1. Clinical-pathological features in placentas of pregnancies with SARS-CoV-2 infection and adverse outcome: case series with and without congenital transmission.
- Author
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Zaigham M, Gisselsson D, Sand A, Wikström AK, von Wowern E, Schwartz DA, Iorizzo L, Nelander M, Blomberg M, Papadogiannakis N, Holmström S, Leijonhfvud Å, and Sengpiel V
- Subjects
- Cesarean Section, Female, Fetal Distress, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical, Placenta blood supply, Pregnancy, Retrospective Studies, SARS-CoV-2, Stillbirth epidemiology, COVID-19, Pregnancy Complications, Infectious diagnosis
- Abstract
Objective: To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and live-born infants presenting with fetal distress., Design: Retrospective, observational., Setting: Nationwide., Population: Five stillborn and nine live-born infants from 13 pregnant women infected with SARS-CoV-2 seeking care at seven different maternity units in Sweden., Methods: Clinical outcomes and placental pathology were studied in 14 cases (one twin pregnancy) of maternal SARS-CoV-2 infection with impaired fetal outcome. Outcomes were correlated to placental pathology in order to investigate the impact of virus-related pathology on the villous capillary endothelium, trophoblast and other cells., Main Outcome Measures: Maternal and fetal clinical outcomes and placental pathology in stillborn and live-born infants., Results: Reduced fetal movements were reported (77%) and time from onset of maternal COVID-19 symptoms to signs of fetal distress among live-born infants was 6 (3-12) days and to diagnosis of stillbirth 11 (2-25) days. Two of the live-born infants died during the postnatal period. Signs of fetal distress led to emergency caesarean section in all live-born infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one live-born neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillositis and trophoblast necrosis were associated with SARS-CoV-2 placental infection and congenital transmission., Conclusions: SARS-CoV-2 can cause rapid placental dysfunction with subsequent acute fetal hypoxia leading to intrauterine fetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillositis and trophoblast degeneration., (© 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
- Published
- 2022
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