tetano
Editor, Senior Moderator
J Pediatric Infect Dis Soc
. 2020 Dec 26;piaa153.
doi: 10.1093/jpids/piaa153. Online ahead of print.
Severe Acute Respiratory Syndrome Coronavirus 2 Placental Infection and Inflammation Leading to Fetal Distress and Neonatal Multi-Organ Failure in an Asymptomatic Woman
Sam Schoenmakers[SUP] 1 [/SUP], Pauline Snijder[SUP] 2 [/SUP], Robert M Verdijk[SUP] 3 [/SUP], Thijs Kuiken[SUP] 4 [/SUP], Sylvia S M Kamphuis[SUP] 5 [/SUP], Laurens P Koopman[SUP] 6 [/SUP], Thomas B Krasemann[SUP] 6 [/SUP], Melek Rousian[SUP] 1 [/SUP], Michelle Broekhuizen[SUP] 2 7 [/SUP], Eric A P Steegers[SUP] 1 [/SUP], Marion P G Koopmans[SUP] 4 [/SUP], Pieter L A Fraaij[SUP] 4 5 [/SUP], Irwin K M Reiss[SUP] 2 [/SUP]
Affiliations
Abstract
Background: In general, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is not considered to be an increased risk for severe maternal outcomes but has been associated with an increased risk for fetal distress. Maternal-fetal transmission of SARS-CoV-2 was initially deemed uncertain; however, recently a few cases of vertical transmission have been reported. The intrauterine mechanisms, besides direct vertical transmission, leading to the perinatal adverse outcomes are not well understood.
Methods: Multiple maternal, placental, and neonatal swabs were collected for the detection of SARS-CoV-2 using real-time quantitative polymerase chain reaction (RT-qPCR). Serology of immunoglobulins against SARS-CoV-2 was tested in maternal, umbilical cord, and neonatal blood. Placental examination included immunohistochemical investigation against SARS-CoV-2 antigen expression, with SARS-CoV-2 ribonucleic acid (RNA) in situ hybridization and transmission electron microscopy.
Results: RT-qPCRs of the oropharynx, maternal blood, vagina, placenta, and urine were all positive over a period of 6 days, while breast milk, feces, and all neonatal samples tested negative. Placental findings showed the presence of SARS-CoV-2 particles with generalized inflammation characterized by histiocytic intervillositis with diffuse perivillous fibrin depositions with damage to the syncytiotrophoblasts.
Conclusions: Placental infection by SARS-CoV-2 leads to fibrin depositions hampering fetal-maternal gas exchange with resulting fetal distress necessitating a premature emergency cesarean section. Postpartum, the neonate showed a fetal or pediatric inflammatory multisystem-like syndrome with coronary artery ectasia temporarily associated with SARS-CoV-2 for which admittance and care on the neonatal intensive care unit (NICU) were required, despite being negative for SARS-CoV-2. This highlights the need for awareness of adverse fetal and neonatal outcomes during the current coronavirus disease 2019 pandemic, especially considering that the majority of pregnant women appear asymptomatic.
Keywords: Kawasaki-like syndrome; SARS-CoV-2; fetal distress; inflammation; placenta.
. 2020 Dec 26;piaa153.
doi: 10.1093/jpids/piaa153. Online ahead of print.
Severe Acute Respiratory Syndrome Coronavirus 2 Placental Infection and Inflammation Leading to Fetal Distress and Neonatal Multi-Organ Failure in an Asymptomatic Woman
Sam Schoenmakers[SUP] 1 [/SUP], Pauline Snijder[SUP] 2 [/SUP], Robert M Verdijk[SUP] 3 [/SUP], Thijs Kuiken[SUP] 4 [/SUP], Sylvia S M Kamphuis[SUP] 5 [/SUP], Laurens P Koopman[SUP] 6 [/SUP], Thomas B Krasemann[SUP] 6 [/SUP], Melek Rousian[SUP] 1 [/SUP], Michelle Broekhuizen[SUP] 2 7 [/SUP], Eric A P Steegers[SUP] 1 [/SUP], Marion P G Koopmans[SUP] 4 [/SUP], Pieter L A Fraaij[SUP] 4 5 [/SUP], Irwin K M Reiss[SUP] 2 [/SUP]
Affiliations
- PMID: 33367801
- DOI: 10.1093/jpids/piaa153
Abstract
Background: In general, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is not considered to be an increased risk for severe maternal outcomes but has been associated with an increased risk for fetal distress. Maternal-fetal transmission of SARS-CoV-2 was initially deemed uncertain; however, recently a few cases of vertical transmission have been reported. The intrauterine mechanisms, besides direct vertical transmission, leading to the perinatal adverse outcomes are not well understood.
Methods: Multiple maternal, placental, and neonatal swabs were collected for the detection of SARS-CoV-2 using real-time quantitative polymerase chain reaction (RT-qPCR). Serology of immunoglobulins against SARS-CoV-2 was tested in maternal, umbilical cord, and neonatal blood. Placental examination included immunohistochemical investigation against SARS-CoV-2 antigen expression, with SARS-CoV-2 ribonucleic acid (RNA) in situ hybridization and transmission electron microscopy.
Results: RT-qPCRs of the oropharynx, maternal blood, vagina, placenta, and urine were all positive over a period of 6 days, while breast milk, feces, and all neonatal samples tested negative. Placental findings showed the presence of SARS-CoV-2 particles with generalized inflammation characterized by histiocytic intervillositis with diffuse perivillous fibrin depositions with damage to the syncytiotrophoblasts.
Conclusions: Placental infection by SARS-CoV-2 leads to fibrin depositions hampering fetal-maternal gas exchange with resulting fetal distress necessitating a premature emergency cesarean section. Postpartum, the neonate showed a fetal or pediatric inflammatory multisystem-like syndrome with coronary artery ectasia temporarily associated with SARS-CoV-2 for which admittance and care on the neonatal intensive care unit (NICU) were required, despite being negative for SARS-CoV-2. This highlights the need for awareness of adverse fetal and neonatal outcomes during the current coronavirus disease 2019 pandemic, especially considering that the majority of pregnant women appear asymptomatic.
Keywords: Kawasaki-like syndrome; SARS-CoV-2; fetal distress; inflammation; placenta.