Prenatal ultrasound evaluation of fetal cutaneous hemangioma and related complications

doi:10.21203/rs.3.rs-1652610/v1

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Prenatal ultrasound evaluation of fetal cutaneous hemangioma and related complications

https://doi.org/10.21203/rs.3.rs-1652610/v1

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Objectives：Congenital hemangiomas are rare benign vascular tumors but can lead to serious adverse pregnancy outcomes. We explored the clinical applications of prenatal ultrasound for evaluating fetal cutaneous hemangioma and associated complications.

Methods: A retrospective observational study was conducted comprising a population of pregnant women with fetal cutaneous hemangioma, the latter diagnosed by prenatal ultrasound, between January 2016 and December 2020. The clinical characteristics, sonographic images, complications, and pregnancy outcomes were documented and analyzed.

Results: We identified 20 cases of fetal cutaneous hemangioma diagnosed by the prenatal ultrasound and confirmed by the postpartum examinations. Most hemangiomas were in the head and neck (55%), with either solid isoechoicity (25%) or solid mildly hyperechoicity (25%) and clear boundary (80%). Eight (40%) fetuses were found to have complications, which often occurred in fetuses with large hemangiomas (67% with maximum diameter ≥5 cm; 100% with a volume ≥40 cm³). The most common complications were cardiac-related (88%), including elevated cardiothoracic area ratio, atrioventricular valve regurgitation, and fetal edema. A large hemangioma was usually associated with advanced gestational age and a fast hemangioma growth rate. In five (25%) cases, the pregnancy was terminated; these involved hemangioma of the head or neck. One newborn developed Kasabach-Merritt phenomenon, pulmonary hemorrhage, respiratory distress, and died 3 days after birth. Among the 14 (70%) fetuses that survived birth, all hemangiomas disappeared or regressed after treatments with propranolol, interventional surgery, or routine observations.

Conclusions: Prenatal ultrasound examination could accurately diagnose fetal cutaneous hemangioma and related complications to facilitate appropriate management during the pregnancy.

prenatal ultrasound

fetal cutaneous hemangioma

pregnancy outcome

fetal complications

retrospective study

Fetal cutaneous hemangiomas can lead to structural complications and affect pregnant outcomes. Prenatal ultrasound examination could be a method to accurately diagnose and monitor these hemangiomas.

Hemangiomas are vascular tumors formed by rapid endothelial cell proliferations, with unclear pathogenesis.¹ Congenital hemangiomas commonly appear in the head, neck, trunk, or extremities and are fully formed at birth.² Congenital hemangiomas can cause serious intrauterine complications, such as fetal high output heart failure, edema, anemia, thrombocytopenia, and even death.^3–7 During the delivery, fetuses with large hemangiomas in the head and neck may have airway obstruction that requires immediate ex-utero intrapartum treatments or postpartum managements. Therefore, early prenatal diagnosis of congenital hemangiomas is essential to improve pregnancy outcomes.⁸

The diagnosis of congenital hemangiomas is mostly based on imaging evaluations, such as magnetic resonance imaging (MRI) and ultrasound examinations.⁹ MRI scanning is expensive and cannot provide real-time evaluations. In contrast, ultrasound is a non-invasive bedside convenient test at relatively low cost. However, there have been few reports regarding the prenatal ultrasound diagnosis and monitoring of fetal cutaneous hemangiomas.^5,9−14

Here, we present our retrospective study that analyzed 20 cases of fetal cutaneous hemangiomas, diagnosed by prenatal ultrasound, and confirmed by postpartum evaluations. We describe the prenatal ultrasound characteristics of fetal cutaneous hemangioma. The fetal structural complications and pregnancy outcomes are also reported.

2.1 Study design and participant selection

A retrospective study was conducted based on the medical records of pregnant women who received prenatal care at Guangdong Women and Children Hospital in Guangzhou, China between January 2016 and December 2020. The study protocol was approved by the hospital ethics committee (approval number 202101328).

In our hospital, prenatal ultrasound is routinely performed for all pregnant women during gestational weeks 22 through 26, to evaluate fetal development and pregnancy progress. Pregnant women who received a diagnosis of fetal cutaneous hemangiomas, as diagnosed by the prenatal ultrasound screening and confirmed by the postpartum examinations, were included in the present study. Women with incomplete data on the prenatal examinations or follow-up outcomes were excluded.

2.2 Diagnosis criteria of cutaneous hemangiomas

The 2018 ISSVA classification assigned vascular diseases to 2 categories: vascular tumors and vascular malformations.¹⁵ Vascular tumors were further categorized as benign (locally aggressive or borderline), or malignant. Congenital hemangioma is a benign vascular tumor. During a prenatal ultrasound examination, when a mixed or homogeneous solid mass on the fetal body surface was detected and showed blood flow in the color Doppler, with or without dilated venous sinuses, cutaneous hemangioma was diagnosed.^15,16 The diagnosis of postpartum cutaneous hemangiomas was based on the clinical examinations.

2.3 Prenatal evaluations

All fetuses received the prenatal ultrasound evaluations. The ultrasound system was the GE Voluson E8 and E10 and Samsung WS80A (GE Healthcare, Chicago, USA), with a transabdominal 2-dimensional (2D) convex array probe, 3-dimensional (3D) volume probe, and high-frequency linear array probe, at frequencies 2.0 to 5.0 MHz, 6.0 to 8.0 MHz, and 3.0 to 12.0 MHz, respectively.

During the prenatal ultrasound examination, if a mass was identified in the fetal skin, a 2D ultrasound with a high-frequency linear array probe was used to determine the mass location, size, shape, echogenicity, boundary, internal blood flow, and relationship between the mass and surrounding tissues. A 3D ultrasound surface imaging was applied to identify the mass location and shape. Hemangiomas were grouped as < 5 cm or ≥ 5 cm based on the maximum diameter, and < 40 cm³ or ≥ 40 cm³ in volume.

In addition to the ultrasound evaluations, some fetuses also received MRI scanning and genetic testing, by the judgement of their treating physicians. MRI scanning was performed with a Brivo MR355 1.5T MRI scanner with 8-channel coil system (GE Healthcare, Chicago, IL, USA). Two experienced radiologists jointly gave the MRI reports, which included tumor location, size, signal intensity, and concurrent morbidities. Genetic testing was performed using umbilical cord blood lymphocytes. G-banded chromosome analysis (320 bands) and chromosomal microarray analysis (gene chip Affymetrix Cytoscan 750K, Thermo Fisher Scientific, Santa Clara, CA, USA) were conducted. Tests were duplicated for each sample.

2.4 Outcome measurements

Outcome measurements included intrauterine complications and pregnancy outcomes. During the prenatal ultrasound evaluations, possible complications such as an enlarged fetal heart size, atrioventricular valve regurgitation, or fetal hydrops, were determined. Cardiothoracic area ratio was calculated, with the diagnostic criterion for a normal heart no larger than one third of the area of the chest.¹⁷ Fetal hydrops was diagnosed when the fetus had effusions in 2 or more cavities. Anemia, abnormal cardiopulmonary measurements, and polyhydramnios were also recorded. Fetal anemia was defined as an increase in the middle cerebral artery peak systolic velocity (PSV) > 1.5 multiples of the median (MoM).¹⁸

Pregnancy outcomes included death or survival, as well as the treatments received and prognosis of the hemangiomas.

2.5 Statistical analysis

Continuous data are shown as mean and standard deviation or median, as appropriate. Categorical data are shown as number and percentage. Associations between the size of the hemangiomas and gestational age, as well as the growth rate, were analyzed by paired t-test. All statistical analyses were performed using SPSS software (version 19.0, IBM, NY, USA).

3.1 Clinical characteristics of study participants

Overall, 21 fetal cutaneous hemangiomas were diagnosed by the prenatal ultrasound. Among them, 20 (95.2%) were confirmed as cutaneous hemangiomas through the postpartum examinations. The mean maternal age was 28.6 (± 4.9) years. The mean gestational weeks at the diagnosis of fetal cutaneous hemangioma was 28 weeks.

All these 20 patients underwent prenatal ultrasound examinations. Among them, there were 5 (25%) initial misdiagnoses of neck skin thickening (2 patients), and for one patient each, placental hemangioma, teratoma, or possible hemangioma or meningocele, respectively (Table 1).

Table 1

Cases of misdiagnoses at the initial prenatal ultrasound evaluation.
	Gestational weeks
	At misdiagnosis	At correct diagnosis
Neck skin thickening (2 cases)	24	24^+ 3
	35	35^+ 1
Placental hemangioma	30	31
Teratoma	24	25
Suspected hemangioma or meningocele	28	30^+ 4

Twelve (60%) patients received prenatal MRI scanning, which reported hemangiomas and vascular malformations in 9 and 3 fetuses, respectively. The 3 cases diagnosed as vascular malformations by MRI were diagnosed as hemangiomas after prenatal ultrasound evaluations performed within the same gestational weeks.

3.2 Ultrasound characteristics of congenital hemangiomas

The ultrasound characteristics are shown in Table 2. The earliest gestational age to diagnose hemangiomas was 23 weeks. Most hemangiomas were in the head and neck (55%), with either solid isoechoicity (25%) or solid mildly hyperechoicity (25%) and clear boundary (80%). All (100%) the hemangiomas had a rich internal blood supply.

Table 2

Ultrasound characteristics of 20 congenital cutaneous hemangiomas.
	Categories	N (%)
Location	Head and neck	11 (55)
	Trunk	2 (10)
	Limbs	5 (25)
	Trunk and upper limbs	1 (5)
	Trunk and neck	1 (5)
Echogenicity	Cystic solid	4 (20)
	Solid hypoechoic	3 (15)
	Solid isoechoic	5 (25)
	Solid mildly hyperechoic	5 (25)
	Solid hyperecho	3 (15)
Boundary	Clear boundary	16 (80)
	Unclear boundary	4 (20)
Internal blood supply	Rich blood flow	20 (100)
	No blood flow	Nil

Some hemangiomas showed tortuous tubular anechoic signals, which were dilated vascular sinuses (Fig. 1), or honeycomb structures without obvious capsules (Fig. 2). Hemangiomas with tumor-like growth had a clear boundary (Figs. 3–4), while cirsoid angioma had an unclear boundary (Figs. 1–2). Hemangioma with arteriovenous leakage had multicolored mosaic blood flow signals at the site of leakage, with spiculated spectrums (Fig. 2). On the 3D ultrasound, the location and shape of the mass could be observed stereoscopically. The relationship between the mass and the fetal body surface could be determined clearly under the ultrasound (Figs. 3–6).

In 7 fetuses with repeated prenatal ultrasound examinations, large hemangiomas (cases 4 and 5) were associated with advanced gestational ages (P < 0.05, Table 3, Fig. 7) and fast growth rates (at rates of 42.2 and 32.1 cm³/week in cases 4 and 5, respectively; Table 3).

Table 3

Size and growth rate of fetal cutaneous hemangioma diagnosed at different gestational weeks in 7 cases with repeated ultrasound evaluations.
	Ultrasound	First time	Second time	Third time	Fourth time	Growth rate, cm³/wk *
1	Gestational week	23	28	32	40	8.35
	Dimensions, mm	57 × 46 × 24	66 × 56 × 45	68 × 52 × 50	87 × 62 × 53
	Volume, cm³	32.9	87.0	92.5	149.5
2	Gestational week	29	32	34	36	6.11
	Dimensions, mm	58 × 41 × 40	58 × 41 × 55	65 × 45 × 60	66 × 57 × 47
	Volume, cm³	49.7	68.4	91.8	92.5
3	Gestational week	31	33	36		5.6
	Dimensions, mm	65 × 45 × 46	62 × 61 × 38	70 × 64 × 42
	Volume, cm³	70.4	75.2	98.4
4	Gestational week	35	36			42.2
	Dimensions, mm	78 × 31 × 66	90 × 30 × 89
	Volume, cm³	83.5	125.7
5	Gestational age, wk	31	36			32.06
	Dimensions, mm	98 × 75 × 43	112 × 109 × 51
	Volume, cm³	165.3	325.6
6	Gestational week	25	30			2.8
	Dimensions, mm	27 × 18 × 33	37 × 29 × 40
	Volume, cm³	8.4	22.4
7	Gestational week	25	32			0.28
	Dimensions, mm	29 × 23 × 13	34 × 26 × 15
	Volume, cm³	4.5	6.5
* Average

3.3 Complications in fetuses with congenital hemangiomas

All the fetuses with hemangiomas in the < 5 cm group were without complications. Among the fetuses with hemangiomas ≥ 5 cm, 8 (67%) had complications (Tables 4). Fetuses with hemangiomas < 40 cm³ were without complications. All 8 fetuses with hemangiomas ≥ 40 cm³ showed complications (Table 4).

Table 4

Incidences of complications in cutaneous hemangiomas with different maximum diameters and volumes.
	Categories	N	Cases with complications, N (%)
Maximum diameter	< 5 cm	8	Nil
	≥ 5 cm	12	8 (67%)
Volume	< 40 cm³	12	Nil
	≥ 40 cm³	8	8 (100%)

As shown in Table 5, most of the complications were cardiac-related (7/8, 88%). Six fetuses had elevated cardiothoracic area ratio (A, B, C, F, G, and H, 6/20, 60%) and 4 fetuses had tricuspid regurgitation (A, B, C, and F, 4/20, 20%). One fetus (C) had anemia, with increased PSV (80.8 cm/s) to > 1.5 MoM in the middle cerebral artery. The other 2 fetuses had severe postpartum pulmonary hypertension (A and B).

Table 5

Prenatal ultrasound findings and pregnancy outcomes in 8 fetuses with complications.
	Dimension, mm	Volume, cm³	Complications	Delivery	Postpartum findings	Treatments
A	65 × 45 × 46	70.4	At 31 weeks: cardiac enlargement (cardiothoracic area ratio 0.44) and tricuspid regurgitation (regurgitation area 1.57 cm²); at 32 weeks: cardiac enlargement (cardiothoracic area ratio 0.50) and tricuspid regurgitation (regurgitation area 1.90 cm²) reverse blood flow signals were seen in the diastole of aortic arch and ascending aorta	At 38^+ 6 weeks: C-section	Severe tricuspid regurgitation (regurgitation area 2.10 cm²), severe pulmonary hypertension, heart failure	Propranolol treatment was ineffective; supply artery was ligated
B	58 × 41 × 40	49.7	At 29 weeks: hemangioma complicated with arteriovenous fistula, cardiac enlargement (cardiothoracic area ratio 0.4), tricuspid regurgitation (regurgitation area 0.4 cm²), compensatory widening of left subclavian artery, left innominate vein and superior vena cava	At 37^+ 2 weeks: C-section	Moderate-severe tricuspid regurgitation (regurgitation area 1.79 cm²), severe pulmonary hypertension	Propranolol treatment was ineffective; supply artery was ligated
C	98 × 75 × 43	165.3	At 31 weeks: the heart enlarged (cardiothoracic area ratio 0.37), pericardial effusion, the inner diameter of the inferior vena cava widened, the PSV value of the middle cerebral artery increased (80.75 cm/s (> 1.5 MoM)), and the left lower extremity skin edema and thickened.	At 36^+ 5 weeks: C-section	Fetal secondary and tricuspid regurgitation (regurgitation area 0.34 cm²), mitral regurgitation (regurgitation area 0.67 cm²)	Propranolol treatment
D	78 × 31 × 66	8305	At 35 weeks: fetal hydrops (skin edema, pleural effusion), moderate polyhydramnios; at 36^+ 1 weeks: intrauterine week fetal distress	At 36^+ 1 weeks: C-section	KMP, DIC, pulmonary hemorrhage, respiratory distress syndrome	Death on day 3 after birth
E	91 × 47 × 70	156.5	At 31 weeks: the intra-abdominal segment of umbilical vein widened.	Termination of pregnancy
F	56 × 33 × 56	54.1	At 27 weeks: heart enlargement (cardiothoracic area ratio 0.66), tricuspid regurgitation (regurgitation area 1.68 cm²), mitral regurgitation (regurgitation area 0.40 cm²)	Termination of pregnancy
G	69 × 27 × 56	54.6	At 24 weeks: cardiothoracic enlargement (cardiothoracic area ratio 0.42), superior vena cava dilation	Termination of pregnancy
H	57 × 46 × 34	46.6	At 27 weeks: enlarged heart (cardiothoracic area ratio 0.41)	Termination of pregnancy
KMP, Kasabach-Merritt phenomenon; DIC, disseminated intravascular coagulation.

Six fetuses were given prenatal chromosomal examination, with no obvious abnormalities found. Clinical diagnosis revealed abnormal prenatal ultrasound findings, while G-banded karyotype analysis was 46, XN (no abnormal karyotype; Supplementary Fig. 1). Chromosomal microarray analysis indicated no obvious abnormal results (Supplementary Fig. 2).

3.4 Pregnancy outcomes

As shown in Table 6, 15 fetuses (75%) reached delivery (including one death at day 3 after the birth). Their gestational weeks were 36^+ 1 to 40^+ 6 weeks (mean 38^+ 1 weeks) and the birth weights ranged from 1.96 to 3.85 kg (mean 3.13 kg). Five (25%) pregnancies were terminated after discussion between the parents and treating physicians.

Table 6

Pregnancy outcomes.
	Categories	N (%)
Pregnancy outcomes	Survive after birth	14 (70)
	Termination of pregnancy	5 (25)
	Death at day 3 after birth	1 (5)
Gestational weeks at birth	36–36^+ 6	3 (3/15)
	37–40	10 (10/15)
	> 40	2 (2/15)
Mode of delivery	Spontaneous labor	5 (5/15)
	Cesarean section	10 (10/15)
Birth weight	< 2.5 kg	1 (1/15)
	2.5-4.0 kg	14 (14/15)
Gender of newborn	Male	7 (7/15)
	Female	8 (8/15)
Postpartum hemangioma treatment	Postnatal surgery or interventions	5 (25)
	Propranolol treatment	1(5)
	No operation	8 (40)

All the fetuses in which pregnancy was terminated had cutaneous hemangiomas in the head and neck (4 with complications [Table 5]. There was one fetus with occipital scalp hemangioma and without complications, and the pregnancy was terminated as requested by the mother). All masses had significant blood flow signals, with a PSV of 18.3 to 91.1 (median 43.1) cm/s and resistance index (RI) 0.3 to 0.8 (median 0.6).

Among the 14 newborns who survived after birth, 5 (25%) underwent postnatal surgery or interventional treatments for hemangioma. One (5%) received propranolol treatment. Eight parents (40%) opted for no surgery and their children were continually followed by the clinic. At this writing, the oldest child is 6 years old and the youngest child is 1 year old. All the hemangiomas disappeared or regressed regardless of whether they were treated with drugs, interventional surgery, or routine observations.

In 8 fetuses with intrauterine complications (Table 5), 4 underwent termination of pregnancy and 4 were delivered by cesarean section. One (D) developed fetal distress in the third trimester, complicated with Kasabach-Merritt phenomenon (KMP) after birth. In this case, the prenatal ultrasound examination showed a hypoechoic mass, with unclear boundary and uniform internal echo, from the right buccal neck to the right anterior chest. Color Doppler flow imaging showed abundant blood flow signals, with a PSV of 36.4 cm/s and RI of 0.8. The fetus also had skin edema (thickness 11.1 mm), right pleural effusion (56 × 10 × 44 mm), and polyhydramnios (amniotic fluid 125 mm, with an index 334 mm). Fetal distress occurred at 36^+ 1 weeks. The umbilical artery systolic/diastolic ratio increased from 3.7 to 5.6. The middle cerebral artery pulsatility index (MCA-PI) was normal (1.1). The MCA-PI/umbilical artery pulsatility index (UA-PI) decreased 0.9 (< 1.1). During the emergency cesarean section, the Apgar scores were 2, 5, and 8 at 1, 5, and 10 min, respectively. A large hemangioma in the neck and jaw (10 × 15 cm) was identified at birth. During the difficult endotracheal intubation, the fetus demonstrated weak breathing, a heart rate of 80 beats/min, and abnormal development of the oral cavity and airway. Laboratory tests showed anemia (hemoglobin 59 g/L), low platelet 23 ×10^− 9/L, low fibrinogen 0.7 g/l, high D-dimer 154.6 mg/L, and high fibrin degradation product 451.2 µg/mL. The activated partial thrombin time, prothrombin time, and the thrombin time were 79.1, 13.8 and 16.2 s, respectively. The neonate died 3 days after the birth. No pathological examination was performed.

This retrospective study explored the applications of prenatal ultrasound in the diagnosis of fetal cutaneous hemangioma. We also reviewed the structural complications and pregnancy outcomes in these cases.

Previous studies reported that most cutaneous hemangiomas were in the head and neck,^20,21 and less often in the trunk, extremities, and mucosal surface.¹⁹ In the present study, cutaneous hemangiomas were found in the head and neck (55%), lower limbs (25%), trunk (10%), and upper limbs. This differed from previous reports,^3,19 in which the incidence in the middle trunk was higher than in the lower extremities. Of note, all 5 cases in which the pregnancy was terminated had cutaneous hemangiomas in the head and neck. Hemangiomas in these locations suggest a poor outcome.

The main prenatal ultrasonic characteristics of cutaneous hemangiomas were thickening of the subcutaneous soft tissue, with solid or solid-cystic mixed masses. The internal echo could be hypoechoic, iso-echoic, or hyperechoic. Color Doppler ultrasound could detect multiple strip color blood flow signals, which were important toward diagnosing hemangioma. The PSV and RIs of the cutaneous hemangioma blood supply varied significantly and had little diagnostic value. A hemangioma of large size was usually associated with advanced gestational age and a fast growth rate.

Cutaneous hemangiomas are easily misdiagnosed as teratoma, placental hemangioma, meningocele, or meningoencephalocele, and in the present study this occurred in 5 cases. Teratomas are mostly located in the sacrococcygeal region, head, and neck, with lipid stratification and calcified hyperechoic mass. Placental hemangiomas are mostly located on the fetal surface of the placenta, close to the entrance of the umbilical cord placenta and protruding into the amniotic cavity. The internal echo and blood supply are similar to that of fetal cutaneous hemangiomas. The relationship between the mass and surrounding tissues and organs should be monitored to determine its origin, in order to differentiate between placental and cutaneous hemangioma. Meningocele or meningoencephalocele is the interruption of the continuity of the strong echo light band of the skull, with a bulging mass at the skull defect. The meninges, brain tissue, or both bulge outward through the defect to form the mass. In Fig. 6, it can be clearly observed that the fetal skull had good continuity. The mass was not connected with the intracranial tissue.

There were no complications among cases in which the maximum diameter of the hemangioma was < 5 cm or volume < 40 cm³. The complication rates in cases in which the maximum diameter was ≥ 5 cm or volume ≥ 40 cm³ were 66.7% and 100%, respectively. Most complications were cardiac-related (87.5%), mainly indicated by an increased cardiothoracic area ratio and atrioventricular valve regurgitation. Tricuspid regurgitation could range from mild to severe in the third trimester. This suggested that ultrasound should be used to rule out structural abnormalities in fetuses when the cutaneous hemangioma has a maximum diameter ≥ 5 cm or mass volume ≥ 40 cm³.

One newborn developed KMP after the birth. KMP can be life-threatening, with significant thrombocytopenia, decreased fibrinogen level, increased fibrin degradation products, and accelerated tumor growth. It is a rare consumptive coagulation illness that occurs with certain vascular tumors.^3,4,9,20 Successful management can resolve KMP and make angioma regress.⁴ The only case of postnatal death in this study involved a newborn with congenital clustered hemangioma or kaposiform hemangioendothelioma (KHE) related to KMP. It is necessary to rule out cluster hemangiomas and KHE in cases with KMP.

Polyhydramnios can occur in up to 40% of fetuses with prenatal diagnosis of large neck masses.²⁸ When there is polyhydramnios, the possibility of esophagus and airway obstruction should be highly suspected. Real-time ultrasound can evaluate these functions in the fetus. Ultrasound is the first choice and highly accurate for prenatal examination of fetal cutaneous hemangiomas, while MRI can be used as a supplementary method. Prenatal ultrasound and MRI may also help delivery planning and immediate postnatal care.³¹

The high cardiac output caused by fetal cutaneous hemangioma can lead to fetal hydrops. Fetuses with fetal hydrops are more likely to have fetal distress in utero, which is easily complicated with KMP. Fetuses with hemangioma complicated with arteriovenous fistula and high cardiac output should rule out postnatal pulmonary hypertension. In Patient 4 and 5 in the present study, severe pulmonary hypertension occurred after the birth. After failing to respond to propranolol, they received artery ligation and achieved satisfactory outcomes. Therefore, clinical monitoring of growth in the mid and late pregnancy is very important.

In the present study, chromosome examination was performed in 6 patients before delivery, with no obvious abnormalities found. This result was similar to a previous study reported by Zheng et al.⁹

If the newborn survives, most congenital hemangiomas regress rapidly during the first year of life.^22,23 Some of them may remain stable or partially regress.² In the present study, the hemangiomas of newborns who were not give surgery or interventional treatments regressed to varying degrees during the follow-ups of up to 6 years. Regarding the treatment of cutaneous hemangioma, the conventional methods include oral glucocorticoids, cryotherapy, laser, local injection of sclerosing agent, and surgical resections. The outcome is uncertain and side effects can be significant. Currently, oral propranolol is the first-line treatment for hemangioma. It should be initiated as early as possible to minimize any potential side effects.^32,35,36 For large and complex hemangiomas, a variety of combined treatments can be considered.

Prenatal ultrasound examination is an important tool in the diagnosis of fetal cutaneous hemangioma and pregnancy monitoring. It can measure not only the size and growth rate of hemangiomas but also detect fetal structural complications to facilitate postpartum management.

MRI, magnetic resonance imaging; KMP, Kasabach-Merritt phenomenon; PSV, peak systolic velocity.

Acknowledgments

None.

Author contributions

ML designed the clinical study and drafted and revised the manuscript. BH performed the data analysis and processed the Figures. ZX collected data and performed the initial data analysis. LW, YC, and XL collected and analyzed the image data. SS prepared the Tables. NS designed the clinical study and reviewed and revised the manuscript.

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Prenatal ultrasound evaluation of fetal cutaneous hemangioma and related complications

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Abstract

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Key Message

1. Introduction

2. Materials And Methods

2.1 Study design and participant selection

2.2 Diagnosis criteria of cutaneous hemangiomas

2.3 Prenatal evaluations

2.4 Outcome measurements

2.5 Statistical analysis

3. Results

3.1 Clinical characteristics of study participants

3.2 Ultrasound characteristics of congenital hemangiomas

3.3 Complications in fetuses with congenital hemangiomas

3.4 Pregnancy outcomes

4. Discussion

5. Conclusion

Abbreviations

Declarations

References

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