Placental Pathology in COVID-19

Shanes, Elisheva D; Mithal, Leena B.; Otero, Sebastián; Azad, Hooman; Miller, Emily S.; Goldstein, Jeffrey A.

doi:10.1093/ajcp/aqaa089

Cited by 566 publications

(675 citation statements)

References 42 publications

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“…Increased intervillous brin deposition in relation to COVID-19 has also been observed by Shanes et al [4] and Baergen and Heller [5] in PCR-negative third trimester placentas. Moreover, this nding has been described in a small series of placentas delivered from pregnant women with severe acute respiratory syndrome caused by the SARS-COV virus during the 2003 epidemic [10].…”

Section: Discussion Main Ndings -Tendency Toward Thrombosis and Brin supporting

confidence: 69%

“…As of the time of this writing vertical SARS-COV-2 transmission remains controversial, while viral RNA has been detected in some placentas of COVID-19-affected mothers suggesting placental infection [1][2][3]. Emerging data on COVID-19-induced placental pathology are still limited [4,5]. We herein present in detail the placental pathology in two cases of pregnant women mildly affected with COVID-19 at term, and describe the pathological changes, including novel ndings not previously reported, along with their pathophysiological correlates.…”

Section: Introductionmentioning

confidence: 99%

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Further placental pathology in mild COVID-19 of term pregnancy with pathophysiological correlates

Konstantinidou¹,

Papaevangelou²,

Tsakris³

et al. 2020

Preprint

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Abstract Placental pathology related to SARS-COV-2 infection during pregnancy is under investigation, with emerging but still limited and variable data, mainly including changes of fetal and maternal vascular malperfusion. We observed novel pathological findings not previously reported in two term placentas delivered from women mildly affected with COVID-19, with a 2-day and 6-day interval between the onset of symptoms and delivery. The main changes involved the maternal more than the fetal components of the placenta and included a tendency toward thrombosis and fibrin formation, and mild maternal malperfusion. We further observed fibrin degeneration in the intervillous space, the presence of particles of undetermined origin, and mild or moderate maternal decidual inflammatory exudates consisting of monocytes, macrophages, T-lymphocytes, and plasmacytes. Mild inflammation and incipient mural thrombus formation were noted in the fetal vasculature, as well as endothelial vacuolation of the umbilical vessels, not previously described. The maternal changes were more prominent in the case with a relatively longer clinical manifestation-to-delivery interval, and were associated to a prolonged postpartum maternal viral carriage of 30 days and the development of a low-grade febrile response in the neonate. Both infants showed mild morbidity but eventually had a very good outcome. RT-PCR was negative for SARS-CoV-2 RNA in both cases.We concluded that placental involvement in mild COVID-19 of very short duration at term pregnancy suggested the systemic nature of the disease and appeared related to, though not pathognomonic of COVID-19. Fetoplacental vascular changes and endothelial vacuolation associated with mild neonatal morbidity may suggest a possible transplacental impact on the fetus, to be further investigated.

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Section: Discussion Main Ndings -Tendency Toward Thrombosis and Brin supporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Further placental pathology in mild COVID-19 of term pregnancy with pathophysiological correlates

Konstantinidou¹,

Papaevangelou²,

Tsakris³

et al. 2020

Preprint

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“…Miscarriages and premature births to COVID-19-positive pregnant women have also been reported (7)(8)(9). Recently, a study showed that placentas from COVID-19-positive pregnant women displayed injury (10). Finally, SARS-CoV-2 was also detected in semen (11).…”

Section: Main Textmentioning

confidence: 95%

Sofosbuvir protects human brain organoids against SARS-CoV-2

Mesci

Macia

Saleh

et al. 2020

Preprint

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COVID-19 was rapidly declared a pandemic by the World Health Organization, only three months after the initial outbreak in Wuhan, China. Early clinical care mainly focused on respiratory illnesses. However, a variety of neurological manifestations in both adults and newborns are also emerging. To determine whether SARS-CoV-2 could target the human brain, we infected iPSC-derived human brain organoids. Our findings show that SARS-CoV-2 was able to infect and kill neural cells, including cortical neurons. This phenotype was accompanied by impaired synaptogenesis. Finally, Sofosbuvir, an FDA-approved antiviral drug, was able to rescue these alterations. Given that there are currently no vaccine or antiviral treatments available, urgent therapies are needed. Our findings put Sofosbuvir forward as a potential treatment to alleviate COVID-19-related neurological symptoms.One Sentence Summary: SARS-CoV-2 infection causes neuronal death and impaired synaptogenesis, both rescued by Sofosbuvir treatment.

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“…The placentas showed features of maternal vascular malperfusion, most prominently decidual arteriopathy and increased incidence of chorangiosis. Although, placental swabs were not performed which makes it unclear whether it was a local phenomenon or a systemic phenomenon [5]. Similarly, Hosier et al showed similar risk factors for maternal vascular malperfusion, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Lopes de Sousa et al published a systematic review in June 2020 and concluded that there is no concrete evidence for vertical transmission of COVID-19 but acknowledged that signi cant knowledge gaps exist and they cannot rule out this possibility [4]. The presence of COVID-19 has been assessed in neonates born to COVID-19 positive mothers by examining the placenta, and carrying out nucleic acid testing on breast milk and vaginal mucus [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Significance of placental swab in diagnosing vertical transmission in SARS-CoV-2 positive mothers.

Sweeney

Assaf

Khan

2020

Preprint

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AimsCurrently, there is limited date on the effects of COVID-19 on pregnancy and neonatal outcome. This literature review aims to investigate the possibility of fetal vertical transmission in COVID-19 positive pregnant mothers by diagnosing through placental swabs.MethodsThe search terms ‘pregnant COVID-19 positive mothers’, ‘fetal vertical transmission’ and ‘placental swabs’ were used. 11 papers were selected for this review.ResultsThis literature review comprises 45 COVID-19 positive pregnant women whose placentas and neonates were also analysed by RT-PCR for the presence of SARS-CoV-2. 43 neonates were successfully delivered primarily via caesarean section out of 45 expectant mothers (96%). 2 mothers did not deliver due to severe preeclampsia and a miscarriage both occurring in the second trimester. 3 neonates tested positive for SARS-CoV-2 (7%). We report no neonatal mortality after birth and no maternal mortality. 8 female’s placentas tested positive for SARS-CoV-2 out of a total of 45 tested (18%). Of these 8, 2 cases of SARS-CoV-2 were identified in the maternal, neonatal and placental tissue.ConclusionAfter reviewing multiple studies and investigating the nature of placental physiology in SARS-CoV-2 positive mothers we conclude that there is no concrete evidence of vertical transmission occurring between mother and infant. However, there are inconsistencies across the different papers used for this review and further research investigating the effects of COVID-19 on pregnant women by using RT-PCR to test the mother, placenta, vaginal fluid, breast milk and infant for SARS-CoV-2 at various stages of transmission is urgently needed.

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Placental Pathology in COVID-19

Cited by 566 publications

References 42 publications

Further placental pathology in mild COVID-19 of term pregnancy with pathophysiological correlates

Further placental pathology in mild COVID-19 of term pregnancy with pathophysiological correlates

Sofosbuvir protects human brain organoids against SARS-CoV-2

Significance of placental swab in diagnosing vertical transmission in SARS-CoV-2 positive mothers.

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