Placental abruption in a twin pregnancy at 32 weeks’ gestation complicated by coronavirus disease 2019 without vertical transmission to the babies

Kuhrt, Katy; McMicking, Jess; Nanda, Surabhi; Nelson‐Piercy, Catherine; Shennan, Andrew

doi:10.1016/j.ajogmf.2020.100135

Cited by 40 publications

(45 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Evidence of MVM included a diffuse increase in syncytial knotting and microinfarction in P1, while decidual arteriopathy was not seen in either case. MVM has also been observed in the case series reported by Shanes et al [4] and in the case of a 32w-placenta abruption reported by Kuhrt et al [11].…”

Section: Maternal Vascular Malperfusion (Mvm)supporting

confidence: 55%

Further placental pathology in mild COVID-19 of term pregnancy with pathophysiological correlates

Konstantinidou¹,

Papaevangelou²,

Tsakris³

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Placental pathology related to SARS-COV-2 infection during pregnancy is under investigation, with emerging but still limited and variable data, mainly including changes of fetal and maternal vascular malperfusion. We observed novel pathological findings not previously reported in two term placentas delivered from women mildly affected with COVID-19, with a 2-day and 6-day interval between the onset of symptoms and delivery. The main changes involved the maternal more than the fetal components of the placenta and included a tendency toward thrombosis and fibrin formation, and mild maternal malperfusion. We further observed fibrin degeneration in the intervillous space, the presence of particles of undetermined origin, and mild or moderate maternal decidual inflammatory exudates consisting of monocytes, macrophages, T-lymphocytes, and plasmacytes. Mild inflammation and incipient mural thrombus formation were noted in the fetal vasculature, as well as endothelial vacuolation of the umbilical vessels, not previously described. The maternal changes were more prominent in the case with a relatively longer clinical manifestation-to-delivery interval, and were associated to a prolonged postpartum maternal viral carriage of 30 days and the development of a low-grade febrile response in the neonate. Both infants showed mild morbidity but eventually had a very good outcome. RT-PCR was negative for SARS-CoV-2 RNA in both cases.We concluded that placental involvement in mild COVID-19 of very short duration at term pregnancy suggested the systemic nature of the disease and appeared related to, though not pathognomonic of COVID-19. Fetoplacental vascular changes and endothelial vacuolation associated with mild neonatal morbidity may suggest a possible transplacental impact on the fetus, to be further investigated.

show abstract

Section: Maternal Vascular Malperfusion (Mvm)supporting

confidence: 55%

Further placental pathology in mild COVID-19 of term pregnancy with pathophysiological correlates

Konstantinidou¹,

Papaevangelou²,

Tsakris³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Serum biochemistry results were reported in 37 studies encompassing 381 women respectively 4,5,9–11,13–15,17,18,20,21,25,29,30,33–36,39,41,44–50,53,56,57–60,63,66 . In this group, raised serum C‐reactive protein was reported among 275 (72.2%) women, lymphopenia among 179 (47.0%) women, and transaminitis among 93 (24.4%) women.…”

Section: Resultsmentioning

confidence: 92%

“…Seven (1.9%) women were aged 40 years or older. Presenting symptoms were reported in 55 studies, comprising 515 pregnant women 4,5,7,11–19,21–30,32–57 . Of these, the most common symptoms at presentation were fever (n=273, 53.0%), cough (n=224, 43.5%), myalgia/malaise (n=79, 15.3%), dyspnea (n=64, 12.4%), diarrhea (n=18, 3.5%), and sore throat (n=18, 3.5%), regardless of gestational age.…”

Section: Resultsmentioning

confidence: 99%

“…Chest imaging findings were reported in 42 studies (n=274 women), and comprised 267 computed tomography (CT) scans of the chest, 15 plain chest X‐rays, and 5 CT pulmonary angiogram (CTPA) examinations 4,5,9–11,13,15–17,22–30,33–37,39–41,44,45,49–51,53,57–60,62–66 . In 26 studies, totaling 221 women from China with mild COVID‐19, 196 (88.7%) had abnormal chest CT and X‐ray findings, of whom 17 (8.7%) were asymptomatic at the time of radiologic evaluation 4,5,9–11,13,16,29,34–37,40,41,44,45,49–51,53,57‐60,62–64 . Abnormal pulmonary findings among pregnant women with mild disease included focal unilateral or bilateral ground glass opacities, whereas diffuse, bilateral ground glass opacities with subpleural involvement and pleural effusion were observed among all women with severe and critical COVID‐19.…”

Section: Resultsmentioning

confidence: 99%

“…Hemorrhagic complications were observed in 10 cases (Table 1). Four women presented at hospital with antepartum hemorrhage described as one of their presenting symptoms 45,51 . In addition, six women experienced postpartum hemorrhage (estimated blood loss >1000 mL), all of whom had undergone cesarean delivery.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

Turan

Hakim

Dashraath

et al. 2020

Intl J Gynecology & Obste

117

192

View full text Add to dashboard Cite

Background Pregnant women represent a potentially high‐risk population in the COVID‐19 pandemic. Objective To summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID‐19. Search strategy Relevant databases were searched up until May 29, 2020. Selection criteria Case series/reports of hospitalized pregnant women with laboratory‐confirmed COVID‐19. Data collection and analysis PRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools. Main results Overall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory‐confirmed SARS‐CoV‐2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D‐dimer and interleukin‐6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID‐19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours. Conclusions Advanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D‐dimer and interleukin‐6 levels are predictive of poor pregnancy outcomes in COVID‐19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.

show abstract

Mechanisms and evidence of vertical transmission of infections in pregnancy including SARS‐CoV‐2s

et al. 2020

View full text Add to dashboard Cite

There remain unanswered questions concerning mother-to-child-transmission of SARS-CoV-2. Despite reports of neonatal COVID-19, SARS-CoV-2 has not been consistently isolated in perinatal samples, thus definitive proof of transplacental infection is still lacking. To address these questions, we assessed investigative tools used to confirm maternal-fetal infection and known protective mechanisms of the placental barrier that prevent transplacental pathogen migration. Forty studies of COVID-19 pregnancies reviewed suggest a lack of consensus on diagnostic strategy for congenital infection. Although real-time polymerase chain reaction of neonatal swabs was universally performed, a wide range of clinical samples was screened including vaginal secretions (22.5%), amniotic fluid (35%), breast milk (22.5%) and umbilical cord blood. Neonatal COVID-19 was reported in eight studies, two of which were based on the detection of SARS-CoV-2 IgM in neonatal blood. Histological examination demonstrated sparse viral particles, vascular malperfusion and inflammation in the placenta from pregnant women with COVID-19. The paucity of placental coexpression of ACE-2 and TMPRSS2, two receptors involved in cytoplasmic entry of SARS-CoV-2, may explain its relative insensitivity to transplacental infection. Viral interactions may utilise membrane receptors other than ACE-2 thus, tissue susceptibility may be broader than currently known. Further spatial-temporal studies are needed to determine the true potential for transplacental migration.

show abstract

Placental abruption in a twin pregnancy at 32 weeks’ gestation complicated by coronavirus disease 2019 without vertical transmission to the babies

Cited by 40 publications

References 6 publications

Further placental pathology in mild COVID-19 of term pregnancy with pathophysiological correlates

Further placental pathology in mild COVID-19 of term pregnancy with pathophysiological correlates

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

Mechanisms and evidence of vertical transmission of infections in pregnancy including SARS‐CoV‐2s

Contact Info

Product

Resources

About