Placental SARS‐CoV‐2 in a pregnant woman with mild COVID‐19 disease

Abstract

Background The full impact of COVID‐19 on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality. 1 COVID‐19 manifestations appear similar between pregnant and non‐pregnant women. 2 Objectives/Study Design We present a case of placental SARS‐CoV‐2 virus in a woman with mild COVID‐19 disease, then review the literature. RT‐PCR was performed to detect SARS‐CoV‐2. Immunohistochemistry staining was performed with specific monoclonal antibodies to detect SARS‐CoV‐2 antigen or to identify trophoblasts. Results A 29 year‐old multigravida presented at 40‐4/7 weeks for labor induction. With myalgias two days prior, she tested positive for SARS‐CoV‐2. We demonstrate maternal vascular malperfusion, with no fetal vascular malperfusion, as well as SARS‐CoV‐2 virus in chorionic villi endothelial cells, and also rarely in trophoblasts. Conclusions To our knowledge, this is the first report of placental SARS‐CoV‐2 despite mild COVID‐19 disease (no symptoms of COVID‐19 aside from myalgias); patient had no fever, cough, or shortness of breath, but only myalgias and sick contacts. Despite her mild COVID‐19 disease in pregnancy, we demonstrate placental vasculopathy and presence of SARS‐CoV‐2 virus across the placenta. Evidence of placental COVID‐19 raises concern for placental vasculopathy (potentially leading to fetal growth restriction and other pregnancy complications) and possible vertical transmission – especially for pregnant women who may be exposed to COVID‐19 in early pregnancy. This raises important questions of whether future pregnancy guidance should include stricter pandemic precautions, such as screening for a wider array of COVID‐19 symptoms, increased antenatal surveillance, and possibly routine COVID‐19 testing throughout pregnancy. This article is protected by copyright. All rights reserved.

A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective

“…Another study by Blitz et al [103], reported no significant difference between the rates of ICU admission in hospitalized COVID-19 pregnant woman (9.8%; 8/82), and non-pregnant COVID-19 positive patients (15.1%; 50/3320) (p = 0.22). These studies suggest that hospitalized pregnant SARS CoV-2 positive patients are not at an increased risk for severe disease progression compared with non-pregnant COVID-19 positive hospitalized woman [102,103].…”

“…There was no vertical transmission detected in all 310 neonates [101]. COVID-19 symptom progression during pregnancy compared to non-pregnant women was analyzed by Hsu at al., who showed that 8.3% (36/431) of the COVID-19 patients during pregnancy had severe disease, of whom 86% (31/36) progressed to a critical stage and were admitted to the ICU [102]. Another study by Blitz et al [103], reported no significant difference between the rates of ICU admission in hospitalized COVID-19 pregnant woman (9.8%; 8/82), and non-pregnant COVID-19 positive patients (15.1%; 50/3320) (p = 0.22).…”

The Effects of COVID-19 on Placenta and Pregnancy: What Do We Know So Far?

“…A higher frequency of maternal vascular malperfusion (MVM) of the placental bed was reported in placentas of pregnant women infected with SARS-CoV-2 by 13 studies [ 16 , 22 , 23 , 25 , 27 , 28 , 31 , 32 , 38 , 40 , 42 , 43 , 44 ]. It is a recognized pattern of placental injury related to abnormal uterine perfusion, leading to a myriad of pathological changes such as accelerated villous maturation, increased perivillous and intervillous fibrin deposition, decidual vasculopathy, Tenney–Parker change, villous infarction, and intervillous thrombosis [ 75 ].…”

“…Reference lists of the included papers were also checked to identify additional relevant studies. We reviewed all articles (both peer-reviewed and preprints) with reports on placental pathology in pregnant women tested positive for SARS-CoV-2 that were published between 1 January 2020 to 10 October 2020 ( n = 29) [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Articles written in languages other than English and Mandarin were excluded.…”

Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2

“…Hsu and colleagues described a case report of a pregnant woman with COVID-19 who had mild symptoms of COVID-19 prior to her delivery at 40 4 weeks gestation of a healthy infant who tested negative for the virus using RT-PCR [35]. The infant's placenta showed chronic villitis and hypertrophic arteriopathy.…”