SARS-CoV-2 placentitis: An uncommon complication of maternal COVID-19

Linehan, Laura; O’Donoghue, Keelin; Dineen, Susan; White, Jessica; Higgins, John R.; Fitzgerald, Brendan

doi:10.1016/j.placenta.2021.01.012

Cited by 114 publications

(104 citation statements)

References 38 publications

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“…These observations suggest that fetal vascular thrombosis and inflammatory changes may represent a histological marker of COVID-19 placental infection. Moreover, these data are supported by the presence of viral particles in the placenta identified by immunohistochemistry [8,10,11]. In the present case, strong positive staining for SARS-CoV-2 was noted in both trophoblast and fetal villous macrophages.…”

Section: Discussionsupporting

confidence: 84%

“…Vertical transmission of SARS-CoV-2 is a rare event, with an estimated incidence of 1–3% of cases or even lower as reported by other authors [ 8 , 9 ]. Although, the mechanism of vertical transmission remains controversial, detection of SARS-CoV-2 in placental or membrane tissues by immunohistochemistry or molecular methods supports a scenario of vertical transmission of the virus [ 8 , 10 ]. A possible pathway for viral entrance is through the angiotensin-converting enzyme 2 (ACE2), a surface sensitive cell receptor for SARS-CoV-2, that showed an aberrant expression in human placentas.…”

Section: Discussionmentioning

confidence: 99%

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A Case of COVID-19 Pregnancy Complicated with Hydrops Fetalis and Intrauterine Death

Popescu

Cioca²,

Muresan

et al. 2021

Medicina

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Coronavirus disease 2019 (COVID-19) has rapidly evolved into a worldwide pandemic causing a serious global public health problem. The risk of vertical transmission of SARS-CoV-2 is still debated, and the consequences of this virus on pregnant women and their fetuses remain unknown. We report a case of pregnancy complicated with hydrops fetalis that developed 7 weeks after recovery from a mild SARS-CoV-2 infection, leading to intrauterine death of the foetus. Evidence of SARS-CoV-2 placentitis was demonstrated by the presence of viral particles in the placenta identified by immunohistochemistry. As we excluded all possible etiological factors for non-immunologic hydrops fetalis, we believe that the fetal consequences of our case are related to vertical transmission of SARS-CoV-2 virus. To the best of our knowledge, this is the second reported case in the literature of COVID-19 infection complicated with hydrops fetalis and intrauterine fetal demise.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

A Case of COVID-19 Pregnancy Complicated with Hydrops Fetalis and Intrauterine Death

Popescu

Cioca²,

Muresan

et al. 2021

Medicina

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“…Twelve cases with MPFD/CIH dyad and Sars-cov2 infection during pregnancy have been reported in the literature, 8 of whom during the third trimester and 3 during the second one. Five cases out of 12 were associated with fetal demises (included in our table), including 1 termination of pregnancy at 22GW for severe PE [ 3 , 14 , [16] , [17] , [18] , [34] , [35] , [36] ].…”

Section: Resultsmentioning

confidence: 99%

Placental lesions and SARS-Cov-2 infection: Diffuse placenta damage associated to poor fetal outcome

et al. 2021

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Introduction Pregnant women with covid-19 are more likely to experience preterm birth. The virus seems to be associated with a wide range of placental lesions, none of them specific. Method We collected cases of Covid-19 maternal infection during pregnancy associated with poor pregnancy outcomes, for which we received the placenta. We studied clinical data and described pathological findings of placenta and post-mortem examination of fetuses. We performed an immunohistochemical study and RT-PCR of SARS-Cov-2 on placenta samples. Results We report 5 cases of poor fetal outcome, 3 fetal deaths and 2 extreme premature neonates, one with growth restriction, without clinical and biological sign of SARS-Cov-2 infection. All placenta presented massive perivillous fibrin deposition and large intervillous thrombi associated with strong SARS-Cov-2 expression in trophoblast and SARS-CoV-2 PCR positivity in amniotic fluid or on placenta samples. Chronic histiocytic intervillositis was present in 4/5 cases. Placental ultrasound was abnormal and the sFLT1-PIGF ratio was increased in one case. Timing between mothers’ infection and the poor fetal outcome was ≤10 days in 4 cases. The massive placental damage are directly induced by the virus whose receptors are expressed on trophoblast, leading to trophoblast necrosis and massive inflammation in villous chamber, in a similar way it occurs in diffuse alveolar damage in adults infected by SARS-Cov-2. Discussion SARS-Cov-2 can be associated to a rare set of placental lesions which can lead to fetal demise, preterm birth, or growth restriction. Stronger surveillance of mothers infected by SARS-Cov-2 is required.

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“…Following the preparation and report of the paper by Schwartz et al 33 , additional published reports [39][40][41][42] have demonstrated the same triad of placental pathology findings, and one of the authors (DAS) is aware of additional unpublished cases. Among pregnant women infected with the coronavirus, and in the absence of syncytiotrophoblast infection with SARS-CoV-2, the other two components of the pathology triad (chronic histiocytic intervillositis and trophoblast necrosis) appear not to occur.…”

mentioning

confidence: 90%

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infecting Pregnant Women and the Fetus, Intrauterine Transmission, and Placental Pathology During the Coronavirus Disease 2019 (COVID-19) Pandemic: It's Complicated

Schwartz

Levitan

2021

Archives of Pathology &Amp; Laboratory Medicine

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This article was posted on the Archives Web site as an Early Online Release. Note: Due to the extremely time sensitive nature of the content of this article, it has not been copyedited or formatted per journal style. Changes or corrections may be made to this article when it appears in a future print issue of the Archives. Early Online Release articles are citable by using the Digital Object Identifier (DOI), a unique number given to every article.

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SARS-CoV-2 placentitis: An uncommon complication of maternal COVID-19

Cited by 114 publications

References 38 publications

A Case of COVID-19 Pregnancy Complicated with Hydrops Fetalis and Intrauterine Death

A Case of COVID-19 Pregnancy Complicated with Hydrops Fetalis and Intrauterine Death

Placental lesions and SARS-Cov-2 infection: Diffuse placenta damage associated to poor fetal outcome

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infecting Pregnant Women and the Fetus, Intrauterine Transmission, and Placental Pathology During the Coronavirus Disease 2019 (COVID-19) Pandemic: It's Complicated

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