Clinical‐pathological features in placentas of pregnancies with SARS‐CoV‐2 infection and adverse outcome: case series with and without congenital transmission

Objective To correlate clinical outcomes to pathology in SARS‐CoV‐2 infected placentas in stillborn and live‐born infants presenting with fetal distress. Design Retrospective, observational. Setting Nationwide. Population Five stillborn and nine live‐born infants from 13 pregnant women infected with...

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Veröffentlicht in:BJOG : an international journal of obstetrics and gynaecology Jg. 129; H. 8; S. 1361 - 1374
Hauptverfasser: Zaigham, Mehreen, Gisselsson, David, Sand, Anna, Wikström, Anna‐Karin, Wowern, Emma, Schwartz, David A., Iorizzo, Linda, Nelander, Maria, Blomberg, Marie, Papadogiannakis, Nikos, Holmström, Sandra, Leijonhfvud, Åsa, Sengpiel, Verena
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Wiley Subscription Services, Inc 01.07.2022
John Wiley and Sons Inc
Schlagworte:
Apgar score
association
Cesarean Section
chronic histiocytic intervillositis
Clinical Medicine
Clinical outcomes
Congenital diseases
Cord blood
coronavirus
COVID-19
COVID-19 maternal-fetal transmission
Degeneration
Endothelium
Female
fetal
Fetal Distress
Fetuses
Gynaecology, Obstetrics and Reproductive Medicine
Gynekologi, obstetrik och reproduktionsmedicin
Humans
Hypoxia
Infant, Newborn
Infants
Infections
Infectious Disease Transmission, Vertical
Infectious Medicine
Infektionsmedicin
Klinisk medicin
macrophages
maternal floor infarction
maternal-fetal transmission
Medical and Health Sciences
Medicin och hälsovetenskap
Obstetrics & Gynecology
Pathology
Pathophysiology
Placenta
Placenta - blood supply
placental endothelial cells
placental infection
placental pathology
Pregnancy
Pregnancy Complications, Infectious - diagnosis
Prenatal development
Retrospective Studies
SARS-CoV-2
SARS-CoV-2 placental infection
Severe acute respiratory syndrome coronavirus 2
Stillbirth - epidemiology
Umbilical cord
vertical SARS-CoV-2 transmission
villous
villous macrophages
COVID-19
COVID-19 maternal-fetal transmission
fetal distress
SARS-CoV-2
SARS-CoV-2 placental infection
placental endothelial cells
maternal floor infarction
vertical SARS-CoV-2 transmission
coronavirus
placental pathology
chronic histiocytic intervillositis
villous macrophages
ISSN:1470-0328, 1471-0528, 1471-0528
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Zusammenfassung:Objective To correlate clinical outcomes to pathology in SARS‐CoV‐2 infected placentas in stillborn and live‐born infants presenting with fetal distress. Design Retrospective, observational. Setting Nationwide. Population Five stillborn and nine live‐born infants from 13 pregnant women infected with SARS‐CoV‐2 seeking care at seven different maternity units in Sweden. Methods Clinical outcomes and placental pathology were studied in 14 cases (one twin pregnancy) of maternal SARS‐CoV‐2 infection with impaired fetal outcome. Outcomes were correlated to placental pathology in order to investigate the impact of virus‐related pathology on the villous capillary endothelium, trophoblast and other cells. Main outcome measures Maternal and fetal clinical outcomes and placental pathology in stillborn and live‐born infants. Results Reduced fetal movements were reported (77%) and time from onset of maternal COVID‐19 symptoms to signs of fetal distress among live‐born infants was 6 (3–12) days and to diagnosis of stillbirth 11 (2–25) days. Two of the live‐born infants died during the postnatal period. Signs of fetal distress led to emergency caesarean section in all live‐born infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one live‐born neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillositis and trophoblast necrosis were associated with SARS‐CoV‐2 placental infection and congenital transmission. Conclusions SARS‐CoV‐2 can cause rapid placental dysfunction with subsequent acute fetal hypoxia leading to intrauterine fetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillositis and trophoblast degeneration. Tweetable SARS‐CoV‐2 can cause rapid placental dysfunction and intrauterine fetal compromise. Linked article: This article is commented on by Yves Ville, pp. 1375 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17162. This article includes Author Insights, a video available at: https://vimeo.com/bjog/authorinsights17132
Bibliographie:Funding information
This article is commented on by Yves Ville, pp. 1375 in this issue. To view this minicommentary visit
https://doi.org/10.1111/1471-0528.17162
https://vimeo.com/bjog/authorinsights17132
MZ was financed by grants from the Swedish state under an agreement between the Swedish government and the county councils, the ALF‐agreement YF0054; and the South Hospital Region Project Grant (2021‐2020‐0689). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Linked article
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This article includes Author Insights, a video abstract available at
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Funding informationMZ was financed by grants from the Swedish state under an agreement between the Swedish government and the county councils, the ALF‐agreement YF0054; and the South Hospital Region Project Grant (2021‐2020‐0689). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Linked article: This article is commented on by Yves Ville, pp. 1375 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17162.
This article includes Author Insights, a video abstract available at: https://vimeo.com/bjogabstracts/authorinsights17132
ISSN:1470-0328
1471-0528
1471-0528
DOI:10.1111/1471-0528.17132