PP-11 Prenatal diagnosis of a placental cyst with intracystic hemorrhage case report

Objective

Placental cysts (PC) are usually benign masses on the surface of the placenta and can be detected with ultrasonography in the early stages of pregnancy. Although PCs are clinically insignificant and don’t require additional follow-up in most cases, larger cysts may cause intrauterine growth restriction (IUGR), intrauterine asphyxia, and preterm delivery. In this study, we present a case of a placental surface cyst complicated with intracystic hemorrhage. 

Case

A 33-year-old, gravida 2 para 1 woman was referred to Bezmialem Vakıf University, Obstetrics and Gynecology clinic at 36 weeks of gestation with the detection of a placental cyst at detailed ultrasound. Besides the rhesus incompatibility and a dermoid cyst, the patient’s obstetrics, personal, and family histories were normal. Her detailed ultrasound report showed a thin-walled, anechoic placental surface cyst measuring 2.7x1.8 cm at its widest point, located adjacent to the umbilical cord insertion to the placenta. In our sonographic examination at the 36th week, the fetal development, and the amniotic fluid index were within normal limits. We observed a placental cyst with the dimensions of 6x7.3 cm containing a 5.3x3.8 cm echogenic area suggesting intracystic bleeding. Middle cerebral artery peak systolic velocity was 39 cm/s. A healthy, 3480-g female neonate was born at 38 weeks of gestation via cesarean section. Separation of the placenta resulted in uterine inversion. After the eversion of the uterus, the placenta was sent to pathology. The pathological examination confirmed a placental subchorionic cyst with an undamaged capsule and an area of infarct measuring 8x7x4.5 cm. When the capsule was discharged, brown-colored hemorrhagic fluid was revealed. 

Conclusion

In this case, we presented the diagnosis and management a subchorionic placental cyst complicated with intracystic hemorrhage. Despite its benign course in most cases, subchorionic placental (surface) cysts are prone to hemorrhage as in our case. The extent of the hemorrhage and the position of the cyst may be predictive for perinatal complication such as IUGR, fetal anemia and fetal distress. Therefore, follow-up US of the cyst with regard to size, echo-texture, MCA-PSV should be implemented in these cases. More cases should be collected and reported to establish antenatal follow-up and delivery protocol for PC cases.

Keywords

Hemorrhage, placental cyct, ultrasound

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	File/Dsecription
	Fig.1 Ultrasound showing the placental cyst with intracystic hemorrhage area
	Fig.2 The Doppler Ultrasound reveals the umbilical cord insertion site and the placental cyst, which notably exhibits no detectable blood flow.
	Fig.3 The image depicting the placenta alongside a placental cyst, with the umbilical cord positioned on the right side