Severe Postpartum Hemorrhage and Refractory Uterine Atony Associated with Placental Chorangiosis: A Case Report

Document Type : Case report

Authors

1 Assistant Professor, Department of Perinatology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Assistant Professor, Department of Radiation-oncology, Breast Cancer Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

10.22038/ijogi.2026.91889.6573

Abstract

Introduction: Postpartum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide, with uterine atony being its most common etiology. Rare pathological placental abnormalities, such as chorangiosis, may contribute to the occurrence and severity of PPH, although reports on this association are scarce. In this study, a case of severe postpartum hemorrhage with treatment-resistant atony due to placental chorangiosis is reported.
Case Presentation: We report a case of a 27-year-old primigravid woman (G1) at 38 weeks and 4 days of gestation who underwent an emergency cesarean section due to oligohydramnios and breech presentation. Following the delivery of a healthy newborn, the patient developed severe uterine atony refractory to standard therapeutic measures and ultimately required a subtotal hysterectomy due to massive hemorrhage. Histopathological examination of the placenta revealed chorangiosis. After stabilization of hemodynamic status and intensive care management, the patient was discharged in good general condition.
Conclusions: This case suggests a possible association between placental chorangiosis and severe refractory PPH. Awareness of this rare placental condition may help clinicians anticipate life-threatening complications and optimize management strategies.

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References

  1. Bláha J, Bartošová T. Epidemiology and definition of PPH worldwide. Best practice & research Clinical anaesthesiology. 2022 Dec 1; 36(3-4):325-39.
  2. World Health Organization. Global health agencies issue new recommendations to help end deaths from postpartum haemorrhage [Internet]. [cited 2025 Dec 25]. Available from: https://www.who.int/news/item/05-10-2025-global-health-agencies-issue-new-recommendations-to-help-end-deaths-from-postpartum-haemorrhage?referrer=grok.com
  3. Hemorrhage P. Committee on practice bulletins-obstetrics. Practice bulletin no. 183. Obstet. Gynecol 2017; 130:e168-86.
  4. Yunas I, Islam MA, Sindhu KN, Devall AJ, Podesek M, Alam SS, et al. Causes of and risk factors for postpartum haemorrhage: a systematic review and meta-analysis. The Lancet 2025; 405(10488):1468–80.
  5. Altshuler GE. Chorangiosis. An important placental sign of neonatal morbidity and mortality. Obstetrical & Gynecological Survey 1984; 39(8):493-6.
  6. Akbulut M, Sorkun HC, Bir F, Eralp A, Duzcan E. Chorangiosis: the potential role of smoking and air pollution. Pathology-Research and Practice 2009; 205(2):75-81.
  7. Vafaei H, Karimi Z, Akbarzadeh-Jahromi M, Asadian F. Association of placental chorangiosis with pregnancy complication and prenatal outcome: a case-control study. BMC pregnancy and childbirth 2021; 21(1):99.
  8. Akkour K. Chorangiosis of placenta: A rare case report with unusual presentation and outcome; 2021.
  9. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet global health 2014; 2(6):e323-33.
  10. Stanek J. Chorangiosis of chorionic villi: what does it really mean?. Archives of Pathology & Laboratory Medicine 2016; 140(6):588-93.
  11. Darshan HN, Purini PY, Sharmila V, Verma J. Placental chorangiosis–A case report and clinical insights. Philippine Journal of Obstetrics and Gynecology 2025; 49(3):177-9.
  12. Gün BD, Barut F, Tanrıverdi A, Özdamar ŞO, Barut A. Placental Chorangiosis: an important pattern of placental injury. Gynecology Obstetrics & Reproductive Medicine 2006; 12(3):176-9.
  13. Soma H, Watanabe Y, Hata T. Chorangiosis and chorangioma in three cohorts of placentas from Nepal, Tibet, and Japan. Reproduction, fertility and development 1995; 7(6):1533-8.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 28, Issue 12
February 2026
Pages 110-115

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