Intrauterine fetal death during COVID‐19 pregnancy: Typical fetal heart rate changes, coagulopathy, and placentitis

Abstract

Although various perinatal outcomes in coronavirus disease 2019 pregnancies have been reported, the fetal and neonatal consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remain unclear. Several reports of miscarriages and stillbirths have been recorded, but vertical transmission by SARS-CoV-2 is considered very rare, and the cause remains unknown. We report a case of a 22-year-old uncomplicated Japanese woman infected with SARS-CoV-2 during the second trimester, resulting in intrauterine fetal death due to placental insufficiency associated with COVID-19 placentitis. This report emphasizes the importance of longitudinal assessment of fetal well-being by fetal heart rate monitoring and early detection of maternal coagulation dysfunction representing SARS-CoV-2 inflammation to manage COVID-19 in pregnancy.

The effects of COVID-19 on placental morphology

“…Placental vascular changes due to COVID-19 infections during the third trimester have been extensively studied. Studies documented signs of maternal vascular malperfusion which included the presence of infarcts, thrombosis, increased syncytial knots, increased fibrin deposition, villous agglutination and accelerated villous maturation [ 44 , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [56] , [57] , [58] , [59] , [60] , [62] , [63] , [64] , [65] , 68 , 71 , 73 , 74 ]. Furthermore, subsequent studies that reported multi case investigations of placentae from COVID-19 positive mothers which presented different features of foetal vascular malperfusion including avascular villi, karyorrhexis, mural fibrin deposition, villous hypoplasia and chorangiosis [ 44 , 46 , 48 , 49 , 51 , 54 , 56 , 59 , 62 , 63 , 65 , 66 , 69 , 73 ].…”

Cardiovascular Complications of COVID-19 among Pregnant Women and Their Fetuses: A Systematic Review

“…Kato et al reported tachycardia in the fetus of a pregnant woman with COVID-19 [ 73 ]. On the other hand, Cetera et al reported bradycardia in the fetus of the three reported pregnant COVID-19 cases [ 74 ].…”

Maternal and Neonatal Outcomes Associated With COVID-19 Infection in Pregnant Mothers Admitted in Tertiary Care Hospital in Central State of India

“…Kato et al. reported an IUD in a 22-year-old healthy Japanese woman who acquired SARS-CoV-2 infection during her second trimester and lost her fetus in utero due to placental insufficiency brought on by COVID-19 placentitis [ 12 , 23 ]. Some researchers have suggested that fetal death inside the womb is one of the gravest problems that can arise in pregnant women who have COVID-19.…”

“…also conveyed similar findings in their long-term cohort research in which 10,550 neonates born to women infected with COVID-19 during pregnancy had low APGAR scores. In a group of neonates whose mothers had been diagnosed with COVID-19, the risk of having an APGAR score below 7 was 25.4 times higher than the risk for a group of neonates whose mothers had not been diagnosed with COVID-19, indicating that the mother's COVID-19 status affects the neonatal APGAR score [ 23 - 26 ]. Many researchers have claimed that newborns with low APGAR scores may be affected by their mothers' acute symptoms, such as asphyxiation, which can lead to cesarean delivery.…”