Placental pathology and fetal demise at 35 weeks of gestation in a woman with SARS-CoV-2 infection: A case report

Poisson, Tiffany M.; Pierone, Gerald

doi:10.1016/j.crwh.2021.e00289

Cited by 30 publications

(44 citation statements)

References 10 publications

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“…Thorough literature search aimed at including all potentially relevant studies, multitude of histopathological anomalies and the large numbers of included cases 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 represent the main strengths of the present systematic review. The retrospective design of most of the included studies, small sample size, and heterogeneity in histopathological anomalies observed, are the main limitations of this systematic review.…”

Section: Discussionmentioning

confidence: 99%

“… 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%

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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

117

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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: 99%

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

117

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“…16,31,32 Since then, additional similar cases with these findings have been reported. [33][34][35][36][37][38] Hofbauer cells are fetal macrophages that are normally present within chorionic villi from as early as 18 days gestation up to delivery. Located within the chorionic villous stroma, in close proximity to both the trophoblast layer as well as the villous capillaries, Hofbauer cells are in an optimal position to respond to pathogenic organisms potentially crossing the maternalfetal interface.…”

Section: Introductionmentioning

confidence: 99%

Hofbauer Cells and COVID-19 in Pregnancy

Schwartz

Baldewijns

Benachi

et al. 2021

Archives of Pathology &Amp; Laboratory Medicine

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Context.– Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can undergo maternal-fetal transmission, heightening interest in the placental pathology findings from this infection. Transplacental SARS-CoV-2 transmission is typically accompanied by chronic histiocytic intervillositis together with necrosis and positivity of syncytiotrophoblast for SARSCoV-2. Hofbauer cells are placental macrophages that have been involved in viral diseases including HIV and Zika virus, but their involvement in SARS-CoV-2 in unknown. Objective.– To determine whether SARS-CoV-2 can extend beyond the syncytiotrophoblast to enter Hofbauer cells, endothelium and other villous stromal cells in infected placentas of liveborn and stillborn infants. Design.– Case-based retrospective analysis by 29 perinatal and molecular pathology specialists of placental findings from a preselected cohort of 22 SARS-CoV-2-infected placentas delivered to pregnant women testing positive for SARS-CoV-2 from 7 countries. Molecular pathology methods were used to investigate viral involvement of Hofbauer cells, villous capillary endothelium, syncytiotrophoblast and other fetal-derived cells. Results.– Chronic histiocytic intervillositis and trophoblast necrosis was present in all 22 placentas (100%). SARS-CoV-2 was identified in Hofbauer cells from 4/22 placentas (18%). Villous capillary endothelial staining was positive in 2/22 cases (9%), both of which also had viral positivity in Hofbauer cells. Syncytiotrophoblast staining occurred in 21/22 placentas (95%). Hofbauer cell hyperplasia was present in 3/22 placentas (14%). In the 7 cases having documented transplacental infection of the fetus, 2 occurred in placentas with Hofbauer cell staining positive for SARS-CoV-2. Conclusions.– SARS-CoV-2 can extend beyond the trophoblast into the villous stroma, involving Hofbauer cells and capillary endothelial cells, in a small number of infected placentas. Most cases of SARS-CoV-2 transplacental fetal infection occur without Hofbauer cell involvement.

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“…Placental pathology findings from pregnant women with COVID-19 were previously described by many authors ( Table 1 ), [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Poisson and Pierone identified placental lesions such as extensive fetal vascular malperfusion in a case of fetal demise from a woman with SARS-CoV-2 infection without any associated disease [ 12 ]. In a series of 20 cases, Baergen and Heller showed that fetal vascular malperfusion was the most common lesion in their cohort [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of COVID-19 Pregnancy Complicated with Hydrops Fetalis and Intrauterine Death

Popescu

Cioca²,

Muresan

et al. 2021

Medicina

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Coronavirus disease 2019 (COVID-19) has rapidly evolved into a worldwide pandemic causing a serious global public health problem. The risk of vertical transmission of SARS-CoV-2 is still debated, and the consequences of this virus on pregnant women and their fetuses remain unknown. We report a case of pregnancy complicated with hydrops fetalis that developed 7 weeks after recovery from a mild SARS-CoV-2 infection, leading to intrauterine death of the foetus. Evidence of SARS-CoV-2 placentitis was demonstrated by the presence of viral particles in the placenta identified by immunohistochemistry. As we excluded all possible etiological factors for non-immunologic hydrops fetalis, we believe that the fetal consequences of our case are related to vertical transmission of SARS-CoV-2 virus. To the best of our knowledge, this is the second reported case in the literature of COVID-19 infection complicated with hydrops fetalis and intrauterine fetal demise.

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Placental pathology and fetal demise at 35 weeks of gestation in a woman with SARS-CoV-2 infection: A case report

Cited by 30 publications

References 10 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

Hofbauer Cells and COVID-19 in Pregnancy

A Case of COVID-19 Pregnancy Complicated with Hydrops Fetalis and Intrauterine Death

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