“…IgM cutoffs are based on adult data; however, neonates produce less immunoglobulins than adults. 33 activation of transcriptional programs, which in turn induce a proinflammatory cytokine storm, largely driven by production of IL-6. 55 Both an inflammatory and prognostic marker, IL-6 can predict disease progression in adults, as noted in a United States cohort of pregnant patients with severe to critical SARS-CoV-2 infection.…”
The first cases of severe pneumonia from a novel coronavirus were reported in Wuhan, China in December 2019. 10 Since then, the virus has been identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 infection causes fevers, cough, dyspnea, myalgias, pharyngitis, diarrhea, pneumonia, acute respiratory distress syndrome, multisystem organ failure, cytokine storm, endothelial damage, and thrombotic events. 2,3,11-13 It has infected over 12 million people and caused over 550 000 deaths across the globe. 1 The case fatality rate is estimated at 2.3% among the entire population. 14 Recent observations show that the majority of pregnant women are asymptomatic or have mild disease based on the criteria proposed by Wu et al. 14-16 Nevertheless, any infection during pregnancy has potential risks. A recent review of obstetric cases found that 3% of pregnant women with SARS-CoV-2 required intensive care. 17 There have also been cases of preterm labor and perinatal death in the setting of maternal SARS-CoV-2 infection. It is uncertain whether the virus can be vertically transmitted from mother to neonate. Given that SARS-CoV-2 causes inflammatory, coagulation, and endothelial changes, investigating placental and fetal involvement during infection is crucial to providing guidance and care to pregnant patients. Coronaviruses are enveloped positive-sense single-stranded RNA viruses that infect both humans and animals. 18 Human coronaviruses typically cause mild upper and lower respiratory infections, although they can present as severe pneumonia or bronchiolitis. 7,18 Gastrointestinal symptoms can also occur with infection. Coronaviruses were believed to have little clinical significance until the 21st century. Since 2002, three novel coronaviruses have been described: SARS-CoV in 2002, Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, and SARS-CoV-2 in 2019. SARS-CoV appears to primarily target ciliated epithelial cells via the angiotension-converting enzyme 2 (ACE2) receptor. ACE2 is expressed in the cardiovascular system, gut tissue, adipose tissue, lungs, kidneys, the placenta, and fetal tissue. 19-21 SARS-CoV-2 also binds to ACE2 in order to enter cells. 19,20,22 The clinical presentation of coronaviruses is likely due to both direct cell injury and host response.
“…IgM cutoffs are based on adult data; however, neonates produce less immunoglobulins than adults. 33 activation of transcriptional programs, which in turn induce a proinflammatory cytokine storm, largely driven by production of IL-6. 55 Both an inflammatory and prognostic marker, IL-6 can predict disease progression in adults, as noted in a United States cohort of pregnant patients with severe to critical SARS-CoV-2 infection.…”
The first cases of severe pneumonia from a novel coronavirus were reported in Wuhan, China in December 2019. 10 Since then, the virus has been identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 infection causes fevers, cough, dyspnea, myalgias, pharyngitis, diarrhea, pneumonia, acute respiratory distress syndrome, multisystem organ failure, cytokine storm, endothelial damage, and thrombotic events. 2,3,11-13 It has infected over 12 million people and caused over 550 000 deaths across the globe. 1 The case fatality rate is estimated at 2.3% among the entire population. 14 Recent observations show that the majority of pregnant women are asymptomatic or have mild disease based on the criteria proposed by Wu et al. 14-16 Nevertheless, any infection during pregnancy has potential risks. A recent review of obstetric cases found that 3% of pregnant women with SARS-CoV-2 required intensive care. 17 There have also been cases of preterm labor and perinatal death in the setting of maternal SARS-CoV-2 infection. It is uncertain whether the virus can be vertically transmitted from mother to neonate. Given that SARS-CoV-2 causes inflammatory, coagulation, and endothelial changes, investigating placental and fetal involvement during infection is crucial to providing guidance and care to pregnant patients. Coronaviruses are enveloped positive-sense single-stranded RNA viruses that infect both humans and animals. 18 Human coronaviruses typically cause mild upper and lower respiratory infections, although they can present as severe pneumonia or bronchiolitis. 7,18 Gastrointestinal symptoms can also occur with infection. Coronaviruses were believed to have little clinical significance until the 21st century. Since 2002, three novel coronaviruses have been described: SARS-CoV in 2002, Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, and SARS-CoV-2 in 2019. SARS-CoV appears to primarily target ciliated epithelial cells via the angiotension-converting enzyme 2 (ACE2) receptor. ACE2 is expressed in the cardiovascular system, gut tissue, adipose tissue, lungs, kidneys, the placenta, and fetal tissue. 19-21 SARS-CoV-2 also binds to ACE2 in order to enter cells. 19,20,22 The clinical presentation of coronaviruses is likely due to both direct cell injury and host response.
“…SARS-CoV-2, the virus responsible for COVID-19, is mainly transmitted through respiratory droplets. However, some cases of perinatal transmission have been described, although it is unclear if these occurred via the transplacental or other routes [ [1] , [2] , [3] , [4] , [5] , [6] ]. Most pregnant women with COVID-19 develop mild forms of the disease, with few cases of severe maternal morbidity and mortality, or perinatal deaths [ 7 , 8 ].…”
Background
There are few reports of miscarriages or stillbirths in women infected with SARS-CoV-2. We present five consecutive cases of fetal death (≥12 weeks) without other putative causes in women with laboratory-confirmed (RT-PCR) COVID-19 managed in a single Brazilian institution.
Case series
All five women were outpatients with mild or moderate forms of COVID-19 and were not taking any medication. Four were nulliparous, all were overweight or obese, and none had any comorbidities or pregnancy complications that could contribute to fetal demise. Fetal death occurred at 21–38 weeks of gestation, on COVID-days 1–22. SARS-Cov-2 was detected by RT-PCR in amniotic fluid in one case and in placental specimens in two cases. All five women had acute chorioamnionitis on placental histology, massive deposition of fibrin, mixed intervillitis/villitis, and intense neutrophil and lymphocyte infiltration. One fetus had neutrophils inside alveolar spaces, suggestive of fetal infection.
Conclusions
These five cases of fetal demise in women with confirmed COVID-19 without any other significant clinical or obstetric disorders suggest that fetal death can be an outcome of SARS-CoV-2 infection in pregnancy. The intense placental inflammatory reaction in all five cases raises the possibility of a direct effect of SARS-CoV-2 on the placenta.
“…11 , 12 Evidence regarding the occurrence of antepartum or peripartum vertical transmission has been conflicting to date. 13 , 14 , 15 , 16 , 17 AJOG MFM at a Glance
Why was this study conducted?
The association between maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and placental histopathology is not well known.…”
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...
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