Coronavirus Diseases in Pregnant Women, the Placenta, Fetus, and Neonate

Schwartz, David A.; Dhaliwal, Amareen

doi:10.1007/978-3-030-63761-3_14

Cited by 18 publications

(18 citation statements)

References 76 publications

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“…Moreover, pregnancy remains one of the most vulnerable periods in terms of morbidity and mortality, not only for the mother, but also for the fetus. In addition, these changes in hormone levels that begin in the first trimester of pregnancy lead to respiratory, cardiovascular, and immune changes that make pregnant women more susceptible to SARS-Cov-2 infection, in addition to an increased risk of developing SARS [14] . Only 3 infants have been tested positive for SARS-CoV-2, between 8 and 20 days of life.…”

Section: Discussionmentioning

confidence: 99%

Neonatal outcomes related to maternal SARS-CoV-2 infection in French Guiana: A case-control study.

Elenga

Wandji

Siban

et al. 2022

Journal of Infection and Public Health

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Section: Discussionmentioning

confidence: 99%

Neonatal outcomes related to maternal SARS-CoV-2 infection in French Guiana: A case-control study.

Elenga

Wandji

Siban

et al. 2022

Journal of Infection and Public Health

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“…However, multiple conflicting results were found in these early studies that proved to be confusing, as a variable and inconsistent spectrum of findings were described. These included fetal and maternal vascular malperfusion, thromboses, hemorrhage, increased fibrin, a variety of inflammatory abnormalities and combinations of these processes [31][32][33]. The absence of specific findings related to COVID-19 in placentas from infected women was suggested in several articles [34][35][36], including one entitled "SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology…" [35], adding to this uncertainty.…”

Section: Discussionmentioning

confidence: 99%

Molecular Pathology Demonstration of SARS-CoV-2 in Cytotrophoblast from Placental Tissue with Chronic Histiocytic Intervillositis, Trophoblast Necrosis and COVID-19

Schwartz

Bugatti

Santoro

et al. 2021

JDB

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A subset of placentas from pregnant women having the SARS-CoV-2 infection have been found to be infected with the coronavirus using molecular pathology methods including immunohistochemistry and RNA in situ hybridization. These infected placentas can demonstrate several unusual findings which occur together—chronic histiocytic intervillositis, trophoblast necrosis and positive staining of the syncytiotrophoblast for SARS-CoV-2. They frequently also have increased fibrin deposition, which can be massive in some cases. Syncytiotrophoblast is the most frequent fetal-derived cell type to be positive for SARS-CoV-2. It has recently been shown that in a small number of infected placentas, villous stromal macrophages, termed Hofbauer cells, and villous capillary endothelial cells can also stain positive for SARS-CoV-2. This report describes a placenta from a pregnant woman with SARS-CoV-2 that had chronic histiocytic intervillositis, trophoblast necrosis, increased fibrin deposition and positive staining of the syncytiotrophoblast for SARS-CoV-2. In addition, molecular pathology testing including RNAscope and immunohistochemistry for SARS-CoV-2 and double-staining immunohistochemistry using antibodies to E-cadherin and GATA3 revealed that cytotrophoblast cells stained intensely for SARS-CoV-2. All of the cytotrophoblast cells that demonstrated positive staining for SARS-CoV-2 were in direct physical contact with overlying syncytiotrophoblast that also stained positive for the virus. The pattern of cytotrophoblast staining for SARS-CoV-2 was patchy, and there were chorionic villi having diffuse positive staining of the syncytiotrophoblast for SARS-CoV-2, but without staining of cytotrophoblast. This first detailed description of cytotrophoblast involvement by SARS-CoV-2 adds another fetal cell type from infected placentas that demonstrate viral staining.

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Section: Introductionmentioning

confidence: 99%

“…Human outbreaks from two coronavirus species prior to the coronavirus disease 2019 (COVID-19) pandemic were the cause of adverse obstetrical outcomes [ 1 , 2 , 3 ]. Both severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) have occurred in pregnant women, causing maternal and perinatal morbidity and mortality [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. In December 2019 a newly emergent coronavirus, termed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), resulted in a large outbreak of respiratory tract disease in Wuhan, China [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…In December 2019 a newly emergent coronavirus, termed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), resulted in a large outbreak of respiratory tract disease in Wuhan, China [ 8 , 9 ]. As SARS-CoV-2 spread globally, during the early stages of the COVID-19 pandemic there was great concern that the virus would be transmissible from infected mothers to their fetuses [ 1 , 2 , 3 , 10 , 11 ]. However, previous experience with SARS-CoV and MERS-CoV during pregnancy had not identified intrauterine transmission [ 1 ], and other respiratory RNA viruses demonstrated either non-existent or rare instances of maternal-fetal transmission [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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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

Schwartz

2022

Viruses

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Stillbirth is a recently recognized complication of COVID-19 in pregnant women. Other congenitally transmitted infections from viruses, bacteria and parasites can cause stillbirth by infecting fetal organs following transplacental transmission of the agent from the maternal bloodstream. However, recent research on pregnant women with COVID-19 having stillbirths indicates that there is another mechanism of stillbirth that can occur in placentas infected with SARS-CoV-2. In these cases, viral infection of the placenta results in SARS-CoV-2 placentitis, a combination of concurrent destructive findings that include increased fibrin deposition which typically reaches the level of massive perivillous fibrin deposition, chronic histiocytic intervillositis and trophoblast necrosis. These three pathological lesions, in some cases together with placental hemorrhage, thrombohematomas and villitis, result in severe and diffuse placental parenchymal destruction. This pathology can involve greater than one-half of the placental volume, averaging 77% in the largest study of 68 cases, effectively rendering the placenta incapable of performing its function of oxygenating the fetus. This destructive placental process can lead to stillbirth and neonatal death via malperfusion and placental insufficiency which is independent of fetal infection. Fetal autopsies show no evidence that direct infection of fetal organs is contributory. Because all mothers examined have been unvaccinated, maternal vaccination may prevent viremia and consequent placental infection.

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Coronavirus Diseases in Pregnant Women, the Placenta, Fetus, and Neonate

Cited by 18 publications

References 76 publications

Neonatal outcomes related to maternal SARS-CoV-2 infection in French Guiana: A case-control study.

Neonatal outcomes related to maternal SARS-CoV-2 infection in French Guiana: A case-control study.

Molecular Pathology Demonstration of SARS-CoV-2 in Cytotrophoblast from Placental Tissue with Chronic Histiocytic Intervillositis, Trophoblast Necrosis and COVID-19

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

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