tetano
Editor, Senior Moderator
BJOG
. 2022 Mar 3.
doi: 10.1111/1471-0528.17132. Online ahead of print.
Clinical-pathological features in placentas of pregnancies with SARS-CoV-2 infection and adverse outcome: case-series with and without congenital transmission
Mehreen Zaigham[SUP] 1 2 [/SUP], David Gisselsson[SUP] 3 4 [/SUP], Anna Sand[SUP] 5 6 [/SUP], Anna-Karin Wikström[SUP] 7 [/SUP], Emma von Wowern[SUP] 2 8 [/SUP], David A Schwartz[SUP] 9 [/SUP], Linda Iorizzo[SUP] 10 [/SUP], Maria Nelander[SUP] 7 [/SUP], Marie Blomberg[SUP] 11 [/SUP], Nikos Papadogiannakis[SUP] 12 [/SUP], Sandra Holmström[SUP] 13 [/SUP], Åsa Leijonhfvud[SUP] 10 [/SUP], Verena Sengpiel[SUP] 14 15 [/SUP]
Affiliations
Abstract
Objective: To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and liveborn infants presenting with foetal distress.
Design: Retrospective, observational.
Setting: Nationwide.
Population or sample: Five stillborn and 9 liveborn infants from 13 pregnant women infected with SARS-CoV-2 seeking care at 7 different maternity units in Sweden.
Methods: Clinical outcomes and placental pathology were studied in 14 cases (1 twin pregnancy) of maternal SARS-CoV-2 infection with impaired foetal outcome. Outcomes were correlated to placental pathology in order to investigate the impact of virus-related pathology on the villous capillary endothelium, trophoblast and other cells.
Main outcome measures: Maternal and foetal clinical outcomes and placental pathology in stillborn and liveborn infants.
Results: Reduced foetal movements were reported (77%) and time from onset of maternal COVID-19 symptoms to signs of foetal distress among liveborn infants was 6 (3-12) days and to diagnosis of stillbirth 11 (2-25) days. Two of the liveborn infants died during the postnatal period. Signs of foetal distress led to emergency Caesarean section in all liveborn infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one liveborn neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillousitis and trophoblast necrosis was associated with SARS-CoV-2 placental infection and congenital transmission.
Conclusions: SARS-CoV-2 can cause rapid placental dysfunction with subsequent acute foetal hypoxia leading to intrauterine foetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillousitis and trophoblast degeneration.
Keywords: COVID-19; COVID-19 maternal-foetal transmission; SARS-CoV-2; SARS-CoV-2 placental infection; chronic histiocytic intervillositis; coronavirus; foetal distress; maternal floor infarction; placental endothelial cells; placental pathology; vertical SARS-CoV-2 transmission; villous macrophages.
. 2022 Mar 3.
doi: 10.1111/1471-0528.17132. Online ahead of print.
Clinical-pathological features in placentas of pregnancies with SARS-CoV-2 infection and adverse outcome: case-series with and without congenital transmission
Mehreen Zaigham[SUP] 1 2 [/SUP], David Gisselsson[SUP] 3 4 [/SUP], Anna Sand[SUP] 5 6 [/SUP], Anna-Karin Wikström[SUP] 7 [/SUP], Emma von Wowern[SUP] 2 8 [/SUP], David A Schwartz[SUP] 9 [/SUP], Linda Iorizzo[SUP] 10 [/SUP], Maria Nelander[SUP] 7 [/SUP], Marie Blomberg[SUP] 11 [/SUP], Nikos Papadogiannakis[SUP] 12 [/SUP], Sandra Holmström[SUP] 13 [/SUP], Åsa Leijonhfvud[SUP] 10 [/SUP], Verena Sengpiel[SUP] 14 15 [/SUP]
Affiliations
- PMID: 35243759
- DOI: 10.1111/1471-0528.17132
Abstract
Objective: To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and liveborn infants presenting with foetal distress.
Design: Retrospective, observational.
Setting: Nationwide.
Population or sample: Five stillborn and 9 liveborn infants from 13 pregnant women infected with SARS-CoV-2 seeking care at 7 different maternity units in Sweden.
Methods: Clinical outcomes and placental pathology were studied in 14 cases (1 twin pregnancy) of maternal SARS-CoV-2 infection with impaired foetal outcome. Outcomes were correlated to placental pathology in order to investigate the impact of virus-related pathology on the villous capillary endothelium, trophoblast and other cells.
Main outcome measures: Maternal and foetal clinical outcomes and placental pathology in stillborn and liveborn infants.
Results: Reduced foetal movements were reported (77%) and time from onset of maternal COVID-19 symptoms to signs of foetal distress among liveborn infants was 6 (3-12) days and to diagnosis of stillbirth 11 (2-25) days. Two of the liveborn infants died during the postnatal period. Signs of foetal distress led to emergency Caesarean section in all liveborn infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one liveborn neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillousitis and trophoblast necrosis was associated with SARS-CoV-2 placental infection and congenital transmission.
Conclusions: SARS-CoV-2 can cause rapid placental dysfunction with subsequent acute foetal hypoxia leading to intrauterine foetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillousitis and trophoblast degeneration.
Keywords: COVID-19; COVID-19 maternal-foetal transmission; SARS-CoV-2; SARS-CoV-2 placental infection; chronic histiocytic intervillositis; coronavirus; foetal distress; maternal floor infarction; placental endothelial cells; placental pathology; vertical SARS-CoV-2 transmission; villous macrophages.