2 tiny coils save baby from blood tumor in utero
A chorangioma is a blood tumor that develops in the placenta during pregnancy. When the tumor is small and doesn’t grow, it poses little risk to the baby, but in rare cases, the cells multiply and the tumor becomes deadly.
But doctors at University of Pittsburgh Medical Center Magee-Womens Hospital used an out-of-the-box solution to save one little boy.
Little Oliver White is a 1-year-old miracle. Happy. Healthy. And here, despite incredible odds.
Mom and dad Samantha and Jesse were thrilled when they learned they were pregnant with their first. Then, at 22 weeks, and ultrasound showed a frightening complication.
“We had a large tumor on the placenta, and we needed to do something right away,” Samantha said.
“It was growing at a pretty rapid pace," Jesse said. "There was a good chance another two weeks had gone by, it would have been too late.”
“It was a 10-centimeter tumor. It was as big as the baby was,” maternal-fetal medicine specialist Dr. Stephen Emery said.
Emery and interventional radiologist Dr. Philip Orons teamed up to cut off the blood supply to just the tumor, without harming Samantha or her baby. The best bet? A minimally invasive technique called microcoil embolization.
“It’s basically just a needle passed through the skin through the wall of the uterus and into the feeding blood vessels,” Emery said.
After Emery positioned the needle, Orons deployed two tiny coils through the catheter.
“Within moments, seconds of putting the coils in place, we saw the blood flow had stopped,” Orons said.
With the tumor sealed off, Samantha continued her pregnancy and delivered Oliver full-term. The Whites say they’ll tell their son about his medical journey someday.
“Tell him he’s famous. One of a kind,” Jesse said.
When Samantha delivered Oliver, the microcoils also came out, so there was no need for another surgery to remove them.
The doctors say they’re not sure they are the first to try this procedure in the United States, but they say they believe they are the first to have a successful outcome.
TOPIC: SAVING OLIVER WITH TWO TINY COILS
REPORT: MB #4548
BACKGROUND: Chorioangioma of the placenta is a rare tumor with a frequency of about one percent, which usually presents as a solitary nodule or, less frequently, as multiple nodules. It is found on the fetal surface of the placenta. Most chorioangiomas are small and possess no clinical significance. On the contrary, clinically significant chorioangiomas, greater than five cm, may be associated with pregnancy complications.
COMPLICATIONS: Possible complications of chorioangioma in the mother include polyhydramnios, where there is excess fluid in the amniotic sac surrounding the fetus, preterm labor, preeclampsia, which is a condition characterized by high blood pressure, loss of protein in the urine, and fluid retention. Preeclampsia could progress to eclampsia, where the mother suffers from seizures. More complications include placental abruption, or separation of the placenta from the wall of the uterus, excessive bleeding, and problems with clotting of blood.
Chorioangioma may be associated with complications in the fetus. These include heart failure, birth defects, restricted growth of the fetus, clotting disorders in the baby, and enlargement of the heart.
MICROCOIL EMBOLIZATION: Philip Orons, DO, an Interventional Radiologist at UPMC Magee-Women’s Hospital said, “We were very worried there was going to be shunting inside the tumor. And if we used agents that moved too easily, we risk them going right to the tumor and going right to the baby. In this case, we wanted to use something larger. In general, one of the tenets of embolotherapy is the bigger the embolic, the safer the embolic. The biggest embolics we have are actually cup coils.” He explained the treatment, “We use something called a micro coil which is a little platinum device with little threads on it. It looks almost like a teeny fishing lure and we call it a coil because even though it starts out straight when you push it through a catheter or through a needle it coils up.” These percutaneously placed microcoils initiate clot formation at the site of insertion and are unable to migrate through the tumor, thereby minimizing fetal harm.
(Source: Philip Orons, DO & https://www.ncbi.nlm.nih.gov/pubmed/30345160)