Histological characterization of placenta in COVID19 pregnant women

Cribiù, Fulvia Milena; Croci, Giorgio Alberto; Gobbo, Alessandro Del; Rizzuti, Tommaso; Iurlaro, Enrico; Tondo, Marta; Viscardi, Anna; Bòsari, Silvano; Ferrero, Stefano

doi:10.1016/j.ejogrb.2020.06.041

Cited by 10 publications

(11 citation statements)

References 6 publications

(4 reference statements)

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“…Regarding the previously reported series of placentas delivered by women with SARS-CoV-2 infection, no specific findings have been reported so far [6,22,31,33,47,48,53,54]. In particular, Hecht et al examined 19 placentas and found no characteristic histopathological features.…”

Section: Discussionmentioning

confidence: 93%

“…To date, placental histopathology in COVID-19 has been investigated [6,7,18,22,31,33,47,48,53,54], but specific features or hallmarks have not been identified. Nevertheless, the inflammatory activation and the increased thrombotic risk described in patients with COVID-19 [35,52,57] make the placenta a potential target of pathophysiological phenomena which could affect pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Placenta histopathology in SARS-CoV-2 infection: analysis of a consecutive series and comparison with control cohorts

et al. 2021

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Infection by SARS-CoV-2 has been shown to involve a wide range of organs and tissues, leading to a kaleidoscope of clinical conditions. Within this spectrum, an involvement of the fetal-maternal unit could be expected, but, so far, the histopathological evaluation of placentas delivered by women with SARS-CoV-2 infection did not show distinct hallmarks. A consecutive series of 11 placentas, delivered by 10 women with COVID-19 admitted to our Obstetrics and Gynecology clinic have been investigated and compared to a control cohort of 58 pre-COVID-19 placentas and 28 placentas delivered by women who had a previous cesarean section. Four out of eleven placentas showed changes consistent with chronic villitis/villitis of unknown etiology (VUE), while in one case, chronic histiocytic intervillositis was diagnosed. Thrombo-hemorrhagic alterations were observed in a subset of cases. Compared to the control cohort, chronic villitis/VUE (p < 0.001), chronic deciduitis (p = 0.023), microvascular thrombosis (p = 0.003), presence of infarction areas (p = 0.047) and of accelerated villous maturation (p = 0.005) showed higher frequencies in placentas delivered by women with COVID-19. Chronic villitis/VUE (p = 0.003) and accelerated villous maturation (p = 0.019) remained statistically significant by restricting the analysis to placentas delivered after a previous cesarean section. The observed differences in terms of pathological findings could be consistent with SARS-CoV-2 pathogenesis, but just a subset of alterations remained statistically significant after adjusting for a previous cesarean section. A careful consideration of potential confounders is warranted in future studies exploring the relationship between COVID-19 and pregnancy.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Placenta histopathology in SARS-CoV-2 infection: analysis of a consecutive series and comparison with control cohorts

et al. 2021

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“…It is assumed that the 5 cases reported by Mulvey et al are incorporated in the larger report by Baegen and Heller from the same institution [ 20 , 21 ]. Cribiù et al reported placentas from 9 patients [ 22 ]. Maternal vascular malperfusion was seen in 2 cases; delayed villous maturation in 5 cases and perivillous fibrin deposits in 8 cases [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cribiù et al reported placentas from 9 patients [ 22 ]. Maternal vascular malperfusion was seen in 2 cases; delayed villous maturation in 5 cases and perivillous fibrin deposits in 8 cases [ 22 ]. Smithgall et al described 51 cases and reported that villous agglutination and subchorionic intervillous thrombi were statistically more common in COVID-19 cases [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 placentitis: An uncommon complication of maternal COVID-19

et al. 2021

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“… 8 Several reports suggest an increased risk of placental lesions due to hypoperfusion and inflammation in women with SARS-CoV-2 infection. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 The potential association between SARS-CoV-2 and impaired placental function is crucial because it might lead to fetal decompensation and increased risk of perinatal mortality and morbidity. 66 , 67 Despite this, the occurrence of placental histopathological abnormalities in pregnancies complicated by SARS-CoV-2 infection is yet to be fully explored.…”

Section: Introductionmentioning

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

119

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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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Histological characterization of placenta in COVID19 pregnant women

Cited by 10 publications

References 6 publications

Placenta histopathology in SARS-CoV-2 infection: analysis of a consecutive series and comparison with control cohorts

Placenta histopathology in SARS-CoV-2 infection: analysis of a consecutive series and comparison with control cohorts

SARS-CoV-2 placentitis: An uncommon complication of maternal COVID-19

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

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