Background: Placental chorioangioma is a rare benign vascular tumour. Large lesions can be associated with significant maternal and fetal morbidity. Early prenatal diagnosis is critical for risk stratification and optimized perinatal care. Case Presentation: We report a case of a giant placental chorioangioma diagnosed at 18 weeks’ gestation in a 33-year-old primigravida. Serial ultrasound and Doppler evaluations showed stable lesion size and normal fetal hemodynamics. At 38 weeks, elective cesarean delivery resulted in the birth of a healthy neonate. Conclusion: This case highlights the importance of accurate prenatal diagnosis and multidisciplinary management. Conservative surveillance can be effective in the absence of fetal compromise, and elective cesarean delivery represents a safe option for large vascular placental tumours.