Study of amniotic fluid in pregnant women infected with SARS-CoV-2 in first and second trimester. Is there evidence of vertical transmission?

Abstract

COVID-19 is a respiratory disease caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The effects of this infection on fetal development and whether there is vertical transmission are currently unknown. We present two cases of pregnant women with COVID-19 infection during the first and second trimester of gestation in which a PCR study of SARS-CoV-2 in amniotic fluid extracted by amniocentesis is performed to try to determine if there is vertical transmission. In both cases, the PCR result was negative. This fact could support the absence of vertical transmission when the infection occurs in these quarters. It would be advisable to carry out more extensive studies to be able to make this statement safely.

Immunological and physiopathological approach of COVID-19 in pregnancy

“…A rang of 2% to 4% of pooled proportion of SARS-CoV-2 viral RNA test in neonatal nasopharyngeal swab resulted positive in recent published studies, even after having ensured no physical contact between the mother and the newborn. Despite the fact that not only nasopharyngeal swabs but umbilical cord, urine and rectal samples have tested positive suggesting a possible vertical transmission, no evidence of the presence of the virus in the amniotic fluid has been reported [92,93].…”

Contracting COVID-19 in the first and second trimester of pregnancy: what we know – a concise qualitative systematic review

“…Out of 223 neonates, the outcomes of 60 infants (31/60: maternal infection during 1st trimester and 29/60: 2nd trimester infections) from 20 studies were specified as either deceased/terminated, misscariage, alive/delivered, or still ongoing pregnancy [17,[22][23][24][25][26][27][28][29][30][31][32][33]36,37,[39][40][41][42][43]. While the majority of 1st trimester infection neonates had a reported status of on-going pregnancy (n=24/31: 77.4%), 4/31 (12.9%) were reported miscarriages, 1/31 (3.2%) abortion, 1 (3.2%) stillbirth and 1 (3.2%) chemical pregnancy was also noted.…”

“…A minority of studies [24][25][26]33,42] documented the condition of 7 placentas upon delivery, of which 2/7 were normal. Histopathological findings documented were: acute villitis and intervillitis (2/7 (28.6%)), acute deciduitis (1/7 (14.3%)), diffuse perivillous fibrin (5/7 (71.4%)) and an inflammatory infiltrate composed of either neutrophiles, t-lymphocytes or macrophages (2/7 (28.6%)).…”

“…One of the placental histopathological investigations determined no membrane inflammation or viral inclusion [33]. A case of decidual inflammation was also reported, but was eventually declared to be caused by abortion of the first trimester rather than COVID-19 disease [42]. Drug treatment of 12 patients in 9 studies were reported [22][23][24][25][26][27]31,36,41].…”

Amniocentesis and SARS-CoV-2, in the light of the experience with other viruses

“…We read with interest the recent article by Rubio Lorente et al describing a Polymerase Chain Reaction (PCR) study of SARS-CoV-2 in amniotic fluid from two amniocenteses [1]. One case was performed at 20 weeks of gestation on a woman currently infected; the second one at 12 weeks of gestation after a diagnosis of delayed miscarriage in a woman with positive SARS-CoV-2 serology and negative nasopharyngeal swab.…”