Third trimester stillbirth during the first wave of the SARS-CoV-2 pandemic: Similar rates with increase in placental vasculopathic pathology

Bunnell, Megan E.; Koenigs, Kathleen J.; Roberts, Drucilla J.; Quade, Bradley J.; Hornick, Jason L.; Goldfarb, Ilona T.

doi:10.1016/j.placenta.2021.04.003

Cited by 20 publications

(16 citation statements)

References 18 publications

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“…There are mixed findings as to whether maternal SARS-CoV-2 infection leads to an increased risk of poor pregnancy outcomes, particularly stillbirth. Whilst there are reports of an increased risk of stillbirth (18,19), other studies have reported no difference (20,21). There have been reports of an increase in neonatal deaths (7,19); however, in our study, there were no poor pregnancy outcomes, although this is partly by design as women with Active COVID and a poor pregnancy outcome (e.g., a prior fetal death) were not approached to take part in the study.…”

Section: Poor Pregnancy Outcomes and Placental Pathologycontrasting

confidence: 61%

Placental Macrophages Following Maternal SARS-CoV-2 Infection in Relation to Placental Pathology

Sharps¹,

Garrod²,

Aneni³

et al. 2022

Front.Virol.

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IntroductionIn December 2019, a novel coronavirus, SARS-CoV-2, was identified. Whilst pregnant women appear to be at risk of severe infection, pre-term birth, and stillbirth, it is unclear whether placental dysfunction is a consistent feature of maternal SARS-CoV-2 infection during pregnancy. We aim to describe the immune response in placentas of women who had COVID-19 infection during pregnancy and investigate whether there are any associated morphological changes.MethodsThe placentas of women testing positive for COVID-19 during their pregnancy were compared to contemporaneous controls who were not known to have had COVID-19 during pregnancy. Samples of each placenta were sent for histopathological analysis or underwent immunohistochemical staining for CD163, CD20, CD3, CD31, and SARS-CoV-2 spike protein. A subset of samples were sent for transmission electron microscopy.ResultsThere was a significant increase in the number of CD163+ macrophages in the Post COVID group (p = 0.0020). There was no difference in the percentage of CD3+, CD20+ cells, but there was an increase in placental vascularity in the Post COVID group compared to controls (p = 0.026).There were no structural differences observed between the samples sent for EM analysis. However, one of the placentas from the Post COVID group was seen to have several large sub-apical vacuoles in the syncytiotrophoblast. We did not observe any virions within the vacuoles and SARS-CoV-2 spike protein staining was negative for the sample. Histopathological investigations indicated that there was no specific placental pathology caused by maternal COVID-19 infection in this cohort of samples.ConclusionsThis study did not confirm previous studies which describe a possible increase in cases of both maternal and fetal vascular malperfusion, and placentitis in women who had COVID-19, which were seen in association with adverse pregnancy outcomes. It remains unclear whether observed abnormalities are caused by maternal infection, or whether maternal infection exacerbates existing placental pathology; understanding why some placentas generate these abnormalities is a key goal.

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Section: Poor Pregnancy Outcomes and Placental Pathologycontrasting

confidence: 61%

Placental Macrophages Following Maternal SARS-CoV-2 Infection in Relation to Placental Pathology

Sharps¹,

Garrod²,

Aneni³

et al. 2022

Front.Virol.

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“…Dumont (2021) 47 1 1 PFD with ischemic changes and necrosis of the villi, intervillous space with inflammatory cells and histiocytes. Bunnell (2021) 48 12 12 MVM (n = 5), FVM (n = 5). No massive PFD or HI.…”

Section: Placental Histology and Possible Mechanisms Of Stillbirthmentioning

confidence: 99%

“…Table 2 lists key studies reporting placental histopathological findings associated with stillbirth in pregnancies with maternal SARS‐CoV‐2 infection 40–63 .…”

Section: Association Between Covid‐19 and Stillbirthmentioning

confidence: 99%

COVID‐19 and stillbirth: direct vs indirect effect of the pandemic

Khalil

Blakeway

Samara

et al. 2022

Ultrasound in Obstet & Gyne

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“…Unlike the examples discussed above in the germline and yolk, cell fusion is the mechanism of syncytium formation in the placenta (reviewed in Gerbaud and Pidoux 2015 ; Soygur and Sati 2016 ). In humans, there are three distinctly localized syncytial layers of trophoblast cells in the placenta, each thought to play an endocrine and immune barrier function (reviewed in Turco and Moffett 2019 ; Roberts et al 2021 ). Trophoblast layers may be some of the most extreme examples of syncytia in nature, with up to 6 × 10^10 nuclei estimated in a human syncytial trophoblast (Simpson et al 1992 ).…”

Section: Distinct Architecture: a Survey Of Tissues With Extra Genomes Across Naturementioning

confidence: 99%

Communal living: the role of polyploidy and syncytia in tissue biology

Peterson

Fox

2021

Chromosome Res

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Multicellular organisms are composed of tissues with diverse cell sizes. Whether a tissue primarily consists of numerous, small cells as opposed to fewer, large cells can impact tissue development and function. The addition of nuclear genome copies within a common cytoplasm is a recurring strategy to manipulate cellular size within a tissue. Cells with more than two genomes can exist transiently, such as in developing germlines or embryos, or can be part of mature somatic tissues. Such nuclear collectives span multiple levels of organization, from mononuclear or binuclear polyploid cells to highly multinucleate structures known as syncytia. Here, we review the diversity of polyploid and syncytial tissues found throughout nature. We summarize current literature concerning tissue construction through syncytia and/or polyploidy and speculate why one or both strategies are advantageous.

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Third trimester stillbirth during the first wave of the SARS-CoV-2 pandemic: Similar rates with increase in placental vasculopathic pathology

Cited by 20 publications

References 18 publications

Placental Macrophages Following Maternal SARS-CoV-2 Infection in Relation to Placental Pathology

Placental Macrophages Following Maternal SARS-CoV-2 Infection in Relation to Placental Pathology

COVID‐19 and stillbirth: direct vs indirect effect of the pandemic

Communal living: the role of polyploidy and syncytia in tissue biology

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