Placental Pathology in Correlation with Inflammatory Markers and Perinatal Outcomes in Maternal COVID: A Prospective Study.

Aim: The purpose of this study is to analyze the morphological findings in the placenta of coronavirus disease-2019 (COVID-19)-positive women in correlation with the severity of infection, elevated inflammatory markers, gestational age at diagnosis and perinatal outcomes. Materials and methods: This is a prospective observational study of 66 singleton placentas of COVID-positive pregnant women over a period of 18 months. Clinical details, inflammatory markers, and perinatal outcomes were collected and analyzed in correlation with placental morphology. Results: Out of 66 pregnancies, 57 (86.3%) culminated in live births, of which 23 (40%) were small for gestation (SGA). Out of 66 cases, 9 (13.7%) experienced complications involving fetal demise intrauterine fetal death (IUFD). Based on the increase in inflammatory markers and gestational age at infection, the pregnancies were analyzed with regard to fetal outcome. Out of 66 pregnancies, 26 (39.4%) had moderate to marked elevation of two or more inflammatory markers. Fetal outcomes in these pregnancies were IUFD (34.6%), SGA (34.6%), appropriate for gestation (AGA) (26.9%) and neonatal death (ND) (3.8%). In women with elevated markers, 20% fetal or neonatal mortality was noted when the infection occurred in the third trimester whereas it was 100% when the infection occurred in the second trimester. All pregnancies affected in the third trimester and without an increase in markers (n = 40) resulted in live birth. The most significant placental finding observed was chronic inflammatory pathology (80%), followed by maternal vascular malperfusion (MVM) with or without fetal vascular malperfusion (FVM) (75.7%), and massive perivillous fibrin deposition (MPVFD) (12%). Conclusion: This study reemphasizes that in maternal COVID, the gestational age at infection, elevated inflammatory markers and severity of placental lesions could explain the perinatal outcomes. [ABSTRACT FROM AUTHOR]