Villitis of unknown etiology in the placenta of a pregnancy complicated by covid-19

Özer, Erdener; Çağlıyan, Erkan; Yuzuguldu, Resmiye Irmak; Cevizci, Mustafa Cuneyt; Duman, Nuray

doi:10.5146/tjpath.2020.01506

Cited by 12 publications

(9 citation statements)

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“…Thorough literature search aimed at including all potentially relevant studies, multitude of histopathological anomalies and the large numbers of included cases 9 , 10 , 11 , 12 , 13 , 14 , 15 , 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 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 represent the main strengths of the present systematic review. The retrospective design of most of the included studies, small sample size, and heterogeneity in histopathological anomalies observed, are the main limitations of this systematic review.…”

Section: Discussionmentioning

confidence: 99%

“… 8 Several reports suggest an increased risk of placental lesions due to hypoperfusion and inflammation in women with SARS-CoV-2 infection. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 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 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 The potential association between SARS-CoV-2 and impaired placental function is crucial because it might lead to fetal decompensation and increased risk of perinatal mortality and morbidity. 66 , 67 Despite this, the occurrence of placental histopathological abnormalities in pregnancies complicated by SARS-CoV-2 infection is yet to be fully explored.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Girolamo

Khalil

Alameddine

et al. 2021

American Journal of Obstetrics & Gynecology MFM

126

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Objectives : To report the spectrum of placental pathology findings in pregnancies complicated by SARS-CoV-2 infection. Methods : MEDLINE, EMBASE, Google Scholar and the Web of Science databases were searched up to August 11 th , 2021. Histopathological anomalies included maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute inflammatory pathology (AIP), chronic inflammatory pathology (CIP), increased perivillous fibrin and intervillous thrombosis. Sub-analyses including only symptomatic women and high-risk pregnancies were also performed. Histopathological analysis of the placenta included gross examination, histopathology on hematoxylin and eosin (H&E), immunohistochemistry (IHC), fluorescence in-situ hybridization (FISH), qRT-PCR on placental tissue, and transmission electron microscope (TEM). Random-effect meta-analyses were used to analyze the data. Results : Fifty-seven studies (1009 pregnancies) were included. MVM was reported in 31.4% (95% CI 21.0-42.8) of placentas, while FVM was observed in 26.9% of cases (95% CI 19.2-35.4). AIP and CIP were reported in 22.6% (95% CI 16.8-28.9) and 26.2% (95% CI 18.9-34.2) of cases, respectively. Increased perivillous fibrin was observed in 32.7% (95% CI 24.1-42.0) of placentas undergoing histopathological analysis, while intervillous thrombosis were observed in 14.6% (95% CI 10.6-21.8) of cases. Other placental findings, including either basal plate with attached myometrial fibers, microscopic accretism, villous edema, increased circulating nucleated Red Blood Cells or membranes with hemorrhage were reported in 38% (95% CI 28.5-48.0) of cases, while only 17.4% (95% CI 10.9-25.0) did not present any abnormal histological findings. Sub-analyses according to maternal symptoms due to SARS-CoV-2 infection or the presence of a high-risk pregnancy showed similar distribution of the different histopathological anomalies to that reported in the main analysis. The risk of placental histopathological anomalies was also higher when considering only case-control studies comparing women with SARS-CoV-2 infection with healthy controls. Conclusions : A significant proportion of placentas where SARS-CoV-2 occurred during pregnancy shows histopathological findings suggesting placental hypoperfusion and inflammation. Future multicenter prospective blinded studies are needed to correlate these placental lesions with pregnancy outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Girolamo

Khalil

Alameddine

et al. 2021

American Journal of Obstetrics & Gynecology MFM

126

View full text Add to dashboard Cite

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“…Intervillous inflammation/predominant HI, neutrophils and massive PFD, maternal floor infarctions, reduced and/or missing placental vascularity, absence of trophoblastic superficial layer. Ozer (2021) 55 1 1 Morphological features of unknown-etiology villitis. Macrophages and CD4-positive T-cells predominantly in villous tissue; high numbers of CD8-positive cells.…”

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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“…Diese schwerwiegende Komplikation ist auch bei der Präeklampsie beschrieben [29]. In der histologischen Aufarbeitung der Plazenta konnte in unserem Fall keine Peri-/Villitis nachgewiesen werden, welche in der aktuellen Literatur jedoch im Zusammenhang mit einer akuten SARS-CoV-2-Infektion beschrieben wird, so dass sodass der fehlende Nachweis vorrangig auf eine Präeklampsie-assoziierte plazentare Dysfunktion hindeuten könnte [30,31]. Allerdings sind auch hier sich wechselseitig beeinflussende pathogenetische Mechanismen zu vermuten, die in ein einheitliches Befundmuster übergehen.…”

Section: Maximalwert/ Minimalwertunclassified

Die Komplexität der SARS-CoV-2-Infektion im klinischen Alltag der Geburtshilfe – Auseinandersetzung anhand eines Fallbeispiels

Möginger

Mand

Schoner

et al. 2022

Z Geburtshilfe Neonatol

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ZusammenfassungSeit Beginn der Pandemie dominiert die Sars-CoV-2-Infektion den klinischen Alltag. In der Behandlung von Hochrisikopopulationen bestand lange Unklarheit über das Ausmaß und die Konsequenzen der Infektion. Zu diesem Risikokollektiv gehört auch die schwangere Patientin. Die Etablierung von klinischen Registerstudien konnte innerhalb kürzester Zeit und unter enormer Anstrengung zu einer Einschätzung der pandemischen Lage für dieses Kollektiv beitragen. Anhand eines klinischen Falls wird im folgenden Bericht die Assoziation zwischen Sars-CoV-2 Infektion einer schwangeren Patientin mit klinischen Zeichen der Präeklampsie bis hin zur Ausbildung eines posterioren reversiblen Enzephalopathiesyndroms (PRES) beschrieben. Anhand des Falles wird die differentialdiagnostische Abklärung zwischen fulminanten Verlauf der Infektion und Präeklampsie dargelegt. Der Artikel stellt die aktuelle Datenlage zum Auftreten eines PRES in der Schwangerschaft im Zusammenhang mit einer Sars-CoV-2-Infektion dar und setzt sich mit möglichen Differentialdiagnosen auseinander. Durch die interdisziplinäre Betreuung der Patientin kann eine Übersicht zu den Aspekten des jeweiligen Fachgebietes dargelegt werden.

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Villitis of unknown etiology in the placenta of a pregnancy complicated by covid-19

Cited by 12 publications

References 0 publications

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

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

Die Komplexität der SARS-CoV-2-Infektion im klinischen Alltag der Geburtshilfe – Auseinandersetzung anhand eines Fallbeispiels

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