Placental pathology in SARS-CoV-2-infected pregnancies seems rather unspecific. However, the identification of the placental lesions due to SARS-CoV-2 infection would be a significant advance in order to improve the management of these pregnancies and to identify the mechanisms involved in a possible vertical transmission. The pathological findings in placentas delivered from 198 SARS-CoV-2-positive pregnant women were investigated for the presence of lesions associated with placental SARS-CoV-2 infection. SARS-CoV-2 infection was investigated in placental tissues through immunohistochemistry, and positive cases were further confirmed by in situ hybridization. SARS-CoV-2 infection was also investigated by RT-PCR in 33 cases, including all the immunohistochemically positive cases. Nine cases were SARS-CoV-2-positive by immunohistochemistry, in situ hybridization, and RT-PCR. These placentas showed lesions characterized by villous trophoblast necrosis with intervillous space collapse and variable amounts of mixed intervillous inflammatory infiltrate and perivillous fibrinoid deposition. Such lesions ranged from focal to massively widespread in five cases, resulting in intrauterine fetal death. Two of the stillborn fetuses showed some evidence of SARS-CoV-2 positivity. The remaining 189 placentas did not show similar lesions. The strong association between trophoblastic damage and placenta SARS-CoV-2 infection suggests that this lesion is a specific marker of SARS-CoV-2 infection in placenta. Diffuse trophoblastic damage, massively affecting chorionic villous tissue, can result in fetal death associated with COVID-19 disease.

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Introduction:The association between preeclampsia and coronavirus disease 2019 is under study. Previous publications have hypothesized the existence of shared risk factors for both conditions or a deficient trophoblastic invasion as possible explanations for this association. The primary aim of this study was to examine baseline risk factors measured in the first-trimester combined screening for preeclampsia in pregnant women with COVID-19 compared with the general population. A secondary aim of this study was to compare risk factors among patients with mild and severe COVID-19. Material and Methods: This was an observational retrospective study conducted at Vall d'Hebron Hospital Campus (Catalonia, Spain). Study patients were 231 pregnant women undergoing the first-trimester screening for preeclampsia and positive for severe acute respiratory syndrome coronavirus 2 between February 2020 and September 2021. The reference cohort were 13 033 women of the general population from six centers across Catalonia from May 2019 to June 2021. Based on the need for hospitalization, patients were classified in two groups: mild and severe COVID-19.First-trimester screening for preeclampsia included maternal history, mean arterial blood pressure, mean uterine artery pulsatility index (UtAPI), placental growth factor (PlGF), and pregnancy-associated plasma protein-A (PAPP-A). Results:The proportion of cases at high risk for preeclampsia was significantly higher among the COVID-19 group compared with the general population (19.0% and 13.2%, respectively; p = 0.012).

Objective: To examine baseline risk factors measured in the first-trimester screening for preeclampsia (PE) in pregnant women with COVID-19 versus the general population. To compare risk factors among patients with mild and severe COVID-19. Design: Observational retrospective study. Setting: Six maternities in Catalonia. Population: Study patients were 231 pregnant women undergoing first-trimester screening for PE and positive for SARS-CoV-2. Reference cohort were 13,033 pregnant women with first-trimester screening for PE from 6 maternities. Methods: Recording of maternal history, mean arterial blood pressure (MAP), mean uterine artery pulsatility index (UtAPI), placental growth factor (PlGF) and pregnancy-associated plasma protein-A at first trimester. Confirmation of SARS-CoV-2 infection. Based on the need for hospitalization, patients were classified into mild and severe COVID-19. Main outcome measures: Comparison of proportion of cases at a high risk for PE and of risk factors for PE among groups. Results: High risk for PE was significantly higher amongst COVID-19 patients compared to the general population, showing higher rates of obesity, chronic hypertension, higher UtAPI, and lower rates of smokers. PlGF did not differ significantly. In women with severe COVID-19, compared with mild COVID-19, BMI and MAP were significantly higher, whereas PlGF and UtAPI did not differ significantly. Conclusions: In patients with COVID-19 there was a higher proportion of women at a high risk for PE than in the general population, mainly due to maternal risk factors, rather than placental signs of a deficient trophoblastic invasion. Likewise, according to COVID-19 severity, differences were due to maternal risk factors only.

Introduction:The primary aim of the study was to identify risk factors associated with fetal or neonatal loss, neonatal morbidity, and the need for surgery in fetuses diagnosed with an abdominal cyst. The secondary aim was to compare the characteristics of the cyst according to trimester at diagnosis.