Clinical‐pathological features in placentas of pregnancies with SARS‐CoV‐2 infection and adverse outcome: case series with and without congenital transmission

Abstract

Objective To correlate clinical outcomes to pathology in SARS‐CoV‐2 infected placentas in stillborn and live‐born infants presenting with fetal distress. Design Retrospective, observational. Setting Nationwide. Population Five stillborn and nine live‐born infants from 13 pregnant women infected with SARS‐CoV‐2 seeking care at seven different maternity units in Sweden. Methods Clinical outcomes and placental pathology were studied in 14 cases (one twin pregnancy) of maternal SARS‐CoV‐2 infection with impaired fetal 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 fetal clinical outcomes and placental pathology in stillborn and live‐born infants. Results Reduced fetal movements were reported (77%) and time from onset of maternal COVID‐19 symptoms to signs of fetal distress among live‐born infants was 6 (3–12) days and to diagnosis of stillbirth 11 (2–25) days. Two of the live‐born infants died during the postnatal period. Signs of fetal distress led to emergency caesarean section in all live‐born infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one live‐born neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillositis and trophoblast necrosis were associated with SARS‐CoV‐2 placental infection and congenital transmission. Conclusions SARS‐CoV‐2 can cause rapid placental dysfunction with subsequent acute fetal hypoxia leading to intrauterine fetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillositis and trophoblast degeneration.

Can SARS-CoV-2 positive pregnant women affect the hearing of their newborns: A systematic review

“…Thus, since a pregnant woman is a particular entity with a fetus in the uterus, SARS-CoV-2 infection affects not only the pregnant woman herself but also the fetus [30] . Second, SARS-CoV-2 infection in pregnant mothers can cause placental dysfunction, resulting in intrauterine hypoxia [31] . This infection can cause localized placental hypoxia through direct damage to the placental villi [32] .…”

Art–science multidisciplinary collaborations to address the scientific challenges posed by COVID-19

“…Current evidence supports coronavirus transmission by semen but not through vaginal fluids [ 38 ]. Congenital transmission of SARS-CoV-2 has been documented with clinical-pathological features [ 39 , 40 ]. Therefore, SARS-CoV-2 sexual and transplacental transmission may be considered in epidemiological studies.…”

Stillbirth after COVID-19 in Unvaccinated Mothers Can Result from SARS-CoV-2 Placentitis, Placental Insufficiency, and Hypoxic Ischemic Fetal Demise, Not Direct Fetal Infection: Potential Role of Maternal Vaccination in Pregnancy

“…Autopsy examination was performed in five cases that showed that all stillborns were anatomically normal with no microscopic evidence that SARS-CoV-2 had affected any fetal organ, and the authors ascribed the fetal deaths as due to placental insufficiency resulting from SARS-CoV-2 placentitis. In Sweden, Zaigham and colleagues reported five stillborn fetuses, including one set of twins, from mothers having COVID-19 infection [ 91 ]. The placentas of all stillborns were characterized by the findings of SARS-CoV-2 placentitis, and the authors concluded that the placental pathology-extensive fibrinoid deposits accompanied by villous necrosis characteristic of massive perivillous fibrin deposition accompanied by intervillositis accounted for the clinical outcomes of the stillborn fetuses.…”

“…Maternal viremia with SARS-CoV-2 has been described to occur in cases of SARS-CoV-2 placentitis and intrauterine fetal demise [ 97 ], and it is highly probable that reported cases of SARS-CoV-2 placentitis and stillbirth were the result of an episode of the virus circulating in the mothers’ bloodstream at some time during the pregnancy. In the 68 cases of stillbirth and early neonatal death from placental insufficiency arising from SARS-CoV-2 placentitis described by Schwartz et al [ 93 ], as well as the six perinatal deaths from Ireland described by Fitzgerald et al [ 78 ], the five stillborns from France reported by Debucs et al [ 92 ], five stillborns from Sweden reported by Zaigham et al [ 91 ], and others [ 98 ], the mothers were all unvaccinated for coronavirus.…”