Intrauteriner Fruchttod bei massiver SARS-CoV-2-assoziierter („severe acute respiratory syndrome coronavirus 2“) plazentarer maternaler Malperfusion im Rahmen einer SARS-CoV-2-Plazentitis

Eich, Marie‐Lisa; Menter, Thomas; Mokwa, Nils; Grüttner, Berthold; Müller, Annette

doi:10.1007/s00292-021-01035-3

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…A diagnosis of CHI was made when histiocytic infiltrates were observed in the intervillous space of the placenta ( Figure 1(A) ). However, since certain infections, including cytomegalovirus and SARS-CoV-2, are known to cause mononuclear inflammatory cells to infiltrate the placenta, 15 , 16 an extensive investigation was conducted to eliminate any possible infectious causes of the histiocytic infiltrates observed in cases of CHI. As part of standardized care in Alberta, all pregnant women underwent routine prenatal screenings for syphilis, human immunodeficiency virus, hepatitis B, hepatitis C, gonorrhea, and chlamydia, as well as testing for immunity to rubella and varicella zoster.…”

Section: Methodsmentioning

confidence: 99%

C4d Staining Is Present in Normal Placentas From Pregnancies Prior to Pregnancy Loss Associated With Chronic Histiocytic Intervillositis and Is Reduced by Immunomodulatory Therapy in Subsequent Pregnancies

Chan

Koning

et al. 2023

Pediatr Dev Pathol

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Introduction: Chronic histiocytic intervillositis (CHI) is associated with adverse pregnancy outcomes and high recurrence risk. Recent studies suggest that CHI may represent a host-vs-graft rejection, and that C4d immunostain can be used as a marker for complement activation and antibody-mediated rejection in CHI. Materials and Methods: This retrospective cohort study focused on 5 fetal autopsy cases associated with CHI (5 index cases) from 5 women. We analyzed placentas from the index cases (fetal autopsy cases associated with CHI) and placentas from the women’s previous and subsequent pregnancies. We assessed the presence and extent of CHI and C4d immunostaining in these placentas. We evaluated each available placenta and graded the severity of CHI as either <50% or ≥50%. Additionally, we conducted C4d immunostaining on one representative section from each placenta and graded the staining levels as follows: 0+ for staining <5%; 1+ for staining between 5% and <25%; 2+ for staining between 25% and <75%; and 3+ for staining ≥75%. Results: Three of the 5 women had pregnancies prior to their index cases (fetal autopsy cases associated with CHI). Despite the absence of CHI in their initial pregnancies, the placentas displayed positive C4d staining with grades of 1+, 3+, and 3+, respectively. These results suggest the presence of complement activation and antibody-mediated rejection in placentas from their prior pregnancies without CHI. Three of the 5 women received immunomodulatory therapy after experiencing pregnancy losses associated with CHI. After treatment, 2 of these women had live births at 35 and 37 gestational weeks, respectively, while the third had a stillbirth at 25 gestational weeks. The severity of CHI and the degree of C4d staining in the placentas decreased in all 3 cases following immunomodulatory therapies. Specifically, the level of C4d staining decreased from 3+ to 2+, 2+ to 0+, and 3+ to 1+ in these 3 cases, respectively. Discussion: In women with a history of recurrent pregnancy loss associated with CHI, C4d immunostaining was present in the placentas from their initial non-CHI pregnancies, suggesting activation of the classical complement pathway and antibody-mediated reaction before the development of CHI in subsequent pregnancies. Immunomodulatory therapy may improve pregnancy outcomes by reducing complement activation, as shown by the reduction of C4d immunopositivity in the placentas after immunomodulatory treatment. Although we believe that the study provides valuable insights, we acknowledge that there are limitations to the findings. Therefore, to further elucidate the pathogenesis of CHI, additional research efforts with a collaborative and multidisciplinary approach are necessary.

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Section: Methodsmentioning

confidence: 99%

C4d Staining Is Present in Normal Placentas From Pregnancies Prior to Pregnancy Loss Associated With Chronic Histiocytic Intervillositis and Is Reduced by Immunomodulatory Therapy in Subsequent Pregnancies

Chan

Koning

et al. 2023

Pediatr Dev Pathol

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Systematic review and synthesis of stillbirths and late miscarriages following SARS-CoV-2 infections

Alcover¹,

Regiroli²,

Benachi³

et al. 2023

American Journal of Obstetrics and Gynecology

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COVID-19 in Pregnant Women, Maternal—Fetal Involvement, and Vertical Mother-to-Child Transmission: A Systematic Review

et al. 2022

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Pregnant women are included in the COVID-19 risk groups even if they do not have any pathology. This requires an analysis of research focused on pregnant women to understand the impact of SARS-CoV-2 on their condition. There is also a need to know whether there is vertical mother-to-child transmission, as well as other consequences in case the pregnant woman is infected and COVID-19 positive. A systematic review was carried out to analyze the existing information on the complications of a pregnant woman infected with the SARS-CoV-2 coronavirus and the possibility of vertical transmission from mother to child, registered in the PROSPERO website and searched in the PubMed, Scopus, CINAHL, and Cochrane Library databases. Finally, 22 articles were included in the review. The review suggests that vertical transmission from mother to child could be exceptionally possible at the time of delivery or breastfeeding, but not through the placenta. It is interesting to point out the good acceptance of vaccination by pregnant women, which may be the reason for the low infectivity. Further research on pregnant women should be carried out to provide evidence on vertical mother-to-child transmission and the role of breast milk in relation to SARS-CoV-2.

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Intrauteriner Fruchttod bei massiver SARS-CoV-2-assoziierter („severe acute respiratory syndrome coronavirus 2“) plazentarer maternaler Malperfusion im Rahmen einer SARS-CoV-2-Plazentitis

Cited by 3 publications

References 22 publications

C4d Staining Is Present in Normal Placentas From Pregnancies Prior to Pregnancy Loss Associated With Chronic Histiocytic Intervillositis and Is Reduced by Immunomodulatory Therapy in Subsequent Pregnancies

C4d Staining Is Present in Normal Placentas From Pregnancies Prior to Pregnancy Loss Associated With Chronic Histiocytic Intervillositis and Is Reduced by Immunomodulatory Therapy in Subsequent Pregnancies

Systematic review and synthesis of stillbirths and late miscarriages following SARS-CoV-2 infections

COVID-19 in Pregnant Women, Maternal—Fetal Involvement, and Vertical Mother-to-Child Transmission: A Systematic Review

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