Article ; Online: Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury.
Archives of pathology & laboratory medicine
2022 Volume 146, Issue 6, Page(s) 660–676
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 ... ...
| 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 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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| MeSH term(s) | COVID-19/complications ; Female ; Fibrin ; Humans ; Hypoxia/pathology ; Hypoxia/virology ; Infant, Newborn ; Infectious Disease Transmission, Vertical ; Perinatal Death/etiology ; Placenta/pathology ; Pregnancy ; Pregnancy Complications, Infectious/mortality ; Pregnancy Complications, Infectious/pathology ; Pregnancy Complications, Infectious/virology ; Retrospective Studies ; SARS-CoV-2 ; Stillbirth | |||||
| Chemical Substances | Fibrin (9001-31-4) | |||||
| Language | English | |||||
| Publishing date | 2022-02-09 | |||||
| Publishing country | United States | |||||
| Document type | Journal Article | |||||
| ZDB-ID | 194119-7 | |||||
| ISSN | 1543-2165 ; 0363-0153 ; 0096-8528 ; 0003-9985 | |||||
| ISSN (online) | 1543-2165 | |||||
| ISSN | 0363-0153 ; 0096-8528 ; 0003-9985 | |||||
| DOI | 10.5858/arpa.2022-0029-SA | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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