Maternal COVID-19 causing intrauterine foetal demise with microthrombotic placental insufficiency: a case report

Abstract

Background Pregnant women have an increased risk of getting infected with SARS-CoV-2 and are more prone to severe illness. Data on foetal demise in affected pregnancies and its underlying aetiology is scarce and pathomechanisms remain largely unclear. Case Herein we present the case of a pregnant woman with COVID-19 and intrauterine foetal demise. She had no previous obstetric or gynaecological history, and presented with mild symptoms at 34 + 3 weeks and no signs of foetal distress. At 35 + 6 weeks intrauterine foetal death was diagnosed. In the placental histopathology evaluation, we found inter- and perivillous fibrin depositions including viral particles in areas of degraded placental anatomy without presence of viral entry receptors and SARS-CoV-2 infection of the placenta. Conclusion This case demonstrates that maternal SARS-CoV-2 infection in the third trimester may lead to an unfavourable outcome for the foetus due to placental fibrin deposition in maternal COVID-19 disease possibly via a thrombogenic microenvironment, even when the foetus itself is not infected.

Placental inflammation in a fetal demise of a SARS-CoV-2-asymptomatic, COVID-19-unvaccinated pregnant woman: a case-report

“…The placental pathology present in cases of fetal demise in COVID-19 patients generally consists of three lesions: chronic histiocytic intervillositis, massive perivillous fibrin deposition [ 13 , 14 ], and trophoblast necrosis; this triad is termed SARS-CoV-2 placentitis [ 15 , 16 ]. It is suggested that SARS-CoV-2 placentitis may affect > 75% of the placenta [ 6 ], negatively compromising its function in gas and nutrient exchange and leading to severe fetal hypoxic-ischemic injury and fetal demise through malperfusion and placenta insufficiency [ 5 , 9 , 16 ]; many of these findings were rare before the COVID-19 pandemic.…”