Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury: A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries
Schwartz, David A; Avvad-Portari, Elyzabeth; Babál, Pavel; Baldewijns, Marcella; Blomberg, Marie; Bouachba, Amine; Camacho, Jessica; Collardeau-Frachon, Sophie; Colson, Arthur; Dehaene, Isabelle; Ferreres, Joan Carles; Fitzgerald, Brendan; Garrido-Pontnou, Marta; Gerges, Hazem; Hargitai, Beata; Helguera-Repetto, A Cecilia; Holmström, Sandra; Irles, Claudine Liliane; Leijonhfvud, Åsa; Libbrecht, Sasha; Marton, Tamás; McEntagart, Noel; Molina, James T; Morotti, Raffaella; Nadal, Alfons; Navarro, Alexandra; Nelander, Maria; Oviedo, Angelica; Oyamada Otani, Andre Ricardo; Papadogiannakis, Nikos; Petersen, Astrid C; Roberts, Drucilla J; Saad, Ali G; Sand, Anna; Schoenmakers, Sam; Sehn, Jennifer K; Simpson, Preston R; Thomas, Kristen; Valdespino-Vázquez, M Yolotzin; van der Meeren, Lotte E; Van Dorpe, Jo; Verdijk, Robert M; Watkins, Jaclyn C; Zaigham, Mehreen
(2022) Archives of pathology & laboratory medicine, volume 146, issue 6, pp. 660 - 676
(Article)
Abstract
CONTEXT.—: Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. OBJECTIVE.—: To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute
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respiratory syndrome coronavirus 2 (SARS-CoV-2). DESIGN.—: Case-based retrospective clinicopathologic analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. RESULTS.—: Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis (32%; 22 of 68). The majority (19; 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. CONCLUSIONS.—: The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.
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Keywords: COVID-19, Female, Fibrin, Humans, Hypoxia/pathology, Infant, Newborn, Infectious Disease Transmission, Vertical, Perinatal Death, Placenta/pathology, Pregnancy, Pregnancy Complications, Infectious/pathology, Retrospective Studies, SARS-CoV-2, Stillbirth, Medical Laboratory Technology, Pathology and Forensic Medicine, Journal Article
ISSN: 0003-9985
Publisher: College of American Pathologists
Note: Funding Information: Babál received support from Slovak Research and Development Agency grant PP-COVID-20-051. Colson received support from the Belgian Fund for Scientific Research (FNRS-F.R.S., grant number 40002773) and the Fetus for Life charity. The other authors have no relevant financial interest in the products or companies described in this article. Publisher Copyright: © 2022 College of American Pathologists. All rights reserved.
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