Case Report: SARS-CoV-2 Mother-to-Child Transmission and Fetal Death Associated With Severe Placental Thromboembolism

Marinho, Penélope Saldanha; Cunha, Antônio José Lêdo Alves da; Chimelli, Leila; Avvad-Portari, Elyzabeth; Andreiuolo, Felipe; Oliveira-Szejnfeld, Patricia Soares de; Mendes, Mayara Abud; Gomes, Ismael Carlos; Souza, Letícia R. Q.; Guimarães, Marília Zaluar P.; Goldman, Suzan Menasce; Oliveira, Mariana Barros Genuíno de; Rehen, Stevens K.; Amim, Joffre; Tovar‐Moll, Fernanda; Prata‐Barbosa, Arnaldo

doi:10.3389/fmed.2021.677001

Cited by 31 publications

(44 citation statements)

References 33 publications

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“…Indeed, third trimester’s pregnant women placentas received in our laboratory showed subnormal placental examination while they presented severe symptoms with respiratory distress requiring emergency fetal extraction. On the other hand, second trimester’s or third trimester’s maternal infections have been reported several times with IUFD despite mild maternal COVID-19 symptoms [ 13 , 24 , 25 , 26 , 27 ]. This makes clinical monitoring difficult and raises the question of ultrasound monitoring.…”

Section: Discussionmentioning

confidence: 99%

Severe placental lesions due to maternal SARS-CoV-2 infection associated to intrauterine fetal death

et al. 2022

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SARS-CoV-2 infection can cause severe placental lesions leading rapidly to intra uterine fetal death (IUFD). From August 2020 to September 2021, in the pathology Department of Toulouse Oncopole, we analyzed 50 placentas from COVID-19 positive unvaccinated mothers. The purpose of our study is to describe the clinicopathological characteristics of these placental damages and to understand the pathophysiology. Ten of them (20%) showed placental lesions with positive immunohistochemistry for SARS-CoV-2 in villous trophoblast. In five cases (10%), we observed massive placental damage associating trophoblastic necrosis, fibrinous deposits, intervillositis as well as extensive hemorrhagic changes due to SARS-CoV-2 infection probably responsible of IUFD by functional placental insufficiency. In five other cases, we found similar placental lesions but with a focal distribution that did not lead to IUFD but live birth. These lesions are independent of maternal clinical severity of COVID-19 infection since they occur despite mild maternal symptoms and are therefore difficult to predict. In our cases, they occurred 1 to 3 weeks after positive SARS-CoV-2 maternal RT-PCR testing and were observed in 2nd and 3rd trimesters of pregnancies. When these lesions are focal, they do not lead to IUFD and can be involved in intra-uterine growth restriction. Our findings, together with recent observations, suggest that future pregnancy guidance should include stricter pandemic precautions such as screening for a wider array of COVID-19 symptoms, enhanced ultrasound monitoring as well as newborn medical surveillance.

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Section: Discussionmentioning

confidence: 99%

Severe placental lesions due to maternal SARS-CoV-2 infection associated to intrauterine fetal death

et al. 2022

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“…Thus, with all the limitations, this single case is the best candidate for the MTCT of SARS-CoV-2 in our one-year experience. Interestingly, the virus has been recently demonstrated in the fetal tissues by RT-PCR and immunofluorecence IHC in a case of IUFD at 34 weeks to a woman with a mild infection [ 23 ]. More data are needed to develop consensus criteria for the definitive, probable and possible diagnoses of SARS-CoV-2 infection and MTCT on autopsy material.…”

Section: Discussionmentioning

confidence: 99%

Infrequent Placental and Fetal Involvement in SARS-CoV-2 Infection: Pathology Data from a Large Medical Center

Thomas

Sun

Debelenko

2021

JDB

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In order to determine the frequency of SARS-CoV-2 placental and fetal involvements, we analyzed placentas of 197 women positive for infection at delivery and fetal tissues in cases of pregnancy loss in women positive by SARS-CoV-2 PCR (N = 2) and COVID-19 serology (N = 4), using in situ hybridization (ISH), immunohistochemistry (IHC) and, in selected cases, RT-PCR of tissue homogenates. The virus was identified in situ, accompanied by intervillositis, in 2 of 197 placentas (1.02%). In three more cases, SARS-CoV-2 was detected by tissue PCR without in situ localization and placental inflammation. There were no maternal mortality or association of placental infection with the clinical severity of COVID-19. All tested neonates born to SARS-CoV-2-positive women (N = 172) were negative for the virus. There were three pregnancy losses among 197 infected women and in two cases available fetal tissues were negative for SARS-CoV-2. In one of four fetal autopsies performed in women with positive COVID-19 serology, the mother-to-child transmission (MTCT) could be inferred based on positive SARS-CoV-2 nucleocapsid IHC in fetal pulmonary endothelium. Placental involvement by SARS-CoV-2 is rare, but may be underestimated due to its transient nature. MTCT is even rarer, supporting the protective role of placenta in SARS-CoV-2 infection.

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“…Initial descriptions of SARS-CoV-2 adverse outcomes during pregnancy did not mention SARS-CoV-2 vertical transmission [ 25 ]. Despite the reports of Spike protein immunostaining in placenta and fetal tissues [ 16 , 17 ], few documented cases and genomic data from SARS-CoV-2 maternal-fetal samples are currently available in databases. In this study clinical, laboratorial, and virological data of five mild antenatally diagnosed COVID19 cases in pregnant women from a reference hospital in the middle west of Brazil are reported; two were hospitalized to treat other medical conditions, three were already clinically recovered when their gestational outcome occurred, four had preterm labor, two had intact membrane C-sections, two had normal delivery of a stillborn and an asymptomatic newborn at 36 weeks of gestation and one had a spontaneous abortion 14 days after the mother’s infection was confirmed, when she was already asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…In Brazil, the virus was detected in the amniotic fluid and placenta of two out of five dead fetuses from SARS-CoV-2-positive pregnant women [ 16 ]. Spike protein was detected in the umbilical cord, lung and liver from an aborted fetus of a SARS-CoV-2 pregnant woman that developed severe placental thromboembolism [ 17 ]. Despite the availability of obstetric data obtained from pregnant women in Brazil, few maternal-fetal data can be retrieved from literature until the present.…”

Section: Introductionmentioning

confidence: 99%

Clinical and genomic data of sars-cov-2 detected in maternal–fetal interface during the first wave of infection in Brazil

Ferreira

Pavon

Napoleão

et al. 2022

Microbes and Infection

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Brazil has the highest SARS-CoV-2 case-fatality rate in pregnant women in the Americas. In this study, clinical and virological findings of five mildly symptomatic pregnant women and their infected fetuses/newborns treated at a referral hospital for COVID19-pregnant women in Midwestern Brazil are reported. Mother and fetal samples were tested by RT-qPCR, ECLIA and Illumina MiSeq sequencing. From the five cases, one resulted in spontaneous abortion, one was stillborn, two were preterm births and one full-term birth. Maternal and fetal placenta, newborn and stillborn secretions were SARS-CoV-2+; one neonate developed ground-glass opacities in his lungs. One neonate’s umbilical cord was IgG+ and all were IgM negative upon hospital discharge. Genomes recovered from two placentas belong to the B.1.1.28 and B.1.1.33 lineages and present nonsynonymous mutations associated with virus fitness and infectivity; other not frequently reported mutations (B.1.1.33: NSP3 V2090G, M A2S and ORF3ab S253P and Y264N; B.1.1.28: NSP3 E995D, NSP12 R240K, NSP14 H1897Y and in ORF7b V21F) were found in proteins involved in viral replication, viral induction of apoptosis, viral interference on interferon and on NF-Κβ pathways. Phylogeny indicates the south of Brazil as the possible origin of these lineages circulating in MT. These findings contribute to describe SARS-CoV-2 infection and outcomes in pregnant women and their fetuses, at any stage of gestation and even in mild symptomatic cases.

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Case Report: SARS-CoV-2 Mother-to-Child Transmission and Fetal Death Associated With Severe Placental Thromboembolism

Cited by 31 publications

References 33 publications

Severe placental lesions due to maternal SARS-CoV-2 infection associated to intrauterine fetal death

Severe placental lesions due to maternal SARS-CoV-2 infection associated to intrauterine fetal death

Infrequent Placental and Fetal Involvement in SARS-CoV-2 Infection: Pathology Data from a Large Medical Center

Clinical and genomic data of sars-cov-2 detected in maternal–fetal interface during the first wave of infection in Brazil

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