What are the novel findings of this work? Preterm delivery occurred in a higher proportion of women with SARS-CoV-2 infection in the PAN-COVID and AAP-SONPM registries compared to contemporaneous and historical national data from uninfected women in the UK and USA. The majority of preterm deliveries occurred between 32 + 0 and 36 + 6 weeks' gestation. SARS-CoV-2 infection in pregnancy did not appear to be associated with a clinically significant effect on fetal growth, adverse neonatal outcome or the rate of stillbirth. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. What are the clinical implications of this work? Pregnant women should be counseled that SARS-CoV-2 infection increases the risk of preterm delivery but not stillbirth, early neonatal death or a small baby. Healthcare providers should recommend SARS-CoV-2 vaccination in pregnant women and women planning pregnancy, alongside enhanced social distancing.

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An 18-year-old primigravida with raised α-fetoprotein levels at 15 weeks of pregnancy displayed reduced amniotic fluid volume (amniotic fluid index [AFI], 11 cm) and bulky placenta at her 20-week mid-trimester scan.A repeat scan at 24 + 6 weeks showed reduced AFI (13 cm), absent end diastolic flow, bulky placenta, and no fetal growth-with significant asymmetric growth restriction (estimated fetal weight, 341 g) (Fig. 1). Because of early-onset severe growth restriction and absent end diastolic flow, the woman was informed of the poor fetal prognosis and received 2 doses of steroid to enhance pulmonary maturity.She subsequently presented to the delivery suite at 25+ 2 weeks of pregnancy with membrane rupture and mild vaginal bleeding. Abdominal and speculum examination revealed findings indicative of placental abruption. Scan showed fundal placenta with significant surrounding blood and absent fetal heartbeat. After initial resuscitation, labor was induced with misoprostol, and a stillborn male infant weighing 268 g was delivered. The woman received 3 units of blood post-delivery owing to a hemoglobin level of 6.4 g. The postnatal period was uneventful.Post mortem showed a fetal weight corresponding to 19 weeks of gestation, with a brain weight corresponding to 24-25 weeks (asymmetric growth restriction). The placenta weighed 412 g and showed massive subchorionic hematoma (Breus mole) involving the entire subchorionic space, with a thickness of up to 5 cm.Breus mole is a rare condition in pregnancy in which the chorionic plate is stripped from the villous chorion by a large amount of blood. Its etiology is unclear, although molecular techniques using polymerase chain reaction analysis have shown that the source of hematoma is maternal, and similar findings-in which 85% of clot DNA was of maternal origin-have been demonstrated with semi-quantitative Southern blot analysis [1].Breus mole has frequently been associated with spontaneous abortion, preterm delivery, intrauterine growth restriction [2], placental abruption [3], and intrauterine fetal death. An association between Breus mole and partial mole has also been reported [1].Prenatal diagnosis of Breus mole can be made using imaging techniques such as magnetic resonance imaging, which-together with ultrasound and pulse Doppler imaging-may help in the clinical management of the condition [4]. Histologic examination of the placenta and membranes further contributes to the diagnosis of Breus mole in the majority of cases.

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