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
(2022) In Archives of pathology & laboratory medicine 146(6). p.660-676- Abstract
CONTEXT.—: Perinatal death is an increasingly important problem as the 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 SARS-CoV-2.
DESIGN.—: Case-based retrospective clinico-pathological 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.—: All 68 placentas had increased fibrin deposition and villous trophoblast... (More)
CONTEXT.—: Perinatal death is an increasingly important problem as the 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 SARS-CoV-2.
DESIGN.—: Case-based retrospective clinico-pathological 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.—: All 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis, the three findings constituting SARS-CoV-2 placentitis. 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%; 25/68) and chronic villitis (32%; 22/68). 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.
(Less)
- author
- 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
LU
; 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
and Zaigham, Mehreen
LU
(Less) - organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Archives of pathology & laboratory medicine
- volume
- 146
- issue
- 6
- pages
- 660 - 676
- publisher
- College of American Pathologists
- external identifiers
-
- pmid:35142798
- scopus:85125634642
- ISSN
- 0003-9985
- DOI
- 10.5858/arpa.2022-0029-SA
- language
- English
- LU publication?
- yes
- additional info
- © 2022 College of American Pathologists.
- id
- fa71f0a4-c8dd-4854-9d2a-c5c665cda4e6
- date added to LUP
- 2022-02-12 08:31:05
- date last changed
- 2024-04-18 05:56:19
@article{fa71f0a4-c8dd-4854-9d2a-c5c665cda4e6,
abstract = {{<p>CONTEXT.—: Perinatal death is an increasingly important problem as the COVID-19 pandemic continues, but the mechanism of death has been unclear.</p><p>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 SARS-CoV-2.</p><p>DESIGN.—: Case-based retrospective clinico-pathological 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.</p><p>RESULTS.—: All 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis, the three findings constituting SARS-CoV-2 placentitis. 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%; 25/68) and chronic villitis (32%; 22/68). 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.</p><p>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.</p>}},
author = {{Schwartz, David A and Avvad-Portari, Elyzabeth and Babál, Pavel and Baldewijns, Marcella and Blomberg, Marie and Bouachba, Amine and Camacho, Jessica and Collardeau-Frachon, Sophie and Colson, Arthur and Dehaene, Isabelle and Ferreres, Joan Carles and Fitzgerald, Brendan and Garrido-Pontnou, Marta and Gerges, Hazem and Hargitai, Beata and Helguera-Repetto, A Cecilia and Holmström, Sandra and Irles, Claudine Liliane and Leijonhfvud, Åsa and Libbrecht, Sasha and Marton, Tamás and McEntagart, Noel and Molina, James T and Morotti, Raffaella and Nadal, Alfons and Navarro, Alexandra and Nelander, Maria and Oviedo, Angelica and Oyamada Otani, Andre Ricardo and Papadogiannakis, Nikos and Petersen, Astrid C and Roberts, Drucilla J and Saad, Ali G and Sand, Anna and Schoenmakers, Sam and Sehn, Jennifer K and Simpson, Preston R and Thomas, Kristen and Valdespino-Vázquez, M Yolotzin and van der Meeren, Lotte E and Van Dorpe, Jo and Verdijk, Robert M and Watkins, Jaclyn C and Zaigham, Mehreen}},
issn = {{0003-9985}},
language = {{eng}},
number = {{6}},
pages = {{660--676}},
publisher = {{College of American Pathologists}},
series = {{Archives of pathology & laboratory medicine}},
title = {{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}},
url = {{http://dx.doi.org/10.5858/arpa.2022-0029-SA}},
doi = {{10.5858/arpa.2022-0029-SA}},
volume = {{146}},
year = {{2022}},
}