Acute SARS‐CoV‐2 alpha variant infection leading to placental insufficiency and fetal distress

Abstract

The effect of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Alpha variant (also known as B.1.1.7 lineage, 20I/501Y.V1, the UK variant or VOC 202012/01) infection on pregnancy is currently unknown.We present a case of a 37-year-old woman admitted to our tertiary hospital at a gestational age of 29 weeks and 1 day because of oligohydramnios with reduced fetal movements for 10 days. About 20 days before admission, she tested positive for SARS-CoV-2 Alpha variant. The following day, due to abnormal cardiotocography, increased brain sparing, and absent end-diastolic flow in the umbilical artery, an urgent cesarean section was performed. The neonate had an uneventful admission to the neonatal intensive care unit. All neonatal samples proved negative for SARS-CoV-2.Pathological examination of the placenta revealed intervillous fibrin deposition, ischemic necrosis of villi and histiocytic intervillositis, corresponding with the SARS-CoV-2 placentitis triad. The placental tissue demonstrated a high viral load, possibly explaining the acute onset of placental insufficiently and subsequent fetal distress. This case demonstrates the importance of seeking medical care when experiencing reduced fetal movement in SARS-CoV-2 infected patients since acute infection can induce significant placental and subsequent fetal pathology.

Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases

“…A national population-based prospective cohort study from Italy including 3306 pregnant women with confirmed SARS-CoV-2 infection reported increased rates of oxygen support requirement and ICU admission among cases with pneumonia during the Alpha variant period compared to the wild-type period [ 14 ]. A case report from Belgium presented placentitis and acute placental insufficiency in a pregnant woman infected by the Alpha variant [ 15 ]. Another single-center retrospective cohort study from the United States compared the pregnancy outcomes between cases admitted to hospital before and after the Delta variant periods.…”

“…These variants are more transmissible and they have the potential for a worse prognosis [30][31][32]. The impact of new SARS-CoV-2 variants on pregnant women has been investigated in recent studies [14][15][16][17][18][19][20]33]. A national population-based prospective cohort study from Italy including 3306 pregnant women with confirmed SARS-CoV-2 infection reported increased rates of oxygen support requirement and ICU admission among cases with pneumonia during the Alpha variant period compared to the wild-type period [14].…”

“…Moreover, higher rates of obstetric complications like preterm delivery, preterm premature rupture of membranes, and fetal distress are observed in pregnancies complicated by COVID-19 [12,13]. There are recent publications in the literature indicating a worse prognosis in pregnant women infected by new SARS-CoV-2 variants [14][15][16][17][18][19][20][21][22]. However, our knowledge is still limited on the impact of new SARS-CoV-2 variants on maternal COVID-19 prognosis and pregnancy outcomes.…”

COVID‐19 and stillbirth: direct vs indirect effect of the pandemic

“…Thomas (2021) 46 197 4 Virus identified in situ, accompanied by intervillositis, in 2/197 placentae. Dumont (2021) 47 1 1 PFD with ischemic changes and necrosis of the villi, intervillous space with inflammatory cells and histiocytes. Bunnell (2021) 48 12 12 MVM (n = 5), FVM (n = 5).…”

“…Table 2 lists key studies reporting placental histopathological findings associated with stillbirth in pregnancies with maternal SARS‐CoV‐2 infection 40–63 .…”