Histopathologic evaluation of placentas after diagnosis of maternal severe acute respiratory syndrome coronavirus 2 infection

Abstract

Background The impact of maternal severe acute respiratory syndrome coronavirus 2 infection on placental histopathology is not well known. Objective To determine if any significant placental histopathologic changes occur after the diagnosis of severe acute respiratory syndrome coronavirus 2 infection during pregnancy and whether these changes are correlated with the presence or absence of symptoms associated with the infection. Study Design A retrospective cohort study of women diagnosed as having severe acute respiratory syndrome coronavirus 2 infection who delivered at a single center from April 9, 2020 to April 27, 2020, and had placental specimens reviewed by the Department of Pathology. Women with singleton gestations and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for inclusion. Historical controls selected from a cohort of women who delivered 6 months before the study period were matched in a 1:1 fashion by weeks of gestation at delivery. Histopathologic characteristics were evaluated in each placenta, and the incidence of these findings was compared between placentas of those who received a diagnosis of maternal severe acute respiratory syndrome coronavirus 2 infection and historical controls, and between placentas from patients with or without typical symptoms related to the infection. Statistical analyses included the use of Wilcoxon rank-sum test and Fisher’s exact test for the comparison of categorical and continuous variables. Statistical significance was defined as a P value of <.05. Results A total of 50 placentas after the diagnosis of maternal severe acute respiratory syndrome coronavirus 2 infection and 50 historical controls were analyzed. Among the placentas from patients diagnosed with severe acute respiratory syndrome coronavirus 2 infection, 3 (6%) were preterm (33 3/7, 34 6/7, and 36 6/7 weeks of gestation), 16 (32%) were from patients with typical symptoms related to the infection, and 34 (68%) were from patients without typical symptoms related to the infection. All patients had received a diagnosis of severe acute respiratory syndrome coronavirus 2 infection in the third trimester. Decidual vasculopathy was not visualized in any of the placentas from patients diagnosed as having severe acute respiratory syndrome coronavirus 2 infection. There was no statistically significant difference in placental histopathologic characteristics between the groups. Severe acute respiratory syndrome coronavirus 2 test results for all neonates at 24 hours of life were negative. Conclusion Based on the results of this study, there are no significant placental histopathologic changes that occur after the diagnosis of severe acute respiratory syndrome coronavirus 2 infection in women during the third trimester of pregnancy compared with a gestational age–matched historical control group. Similar incide...

Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2

“…In a retrospective cohort investigation of the placentas from 50 pregnant women diagnosed with COVID-19 at a hospital in New York and compared with an equal number of control placentas from uninfected women, Gulerson et al [30] found that there were no statistically significant differences in the pathology findings between the two groups. All of the neonates from mothers with COVID-19 were negative for the virus by RT-PCR at 24 h of life.…”

The Effects of COVID-19 on Placenta and Pregnancy: What Do We Know So Far?

“…Reference lists of the included papers were also checked to identify additional relevant studies. We reviewed all articles (both peer-reviewed and preprints) with reports on placental pathology in pregnant women tested positive for SARS-CoV-2 that were published between 1 January 2020 to 10 October 2020 ( n = 29) [ 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 ]. Articles written in languages other than English and Mandarin were excluded.…”

Neonate born with ischemic limb to a COVID-19 positive mother: management and review of literature

“…In a case control study from Chicago of 15 placentas compared against 17,500 historical controls, a statistically significant increase in intervillous thrombi was demonstrated among COVID-19 patients [4]. Conversely, a retrospective control study in New York of 50 placentas from COVID-19 mothers compared to 50 control placentas from patients without COVID-19 showed no statistically significant differences [5]. In our patient, placental pathology was significant for excessive size for gestational age, intravascular fibrin, and infarctsigns of lower than average efficiency.…”

“…If the excessive volume of the placenta effectually led to restriction of fluid and movement of the arm, compression of the arm, and consequent ischemia, this would result in compartment syndrome as the etiology for ischemia. To date, COVID-19 maternal infection has not been found a risk factor for excessive placental size [5].…”

“…Moreover, some histopathologic examinations of placental tissue have shown fetal vascular malperfusion, vascular thrombi, and arteriopathy in COVID-19 mothers [3,4]. A larger study has demonstrated lack of any clinically significant differences in the placentas of mothers with COVID-19 compared to matched controls [5]. These findings indicate a need for more data to determine any relationship between COVID-19 infection and increased hypercoagulability during pregnancy.…”