D. Placental chorioangioma: prenatal diagnosis and clinical significance. Am J Perinatol. 1993;10(2):146-9.\u003c/li\u003e\n\u003cli\u003eWallenburg HC. Chorioangioma of the placenta. Thirteen new cases and a review of the literature from 1939 to 1970 with special reference to the clinical complications. Obstet Gynecol Surv. 1971;26(6):411-25.\u003c/li\u003e\n\u003cli\u003eMerry-Sperry AD, Chaffin DG, Denning KL, Shamma B, Massey C, Werthammer J. Placental Chorioangioma with Nonimmune Hydrops Fetalis. South Med J. 2018;111(8):457-9.\u003c/li\u003e\n\u003cli\u003eRaba AA, Coleman J, Nolan C, Kent E, Doyle E, Smith A, et al. Giant placental chorioangioma causing fetal anaemia and neonatal biventricular cardiac hypertrophy. J Paediatr Child Health. 2022;58(1):194-6.\u003c/li\u003e\n\u003cli\u003eWillis C, Ferguson S, Soydemir F. Placental chorioangioma associated with polyhydramnios and hydrops fetalis. BMJ Case Rep. 2019;12(1).\u003c/li\u003e\n\u003cli\u003eSepulveda W, Alcalde JL, Schnapp C, Bravo M. Perinatal outcome after prenatal diagnosis of placental chorioangioma. Obstet Gynecol. 2003;102(5 Pt 1):1028-33.\u003c/li\u003e\n\u003cli\u003eLiu H, Gu W, Li X. Natural history and pregnancy outcome in patients with placental chorioangioma. J Clin Ultrasound. 2014;42(2):74-80.\u003c/li\u003e\n\u003cli\u003eLim FY, Coleman A, Polzin W, Jaekle R, Habli M, Van Hook J, et al. Giant chorioangiomas: perinatal outcomes and techniques in fetoscopic devascularization. Fetal Diagn Ther. 2015;37(1):18-23.\u003c/li\u003e\n\u003cli\u003eBuca D, Iacovella C, Khalil A, Rizzo G, Sirotkina M, Makatsariya A, et al. Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2020;55(4):441-9.\u003c/li\u003e\n\u003cli\u003eHurwitz A, Milwidsky A, Yarkoni S, Palti Z. Severe fetal distress with hydramnios due to chorioangioma. Acta Obstet Gynecol Scand. 1983;62(6):633-5.\u003c/li\u003e\n\u003cli\u003eDuro EA, Moussou I. Placental chorioangioma as the cause of non-immunologic hydrops fetalis; a case report. Iran J Pediatr. 2011;21(1):113-5.\u003c/li\u003e\n\u003cli\u003eHosseinzadeh P, Shamshirsaz AA, Javadian P, Espinoza J, Gandhi M, Ruano R, et al. Prenatal Therapy of Large Placental Chorioangiomas: Case Report and Review of the Literature. AJP Rep. 2015;5(2):e196-202.\u003c/li\u003e\n\u003cli\u003eZacharis K, Kravvaritis S, Charitos T, Chrysafopoulou E, Fouka A. A rare case of a giant placental chorioangioma with favorable outcome. Pan Afr Med J. 2020;36:214.\u003c/li\u003e\n\u003cli\u003eBhide A, Prefumo F, Sairam S, Carvalho J, Thilaganathan B. Ultrasound-guided interstitial laser therapy for the treatment of placental chorioangioma. Obstet Gynecol. 2003;102(5 Pt 2):1189-91.\u003c/li\u003e\n\u003cli\u003eZanardini C, Papageorghiou A, Bhide A, Thilaganathan B. Giant placental chorioangioma: natural history and pregnancy outcome. Ultrasound Obstet Gynecol. 2010;35(3):332-6.\u003c/li\u003e\n\u003cli\u003ePapaioannou GK, Evangelinakis N, Kourtis P, Konstantinidou A, Papantoniou N. Giant chorioangioma treated with interstitial laser coagulation. Ultrasound Obstet Gynecol. 2018;52(2):280-1.\u003c/li\u003e\n\u003cli\u003eTurgut E, Atalay A, Sakcak B, Sahin D. Interstitial Laser Ablation of Feeding Vessels to a Large Placental Chorioangioma. Z Geburtshilfe Neonatol. 2022;226(4):274-7.\u003c/li\u003e\n\u003cli\u003eQuarello E, Bernard JP, Leroy B, Ville Y. Prenatal laser treatment of a placental chorioangioma. Ultrasound Obstet Gynecol. 2005;25(3):299-301.\u003c/li\u003e\n\u003cli\u003eSepulveda W, Wong AE, Herrera L, Dezerega V, Devoto JC. Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment options. Prenat Diagn. 2009;29(3):201-6.\u003c/li\u003e\n\u003cli\u003eMendez-Figueroa H, Papanna R, Popek EJ, Byrd RH, Goldaber K, Moise KJ, Jr., et al. Endoscopic laser coagulation following amnioreduction for the management of a large placental chorioangioma. Prenat Diagn. 2009;29(13):1277-8.\u003c/li\u003e\n\u003cli\u003eJones K, Tierney K, Grubbs BH, Pruetz JD, Detterich J, Chmait RH. Fetoscopic laser photocoagulation of feeding vessels to a large placental chorioangioma following fetal deterioration after amnioreduction. Fetal Diagn Ther. 2012;31(3):191-5.\u003c/li\u003e\n\u003cli\u003eQuintero RA, Reich H, Romero R, Johnson MP, Gon\u0026ccedil;alves L, Evans MI. In utero endoscopic devascularization of a large chorioangioma. Ultrasound Obstet Gynecol. 1996;8(1):48-52.\u003c/li\u003e\n\u003cli\u003eNicolini U, Zuliani G, Caravelli E, Fogliani R, Poblete A, Roberts A. Alcohol injection: a new method of treating placental chorioangiomas. Lancet. 1999;353(9165):1674-5.\u003c/li\u003e\n\u003cli\u003eWanapirak C, Tongsong T, Sirichotiyakul S, Chanprapaph P. Alcoholization: the choice of intrauterine treatment for chorioangioma. J Obstet Gynaecol Res. 2002;28(2):71-5.\u003c/li\u003e\n\u003cli\u003eDeren O, Ozyuncu O, Onderoglu LS, Durukan T. Alcohol injection for the intrauterine treatment of chorioangioma in a pregnancy with transfusion resistant fetal anemia: a case report. Fetal Diagn Ther. 2007;22(3):203-5.\u003c/li\u003e\n\u003cli\u003eLau TK, Leung TY, Yu SC, To KF, Leung TN. Prenatal treatment of chorioangioma by microcoil embolisation. Bjog. 2003;110(1):70-3.\u003c/li\u003e\n\u003cli\u003eLau TK, Yu SC, Leung TY, To KF, Fung TY, Leung TN. Prenatal embolisation of a large chorioangioma using enbucrilate. Bjog. 2005;112(7):1002-4.\u003c/li\u003e\n\u003cli\u003eBabic I, Tulbah M, Kurdi W. Antenatal embolization of a large placental chorioangioma: a case report. J Med Case Rep. 2012;6:183.\u003c/li\u003e\n\u003cli\u003eSegev Y, Goldberg Y, Riskin-Mashiah S, Berdicef M, Lavie O, Auslender R. Starry sky pattern of fetal liver sonogram as first sign of twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2012;39(6):723-5.\u003c/li\u003e\n\u003cli\u003eMorine M, Maeda K, Higashino K, Miura N, Kinoshita T, Endo S, et al. Transient hydrops fetalis of the donor fetus in twin-twin transfusion syndrome after therapeutic amnioreduction. Ultrasound Obstet Gynecol. 2003;22(2):182-5.\u003c/li\u003e\n\u003cli\u003eRodeck CH, Weisz B, Peebles DM, Jauniaux E. Hypothesis: the placental \u0026apos;steal\u0026apos; phenomenon - a possible hazard of amnioreduction. Fetal Diagn Ther. 2006;21(3):302-6.\u003c/li\u003e\n\u003cli\u003eKosinska-Kaczynska K, Lipa M, Szymusik I, Bomba-Opon D, Brawura-Biskupski-Samaha R, Kozlowski S, et al. Sudden Fetal Hematologic Changes as a Complication of Amnioreduction in Twin-Twin Transfusion Syndrome. Fetal Diagnosis and Therapy. 2018;44(4):311-4.\u003c/li\u003e\n\u003cli\u003eGratac\u0026oacute;s E, Van Schoubroeck D, Carreras E, Devlieger R, Roma E, Cabero L, et al. Transient hydropic signs in the donor fetus after fetoscopic laser coagulation in severe twin-twin transfusion syndrome: incidence and clinical relevance. Ultrasound Obstet Gynecol. 2002;19(5):449-53.\u003c/li\u003e\n\u003cli\u003eGratac\u0026oacute;s E, Van Schoubroeck D, Carreras E, Devlieger R, Roma E, Cabero L, et al. Impact of laser coagulation in severe twin\u0026ndash;twin transfusion syndrome on fetal Doppler indices and venous blood flow volume. Ultrasound in Obstetrics \u0026amp; Gynecology. 2002;20(2):125-30.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003e\u003cstrong\u003eTable 1. The available reports of the chorioangioma treated by interstitial photocoagulation.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"990\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor, year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase no.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGA at procedure, WG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor size, mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-operative findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterstitial laser coagulation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-operative finding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eBhide 2003 [15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e53x45x44\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMild cardiomegaly, dilated umbilical vein, MCA PSV\u0026gt;95\u003csup\u003eth\u003c/sup\u003e centile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17-gauge needle, a 400-um laser fiber, Nd-YAG initial power at 5 W increasing to 20 W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eIncreasing echogenicity inside the placenta mass, revascularization of the chorioangioma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eUnsuccessful interruption of feeding vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026oslash; 60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eFetal hyperdynamic circulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17-gauge needle, a 400-um laser fiber, Nd-YAG initial power at 5 W increasing to 20 W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eResolved fetal hyperdynamic circulation, the fetal cardiomegaly and dilated umbilical vein persisted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eElective cesarean section at 32 WG due to increased UA PI and DV PI, livebirth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eZanardini 2010 [16]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e25\u003csup\u003e+4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMean \u0026oslash; 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eModerate cardiomegaly, MCA PSV\u0026gt;95\u003csup\u003eth\u003c/sup\u003e centile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eUnsuccessful interruption of feeding vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e26\u003csup\u003e+4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eLive birth at 32\u003csup\u003e+3\u0026nbsp;\u003c/sup\u003eWG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e32\u003csup\u003e+3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMean \u0026oslash; 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMild cardiomegaly, MCA PSV\u0026gt;95\u003csup\u003eth\u003c/sup\u003e centile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eLive birth at 39\u003csup\u003e+1\u0026nbsp;\u003c/sup\u003eWG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e29\u003csup\u003e+2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMean \u0026oslash; 54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMild cardiomegaly, MCA PSV\u0026gt;95\u003csup\u003eth\u003c/sup\u003e centile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eUnsuccessful interruption of feeding vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAmnioreduction at 28\u003csup\u003e+6\u003c/sup\u003e WG, IUT at 29 WG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30\u003csup\u003e+4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eLive birth at 37\u003csup\u003e+3\u0026nbsp;\u003c/sup\u003eWG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003ePapaioannou 2018 [17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMaximum \u0026oslash; 140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMild cardiomegaly, MCA PSV\u0026gt;1.5 SD above the mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17-guage needle, 1.07-mm non-contact laser fiber, laser power 30-40 W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eEmergency cesarean section at 31 WG due to fetal distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eTurgut 2022 [18]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e83x80x80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eFetal hydrops, polyhydramnios, MCA PSV 1.65 MoM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18-guage needle, 0.5-mm laser fiber, diode laser power at 40 W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eHigh MCA PSV persisted, no vascular flow inside the mass\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eLive birth at 31 WG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eIUT at 10 days after procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eOur case study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e79x56x54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMild cardiomegaly, MCA PSV at 1.63 MoM, high CCO, polyhydramnios\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17-gauge needle, a 400-um laser fiber, Nd-YAG laser power at 20 W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eResolved fetal hyperdynamic circulation, normal MCA PSV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eTransient fetal hydrops\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eLive birth at 38 WG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAmnioreduction 1,600 ml after IUT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: GA, gestational age; WG, weeks of gestation; MCA, middle cerebral artery; PSV, peak systolic velocity;W, watt; \u0026oslash;, diameter; UA, umbilical artery; PI, pulsatility index; DV, ductus venosus; IUT, intrauterine blood transfusion; SD, standard deviation; MoM, multiple of median, CCO, combined cardiac output\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Placental chorioangioma, Transient fetal hydrops, Interstitial laser coagulation, Amnioreduction","lastPublishedDoi":"10.21203/rs.3.rs-7482135/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7482135/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u0026nbsp;Placental chorioangioma is the most common placental tumor. Large chorioangioma may lead to poor pregnancy outcomes. Current management includes invasive and less invasive procedure such as amnioreduction, interstitial laser coagulation (ILC) and fetoscopic laser ablation. We reported a unique case with transient fetal hydrops after ILC and amnioreduction. However, patient could continue pregnancy until term gestation without maternal and neonatal complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation:\u0026nbsp;\u003c/strong\u003eA 38-year-old, parous woman presented with abdominal distension at 22\u003csup\u003e+6\u003c/sup\u003e WG and transabdominal ultrasound revealed a placental chorioangioma estimating 7.9x5.6x5.4 cm with polyhydramnios and peritumoral hypervascularization. Borderline fetal cardiomegaly, increased combined cardiac output and slightly increased peak systolic velocity of middle cerebral artery were also demonstrated. After extensive counseling, ILC together with amnioreduction was performed at 23 WG. The feeding vessel was completely occluded. Two days after procedure, the fetus developed holosystolic tricuspid regurgitation, starry sky liver and fetal hydrops (scalp edema, pericardial effusion, pleural effusion, and ascites). However, fetal hydrops and tricuspid regurgitation were resolved at 26 WG. The remaining pregnancy was unremarkable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u0026nbsp;Herein, we reported the first case of transient hydrops fetalis developed after successful treatment of large placental chorioangioma by ILC and amnioreduction.\u003c/p\u003e","manuscriptTitle":"Transient hydrops fetalis after interstitial laser coagulation and amnioreduction for treating placental chorioangioma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 10:00:23","doi":"10.21203/rs.3.rs-7482135/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-12T19:52:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-11T17:26:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-08T02:18:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81081426688280577969416143248673225052","date":"2025-09-04T18:14:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176130839567880150269512687865857717691","date":"2025-09-02T15:12:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-02T12:52:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-02T00:17:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-01T10:44:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-01T03:48:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-09-01T03:45:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33624ceb-536f-4ad9-8e7a-4a39683c0ecd","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T16:04:10+00:00","versionOfRecord":{"articleIdentity":"rs-7482135","link":"https://doi.org/10.1186/s12884-025-08304-6","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-12-01 15:57:24","publishedOnDateReadable":"December 1st, 2025"},"versionCreatedAt":"2025-09-09 10:00:23","video":"","vorDoi":"10.1186/s12884-025-08304-6","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08304-6","workflowStages":[]},"version":"v1","identity":"rs-7482135","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7482135","identity":"rs-7482135","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}