Counseling in maternal–fetal medicine: <scp>SARS‐CoV</scp>‐2 infection in pregnancy

Mascio, Daniele Di; Buca, D.; Berghella, Vincenzo; Khalil, Asma; Rizzo, Giuseppe; Odibo, AO; Saccone, Gabriele; Galindo, Alberto; Liberati, Marco; D’Antonio, Francesco

doi:10.1002/uog.23628

Cited by 57 publications

(68 citation statements)

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“…Maternal vascular hypoperfusion is potentially associated with higher risk of impaired placental function, growth restriction, and stillbirth. 77 In the present systematic review, we reported a high incidence of placental lesions suggesting hypoperfusion and inflammation, thus questioning whether these women should undergo additional scans during pregnancy.…”

Section: Discussionmentioning

confidence: 74%

“…More importantly, additional ultrasound scans throughout pregnancy might be required in women presenting with objective risk factors for growth restriction, such as a previous complicated pregnancy, abnormal placental biomarkers or increased pulsatility index in the uterine arteries, because in these women SARS-CoV-2 infection may worsen an already compromised placenta. 77 , 78…”

Section: Discussionmentioning

confidence: 99%

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Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Girolamo

Khalil

Alameddine

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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112

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Objectives : To report the spectrum of placental pathology findings in pregnancies complicated by SARS-CoV-2 infection. Methods : MEDLINE, EMBASE, Google Scholar and the Web of Science databases were searched up to August 11 th , 2021. Histopathological anomalies included maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute inflammatory pathology (AIP), chronic inflammatory pathology (CIP), increased perivillous fibrin and intervillous thrombosis. Sub-analyses including only symptomatic women and high-risk pregnancies were also performed. Histopathological analysis of the placenta included gross examination, histopathology on hematoxylin and eosin (H&E), immunohistochemistry (IHC), fluorescence in-situ hybridization (FISH), qRT-PCR on placental tissue, and transmission electron microscope (TEM). Random-effect meta-analyses were used to analyze the data. Results : Fifty-seven studies (1009 pregnancies) were included. MVM was reported in 31.4% (95% CI 21.0-42.8) of placentas, while FVM was observed in 26.9% of cases (95% CI 19.2-35.4). AIP and CIP were reported in 22.6% (95% CI 16.8-28.9) and 26.2% (95% CI 18.9-34.2) of cases, respectively. Increased perivillous fibrin was observed in 32.7% (95% CI 24.1-42.0) of placentas undergoing histopathological analysis, while intervillous thrombosis were observed in 14.6% (95% CI 10.6-21.8) of cases. Other placental findings, including either basal plate with attached myometrial fibers, microscopic accretism, villous edema, increased circulating nucleated Red Blood Cells or membranes with hemorrhage were reported in 38% (95% CI 28.5-48.0) of cases, while only 17.4% (95% CI 10.9-25.0) did not present any abnormal histological findings. Sub-analyses according to maternal symptoms due to SARS-CoV-2 infection or the presence of a high-risk pregnancy showed similar distribution of the different histopathological anomalies to that reported in the main analysis. The risk of placental histopathological anomalies was also higher when considering only case-control studies comparing women with SARS-CoV-2 infection with healthy controls. Conclusions : A significant proportion of placentas where SARS-CoV-2 occurred during pregnancy shows histopathological findings suggesting placental hypoperfusion and inflammation. Future multicenter prospective blinded studies are needed to correlate these placental lesions with pregnancy outcomes.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Girolamo

Khalil

Alameddine

et al. 2021

American Journal of Obstetrics & Gynecology MFM

Self Cite

112

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“…Furthermore there is an increased risk of abnormalities in fetal oxygenation that could induce cardiac and neurological disorders in fetus and neonates, including in patients without particular risk factors for COVID19 [ 8 ]. For these reasons, the International Society of Ultrasound in Obstetrics & Gynecology recommends monitoring the fetuses of infected mothers closely [ 9 ]. These anomalies could be explained by placental damage.…”

Section: Introductionmentioning

confidence: 99%

Placental lesions and SARS-Cov-2 infection: Diffuse placenta damage associated to poor fetal outcome

et al. 2021

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Introduction Pregnant women with covid-19 are more likely to experience preterm birth. The virus seems to be associated with a wide range of placental lesions, none of them specific. Method We collected cases of Covid-19 maternal infection during pregnancy associated with poor pregnancy outcomes, for which we received the placenta. We studied clinical data and described pathological findings of placenta and post-mortem examination of fetuses. We performed an immunohistochemical study and RT-PCR of SARS-Cov-2 on placenta samples. Results We report 5 cases of poor fetal outcome, 3 fetal deaths and 2 extreme premature neonates, one with growth restriction, without clinical and biological sign of SARS-Cov-2 infection. All placenta presented massive perivillous fibrin deposition and large intervillous thrombi associated with strong SARS-Cov-2 expression in trophoblast and SARS-CoV-2 PCR positivity in amniotic fluid or on placenta samples. Chronic histiocytic intervillositis was present in 4/5 cases. Placental ultrasound was abnormal and the sFLT1-PIGF ratio was increased in one case. Timing between mothers’ infection and the poor fetal outcome was ≤10 days in 4 cases. The massive placental damage are directly induced by the virus whose receptors are expressed on trophoblast, leading to trophoblast necrosis and massive inflammation in villous chamber, in a similar way it occurs in diffuse alveolar damage in adults infected by SARS-Cov-2. Discussion SARS-Cov-2 can be associated to a rare set of placental lesions which can lead to fetal demise, preterm birth, or growth restriction. Stronger surveillance of mothers infected by SARS-Cov-2 is required.

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“…Fever, cough, lymphopenia, and elevated C-reactive protein levels are the main diagnostic signs of SARS-CoV-2 infection in pregnancy [ 7 ]. There are no studies that confirmed that pregnant women are at risk of infection more than the rest of the population due to pregnancy itself, rather than other factors that can affect general population health, as ethnicity.…”

Section: Introductionmentioning

confidence: 99%

Assessment of fetal growth and anomalies in the era of COVID-19 pandemic: an Egyptian pilot study

Eltemamy

Salama

Salem

et al. 2021

Middle East Fertil Soc J

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Background Many issues need to be studied regarding pregnant women during the SARS-CoV-2 (COVID-19) infection pandemic. The aim of this study was to assess fetal growth, fetal well-being, and any observed gross anomalies that may follow SARS-CoV-2 infection in Egyptian pregnant women. During fetal anomaly scan at 22 weeks, we compared 30 pregnant women with a history of SARS-CoV-2 infection at 6‑12 weeks of gestation (group A) with 60 pregnant women (group B) who had no history of SARS-CoV-2. Then, we followed them on 28 and 34 weeks of gestation with fetal biometry and Doppler study. Results Our results revealed no significant difference between both groups regarding fetal biometry, estimated fetal weight, amniotic fluid index, Doppler scan, and gross anomaly scan throughout all visits. Conclusion According to the results of our pilot study, SARS-CoV-2 infection in pregnancy was not found to increase the risk of fetal growth restriction or possible fetal gross anomalies. Nevertheless, larger-scale studies are needed to confirm those findings. Perhaps, post-SARS-CoV-2 infection pregnancies may run an uncomplicated course regarding fetal parameters.

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Counseling in maternal–fetal medicine: SARS‐CoV‐2 infection in pregnancy

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 57 publications

References 68 publications

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Placental lesions and SARS-Cov-2 infection: Diffuse placenta damage associated to poor fetal outcome

Assessment of fetal growth and anomalies in the era of COVID-19 pandemic: an Egyptian pilot study

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