Article ; Online: Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis.
American journal of obstetrics & gynecology MFM
2021 Volume 3, Issue 6, Page(s) 100468
Abstract: ... in pregnancies complicated by SARS-CoV-2 infection.: Data sources: MEDLINE, Embase, Google Scholar, and the Web of Science ... with healthy controls.: Conclusion: In pregnant women with SARS-CoV-2 infection, a significant proportion ... any abnormal histologic findings. The subanalyses according to maternal symptoms owing to SARS-CoV-2 infection ...
| Abstract | Objective: This study aimed to report the spectrum of placental pathology findings in pregnancies complicated by SARS-CoV-2 infection. Data sources: MEDLINE, Embase, Google Scholar, and the Web of Science databases were searched up to August 11, 2021. Study eligibility criteria: Histopathologic anomalies included maternal vascular malperfusion, fetal vascular malperfusion, acute inflammatory pathology, chronic inflammatory pathology, increased perivillous fibrin, and intervillous thrombosis. Moreover, subanalyses of symptomatic women only and high-risk pregnancies were performed. Methods: Histopathologic analysis of the placenta included gross examination, histopathology on hematoxylin and eosin, immunohistochemistry, fluorescence in situ hybridization, quantitative reverse transcription-polymerase chain reaction on placental tissue, and transmission electron microscope. Random-effect meta-analyses were used to analyze the data. Results: A total of 56 studies (1008 pregnancies) were included. Maternal vascular malperfusion was reported in 30.7% of placentas (95% confidence interval, 20.3-42.1), whereas fetal vascular malperfusion was observed in 27.08 % of cases (95% confidence interval, 19.2-35.6). Acute and chronic inflammatory pathologies were reported in 22.68% (95% confidence interval, 16.9-29.0) and 25.65% (95% confidence interval, 18.4-33.6) of cases, respectively. Increased perivillous fibrin was observed in 32.7% (95% confidence interval, 24.1-42.0) of placentas undergoing histopathologic analysis, whereas intervillous thrombosis was observed in 14.6% of cases (95% confidence interval, 9.7-20.2). Other placental findings, including a basal plate with attached myometrial fibers, microscopic accretism, villous edema, increased circulating nucleated red blood cells, or membranes with hemorrhage, were reported in 37.5% of cases (95% confidence interval, 28.0-47.5), whereas only 17.5% of cases (95% confidence interval, 10.9-25.2) did not present any abnormal histologic findings. The subanalyses according to maternal symptoms owing to SARS-CoV-2 infection or the presence of a high-risk pregnancy showed a similar distribution of the different histopathologic anomalies to that reported in the main analysis. Moreover, the risk of placental histopathologic anomalies was higher when considering only case-control studies comparing women with SARS-CoV-2 infection with healthy controls. Conclusion: In pregnant women with SARS-CoV-2 infection, a significant proportion of placentas showed histopathologic 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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| MeSH term(s) | COVID-19 ; Female ; Humans ; In Situ Hybridization, Fluorescence ; Multicenter Studies as Topic ; Placenta ; Pregnancy ; Pregnancy Complications, Infectious ; Pregnancy Outcome ; Prospective Studies ; SARS-CoV-2 |
| Language | English |
| Publishing date | 2021-08-21 |
| Publishing country | United States |
| Document type | Journal Article ; Meta-Analysis ; Review ; Systematic Review |
| ISSN | 2589-9333 |
| ISSN (online) | 2589-9333 |
| DOI | 10.1016/j.ajogmf.2021.100468 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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