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Clinical-pathological features in placentas of pregnancies with SARS-CoV-2 infection and adverse outcome : case-series with and without congenital transmission

Zaigham, Mehreen LU orcid ; Gisselsson, David LU ; Sand, Anna ; Wikström, Anna-Karin ; von Wowern, Emma LU ; Schwartz, David A ; Iorizzo, Linda LU ; Nelander, Maria ; Blomberg, Marie and Papadogiannakis, Nikos , et al. (2022) In BJOG: An International Journal of Obstetrics & Gynaecology 129(8). p.1361-1374
Abstract
Objective: To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and liveborn infants presenting with foetal distress.
Design: Retrospective, observational.
Setting: Nationwide.
Population or sample: Five stillborn and 9 liveborn infants from 13 pregnant women infected with SARS-CoV-2 seeking care at 7 different maternity units in Sweden.
Methods: Clinical outcomes and placental pathology were studied in 14 cases (1 twin pregnancy) of maternal SARS-CoV-2 infection with impaired foetal 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... (More)
Objective: To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and liveborn infants presenting with foetal distress.
Design: Retrospective, observational.
Setting: Nationwide.
Population or sample: Five stillborn and 9 liveborn infants from 13 pregnant women infected with SARS-CoV-2 seeking care at 7 different maternity units in Sweden.
Methods: Clinical outcomes and placental pathology were studied in 14 cases (1 twin pregnancy) of maternal SARS-CoV-2 infection with impaired foetal 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 foetal clinical outcomes and placental pathology in stillborn and liveborn infants.
Results: Reduced foetal movements were reported (77%) and time from onset of maternal COVID-19 symptoms to signs of foetal distress among liveborn infants was 6 (3-12) days and to diagnosis of stillbirth 11 (2-25) days. Two of the liveborn infants died during the postnatal period. Signs of foetal distress led to emergency Caesarean section in all liveborn infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one liveborn neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillousitis and trophoblast necrosis was associated with SARS-CoV-2 placental infection and congenital transmission.
Conclusions: SARS-CoV-2 can cause rapid placental dysfunction with subsequent acute foetal hypoxia leading to intrauterine foetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillousitis and trophoblast degeneration. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BJOG: An International Journal of Obstetrics & Gynaecology
volume
129
issue
8
pages
1361 - 1374
publisher
Wiley-Blackwell
external identifiers
  • pmid:35243759
  • scopus:85128562198
ISSN
1471-0528
DOI
10.1111/1471-0528.17132
language
English
LU publication?
yes
id
fe72e165-57cb-4d0f-90d6-17b141736b53
date added to LUP
2022-03-12 09:26:36
date last changed
2024-12-25 14:25:46
@article{fe72e165-57cb-4d0f-90d6-17b141736b53,
  abstract     = {{Objective: To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and liveborn infants presenting with foetal distress.<br/>Design: Retrospective, observational.<br/>Setting: Nationwide.<br/>Population or sample: Five stillborn and 9 liveborn infants from 13 pregnant women infected with SARS-CoV-2 seeking care at 7 different maternity units in Sweden.<br/>Methods: Clinical outcomes and placental pathology were studied in 14 cases (1 twin pregnancy) of maternal SARS-CoV-2 infection with impaired foetal 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.<br/>Main outcome measures: Maternal and foetal clinical outcomes and placental pathology in stillborn and liveborn infants.<br/>Results: Reduced foetal movements were reported (77%) and time from onset of maternal COVID-19 symptoms to signs of foetal distress among liveborn infants was 6 (3-12) days and to diagnosis of stillbirth 11 (2-25) days. Two of the liveborn infants died during the postnatal period. Signs of foetal distress led to emergency Caesarean section in all liveborn infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one liveborn neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillousitis and trophoblast necrosis was associated with SARS-CoV-2 placental infection and congenital transmission.<br/>Conclusions: SARS-CoV-2 can cause rapid placental dysfunction with subsequent acute foetal hypoxia leading to intrauterine foetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillousitis and trophoblast degeneration.}},
  author       = {{Zaigham, Mehreen and Gisselsson, David and Sand, Anna and Wikström, Anna-Karin and von Wowern, Emma and Schwartz, David A and Iorizzo, Linda and Nelander, Maria and Blomberg, Marie and Papadogiannakis, Nikos and Holmström, Sandra and Leijonhfvud, Åsa and Sengpiel, Verena}},
  issn         = {{1471-0528}},
  language     = {{eng}},
  month        = {{03}},
  number       = {{8}},
  pages        = {{1361--1374}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{BJOG: An International Journal of Obstetrics & Gynaecology}},
  title        = {{Clinical-pathological features in placentas of pregnancies with SARS-CoV-2 infection and adverse outcome : case-series with and without congenital transmission}},
  url          = {{http://dx.doi.org/10.1111/1471-0528.17132}},
  doi          = {{10.1111/1471-0528.17132}},
  volume       = {{129}},
  year         = {{2022}},
}