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Tartaglia S, Di Ilio C, Romanzi F, Moresi S, Nardi E, Bevilacqua E, Arena V, Lanzone A. Effects of SARS-Cov-2 mRNA vaccine on placental histopathology: Comparison of a population of uncomplicated COVID-19 positive pregnant women. Placenta 2024; 149:64-71. [PMID: 38527377 DOI: 10.1016/j.placenta.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
1. INTRODUCTION This study investigates the impact of SARS-CoV-2 infection on placental histopathology in pregnant women, comparing outcomes between vaccinated and non-vaccinated individuals. Despite known adverse pregnancy outcomes linked to SARS-CoV-2 infection, the specific effects on the placenta remain unclear. Although vaccination has demonstrated a substantial reduction in infection severity, its impact on placental health requires more insight. 2. METHODS Between March 2021 and July 2022, 387 COVID-19-positive women were admitted for delivery. Of these, 98 with non-severe symptoms were analyzed: 35 vaccinated during pregnancy, and 63 non-vaccinated. Two independent pathologists evaluated all placental specimens. 3. RESULTS The only differing obstetrical characteristic between groups was the mode of delivery (p 0.047), lacking clinical implications. Over 85% of placentas exhibited microscopic abnormalities, predominantly maternal vascular supply disorders (vaccinated 89.1%; unvaccinated 85.5%). Comparing vaccinated and unvaccinated groups revealed statistically significant differences, notably in increased focal perivillous fibrin deposits (IFPFD) [17.1% vs. 33.3% (p 0.04)] and avascular fibrotic villi (AFV) [0% vs. 11.1% (p 0.04)]. Binomial logistic regression confirmed the vaccine's protective role against IFPFD (aOR 0.36; 95%CI 013-0.99) and AVF (aOR 0.06, 95% CI 0.003-0.98). A sub-analysis in vaccinated women showed a positive correlation between the timing of the first dose and IFPFD presence (p 0.018). 4. DISCUSSION The lower incidence of maternal and fetal vascular malperfusion placental features in vaccinated women, coupled with the timing correlation, supports the vaccine's protective effect on placental tissue in COVID-19-infected pregnant patients. Notably, no side effects were reported post-vaccination, emphasizing the vaccine's safety and advocating for its secure administration in pregnant populations.
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Affiliation(s)
- Silvio Tartaglia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienza della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
| | - Chiara Di Ilio
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Romanzi
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sascia Moresi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienza della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy
| | - Eleonora Nardi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elisa Bevilacqua
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienza della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy
| | - Vincenzo Arena
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, unità di Gineco-patologia e Patologia Mammaria, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy
| | - Antonio Lanzone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienza della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy; Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
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Ercolani G, Capuani S, Maiuro A, Celli V, Grimm R, Di Mascio D, Porpora MG, Catalano C, Brunelli R, Giancotti A, Manganaro L. Diffusion-sensitized magnetic resonance imaging highlights placental microstructural damage in patients with previous SARS-CoV-2 pregnancy infection. Placenta 2024; 145:38-44. [PMID: 38052124 DOI: 10.1016/j.placenta.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been a major global health problem since December 2019. This work aimed to investigate whether pregnant women's mild and moderate SARS-CoV-2 infection was associated with microstructural and vascular changes in the placenta observable in vivo by Intravoxel Incoherent Motion (IVIM) at different gestational ages (GA). METHODS This was a retrospective, nested case-control of pregnant women during the SARS-CoV-2 pandemic (COVID-19 group, n = 14) compared to pre-pandemic healthy controls (n = 19). MRI IVIM protocol at 1.5T was constituted of diffusion-weighted (DW) images with TR/TE = 3100/76 ms and 10 b-values (0,10,30,50,75,100,200,400,700,1000s/mm2). Differences between IVIM parameters D (diffusion), and f (fractional perfusion) quantified in the two groups were evaluated using the ANOVA test with Bonferroni correction and linear correlation between IVIM metrics and GA, COVID-19 duration, the delay time between a positive SARS-CoV-2 test and MRI examination (delay-time exam+) was studied by Pearson-test. RESULTS D was significantly higher in the COVID-19 placentas compared to that of the age-matched healthy group (p < 0.04 in fetal and p < 0.007 in maternal site). No significant difference between f values was found in the two groups suggesting no-specific microstructural damage with no perfusion alteration (potentially quantified by f) in mild/moderate SARS-Cov-2 placentas. A significant negative correlation was found between D and GA in the COVID-19 placentas whereas no significant correlation was found in the control placentas reflecting a possible accelerated senescence process due to COVID-19. DISCUSSION We report impaired microstructural placental development during pregnancy and the absence of perfusion-IVIM parameter changes that may indicate no perfusion changing through microvessels and microvilli in the placentas of pregnancies with mild/moderate SARS-Cov-2 after reaching negativity.
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Affiliation(s)
- Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | | | - Alessandra Maiuro
- CNR ISC Roma Sapienza, Physics Department Rome, Italy; Sapienza University of Rome, Physics Department, Rome, Italy
| | - Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | | | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Italy.
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Turdybekova YG, Kopobayeva IL, Kamyshanskiy YK, Turmukhambetova AA. Comparative clinical and placental pathologic characteristics in pregnancies with and without SARS-CoV-2 infection. J Perinat Med 2023; 51:1179-1188. [PMID: 37475693 DOI: 10.1515/jpm-2022-0371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 06/11/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES To compare the clinical and morphological characteristics of the "mother-placenta-fetus" system in high risk pregnant women of three groups: no SARS-CoV-2 infection, mild SARS-CoV-2 infection, and severe SARS-CoV-2 infection. METHODS A case-control study was performed for all deliveries, at 28 weeks' gestation or greater, who had standard indications for placental pathologic examination. Three groups were formed: (1) control group (no SARS-CoV-2 infection), (2) mild SARS-CoV-2 infection, (3) severe SARS-CoV-2 infection. High-risk pregnancies were registered in all cases in the study groups. The examination of the placenta and the selection of fragments of placental tissue were carried out in accordance with the consensus recommendations of the Amsterdam Placental Workshop Group. The sections were subjected to standard processing and stained with hematoxylin and eosin according to the standard protocol. All cases were reviewed by two pathologists, which did not know any information on pregnancy outcome and clinical data. Statistical analysis was performed using SPSS, p<0.05 was considered statistically significant. RESULTS Women with severe SARS-CoV-2 infection had an increased rate of multimorbidity including diabetes, chronic hypertension and obesity (p<0.01) compared with the other groups. Placentas at severe COVID-19 course were damaged by both chronic and acute injuries, in comparison to the mild and control groups (p<0.001). Also an important finding in severe COVID-19 was diffuse necrosis of the villous trophoblast - homogenization, diffuse circular eosinophilic masses surrounding the chorionic villi. CONCLUSIONS Women with multimorbidity are an "at-risk" subgroup for severe SARS-CoV-2 infection and greater likelihood of both placental damage and perinatal hypoxic-ischemic events. These results suggest that patient education, SARS-CoV-2 disease monitoring and preventive measures would be of benefit to this group.
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Sekulovski M, Mileva N, Chervenkov L, Peshevska-Sekulovska M, Vasilev GV, Vasilev GH, Miteva D, Tomov L, Lazova S, Gulinac M, Velikova T. Endothelial Dysfunction and Pregnant COVID-19 Patients with Thrombophilia: A Narrative Review. Biomedicines 2023; 11:2458. [PMID: 37760899 PMCID: PMC10525846 DOI: 10.3390/biomedicines11092458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/22/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
Pregnancy with SARS-CoV-2 infection can raise the risk of many complications, including severe COVID-19 and maternal-fetal adverse outcomes. Additionally, endothelial damage occurs as a result of direct SARS-CoV-2 infection, as well as immune system, cardiovascular, and thrombo-inflammatory reactions. In this narrative review, we focus on endothelial dysfunction (ED) in pregnancy, associated with obstetric complications, such as preeclampsia, fetal growth retardation, gestational diabetes, etc., and SARS-CoV-2 infection in pregnant women that can cause ED itself and overlap with other pregnancy complications. We also discuss some shared mechanisms of SARS-CoV-2 pathophysiology and ED.
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Affiliation(s)
- Metodija Sekulovski
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, 1 Kozyak Str., 1407 Sofia, Bulgaria
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
| | - Niya Mileva
- Medical Faculty, Medical University of Sofia, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria;
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria;
| | - Monika Peshevska-Sekulovska
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Department of Gastroenterology, University Hospital Lozenetz, 1407 Sofia, Bulgaria
| | - Georgi Vasilev Vasilev
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Clinic of Endocrinology and Metabolic Disorders, UMHAT “Sv. Georgi”, 4000 Plovdiv, Bulgaria
| | - Georgi Hristov Vasilev
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Laboratory of Hematopathology and Immunology, National Specialized Hospital for Active Treatment of Hematological Diseases, “Plovdivsko Pole“ Str., 6, 1756 Sofia, Bulgaria
| | - Dimitrina Miteva
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Department of Genetics, Faculty of Biology, Sofia University “St. Kliment Ohridski”, 8 Dragan Tzankov Str., 1164 Sofia, Bulgaria
| | - Latchezar Tomov
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Department of Informatics, New Bulgarian University, Montevideo 21 Str., 1618 Sofia, Bulgaria
| | - Snezhina Lazova
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Pediatric Clinic, University Hospital “N. I. Pirogov,” 21 “General Eduard I. Totleben” Blvd; 1606 Sofia, Bulgaria
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Bialo More 8 Str., 1527 Sofia, Bulgaria
| | - Milena Gulinac
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Department of General and Clinical Pathology, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
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Heeralall C, Ibrahim UH, Lazarus L, Gathiram P, Mackraj I. The effects of COVID-19 on placental morphology. Placenta 2023; 138:88-96. [PMID: 37235921 DOI: 10.1016/j.placenta.2023.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/10/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
The impact of the COVID-19 infection, caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), during the pandemic has been considerably more severe in pregnant women than non-pregnant women. Therefore, a review detailing the morphological alterations and physiological changes associated with COVID-19 during pregnancy and the effect that these changes have on the feto-placental unit is of high priority. This knowledge is crucial for these mothers, their babies and clinicians to ensure a healthy life post-pandemic. Hence, we review the placental morphological changes due to COVID-19 to enhance the general understanding of how pregnant mothers, their placentas and unborn children may have been affected by this pandemic. Based on current literature, we deduced that COVID-19 pregnancies were oxygen deficient, which could further result in other pregnancy-related complications like preeclampsia and IUGR. Therefore, we present an up-to-date review of the COVID-19 pathophysiological implications on the placenta, covering the function of the placenta in COVID-19, the effects of this virus on the placenta, its functions and its link to other gestational complications. Furthermore, we highlight the possible effects of COVID-19 therapeutic interventions on pregnant mothers and their unborn children. Based on the literature, we strongly suggest that consistent surveillance for the mothers and infants from COVID-19 pregnancies be prioritised in the future. Though the pandemic is now in the past, its effects are long-term, necessitating the monitoring of clinical manifestations in the near future.
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Affiliation(s)
- C Heeralall
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - U H Ibrahim
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - L Lazarus
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - P Gathiram
- Discipline of Family Medicine, School of Public Health and Nursing, University of KwaZulu-Natal, Durban, South Africa
| | - I Mackraj
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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Carvalho-Sauer R, Flores-Ortiz R, Costa MDCN, Teixeira MG, Saavedra R, Niag M, Paixao ES. Fetal death as an outcome of acute respiratory distress in pregnancy, during the COVID-19 pandemic: a population-based cohort study in Bahia, Brazil. BMC Pregnancy Childbirth 2023; 23:320. [PMID: 37147605 PMCID: PMC10161155 DOI: 10.1186/s12884-023-05601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Fetal loss is one of the most serious adverse outcomes of pregnancy. Since the onset of the COVID-19 pandemic, Brazil has recorded an unprecedented number of hospitalizations of pregnant women due to acute respiratory distress (ARD), thereby, we aimed to assess the risk of fetal deaths associated to ARD during pregnancy in Bahia state, Brazil, in the context of the COVID-19 pandemic. METHODS This is an observational population-based retrospective cohort study, developed with women at or after 20 weeks of pregnancy, residents in Bahia, Brazil. Women who had acute respiratory distress (ARD) in pregnancy during the COVID-19 pandemic (Jan 2020 to Jun 2021) were considered 'exposed'. Women who did not have ARD in pregnancy, and whose pregnancy occurred before the onset of the COVID-19 pandemic (Jan 2019 to Dec 2019) were considered 'non-exposed'. The main outcome was fetal death. We linked administrative data (under mandatory registration) on live births, fetal deaths, and acute respiratory syndrome, using a probabilistic linkage method, and analyzed them with multivariable logistic regression models. RESULTS 200,979 pregnant women participated in this study, 765 exposed and 200,214 unexposed. We found four times higher chance of fetal death in women with ARD during pregnancy, of all etiologies (adjusted odds ratio [aOR] 4.06 confidence interval [CI] 95% 2.66; 6.21), and due to SARS-CoV-2 (aOR 4.45 CI 95% 2.41; 8.20). The risk of fetal death increased more when ARD in pregnancy was accompanied by vaginal delivery (aOR 7.06 CI 95% 4.21; 11.83), or admission to Intensive Care Unit (aOR 8.79 CI 95% 4.96; 15.58), or use of invasive mechanical ventilation (aOR 21.22 CI 95% 9.93; 45.36). CONCLUSION Our findings can contribute to expanding the understanding of health professionals and managers about the harmful effects of SARS-CoV-2 on maternal-fetal health and alerts the need to prioritize pregnant women in preventive actions against SARS-CoV-2 and other respiratory viruses. It also suggests that pregnant women, infected with SARS-CoV-2, need to be monitored to prevent complications of ARD, including a careful assessment of the risks and benefits of early delivery to prevent fetal death.
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Affiliation(s)
- Rita Carvalho-Sauer
- Bahia State Health Department, Núcleo Regional de Saúde Leste, Avenida Esperança, 406. Maria Preta. Santo Antônio de Jesus., 44435-500 Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Bahia, Brazil
| | - Renzo Flores-Ortiz
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Bahia, Brazil
| | | | | | - Ramon Saavedra
- Institute of Collective Health, Federal University of Bahia, Bahia, Brazil
| | - Marla Niag
- School of Medicine, Federal University of Recôncavo of Bahia, Bahia, Brazil
| | - Enny S. Paixao
- London School of Hygiene and Tropical Medicine, London, UK
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Claudet A, De Luca D, Mosnino E, Mattern J, Picone O, Sibiude J, Wafo E, Tsatsaris V, Giral E, Grefenstette I, Carrara J, Badr DA, Saint-Frison MH, Prevot S, Benachi A, Vivanti AJ. Impact of SARS-CoV-2 Infection on Unvaccinated Pregnant Women: Non-Reassuring Fetal Heart Rate Tracing Because of Placentitis. Viruses 2023; 15:v15051069. [PMID: 37243156 DOI: 10.3390/v15051069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/14/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
In 2020, a new coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China. SARS-CoV-2 infection has been shown to be highly morbid in pregnant women, being a risk factor for several obstetric conditions leading to increased maternal and neonatal mortality. A few studies since 2020 have shown SARS-CoV-2 maternal-fetal transmission and noted placental abnormalities grouped under the term placentitis. We hypothesized that these placental lesions could be responsible for abnormalities in placental exchange and therefore abnormalities in cardiotocographic monitoring, leading to premature fetal extraction. The objective is to identify the clinical, biochemical, and histological determinants associated with the occurrence of non-reassuring fetal heart rate (NRFHR) outside labor in fetuses of SARS-CoV-2-infected mothers. We conducted a retrospective multicenter case series of the natural history of maternal SARS-CoV-2 infections resulting in fetal delivery outside labor due to NRFHR. Collaboration was sought with the maternity hospitals in the CEGORIF, the APHP and Brussels hospitals. The investigators were contacted by e-mail on three successive occasions over a period of one year. Data from 17 mothers and 17 fetuses were analyzed. Most women had a mild SARS-CoV-2 infection; only two women presented severe infection. No woman was vaccinated. We found a substantial proportion of maternal coagulopathy at birth: elevation of APTT ratio (62%), thrombocytopenia (41%) and liver cytolysis (58.3%). Iatrogenic prematurity was noted in 15 of 17 fetuses, and 100% were born by cesarean delivery due to emergency criteria. One male neonate died on the day of birth due to peripartum asphyxia. Three cases of maternal-fetal transmission were recorded following WHO criteria. Placental analysis in 15 cases revealed eight cases of SARS-CoV-2 placentitis, causing placental insufficiency. In total, 100% of the placentas analyzed showed at least one lesion suggestive of placentitis. SARS-CoV-2 maternal infection during pregnancy is likely to generate neonatal morbidity in relation to placental damage resulting in placental insufficiency. This morbidity may be the consequence of induced prematurity as well as acidosis in the most severe situations. Placental damage occurred in unvaccinated women and in women with no identified risk factor, in contrast to severe maternal clinical forms.
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Affiliation(s)
- Alexandra Claudet
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Elie Mosnino
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Jérémie Mattern
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Olivier Picone
- Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris Nord Val de Seine University, APHP, 75000 Paris, France
- Inserm IAME 1137, 75000 Paris, France
- GRIG: Groupe de Recherche sur les Infections en cours de Grossesse, 75000 Paris, France
| | - Jeanne Sibiude
- Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris Nord Val de Seine University, APHP, 75000 Paris, France
- Inserm IAME 1137, 75000 Paris, France
| | - Estelle Wafo
- Division of Obstetrics and Gynecology, "Marne La Vallée" Hospital, 77600 Jossigny, France
| | - Vassilis Tsatsaris
- Division of Obstetrics and Gynecology, "Port Royal" Hospital, Paris Centre University Hospitals, APHP, 75000 Paris, France
| | - Emilie Giral
- Division of Obstetrics and Gynecology, "André Grégoire" Hospital, 93100 Montreuil, France
| | - Irène Grefenstette
- Division of Obstetrics and Gynecology, "Centre Hospitalier des Quatre Villes", 92064 Saint Cloud, France
| | - Julie Carrara
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Dominique A Badr
- Division of Obstetrics and Gynecology, "University Hospital Brugmann", Université Libre de Bruxelles, 1070 Brussels, Belgium
| | | | - Sophie Prevot
- Division of Pathology, "Bicetre" Hospital, Paris Saclay University Hospitals, APHP, 94270 Le Kremlin-Bicêtre, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
- GRIG: Groupe de Recherche sur les Infections en cours de Grossesse, 75000 Paris, France
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Damman E, Trecourt A, de la Fournière B, Lebreton F, Gaillot-Durand L, Fichez A, Chauvy L, Thonnon C, Destras G, Devouassoux-Shisheboran M, Allias F. Predictive factors for severe placental damage in pregnant women with SARS-CoV-2 infection. Placenta 2023; 136:1-7. [PMID: 36963271 PMCID: PMC10022462 DOI: 10.1016/j.placenta.2023.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION SARS-Cov-2 infection during pregnancy can lead to severe placental lesions characterized by massive perivillous fibrin deposition, histiocytic intervillositis and trophoblast necrosis. Diffuse placental damage of this kind is rare, but can sometimes lead to obstetric complications, such as intrauterine fetal death (IUFD). The objectives of this study were to identify possible predictors of severe placental lesions. METHODS We retrospectively studied 96 placentas from SARS-Cov-2 positive pregnant women who gave birth between March 2020 and March 2022. Cases with and without severe placental lesions were compared in terms of clinical and laboratory findings. RESULTS Twelve of the 96 patients had severe placental lesions. There was no significant association with diabetes, obesity or severe clinical maternal disease. In contrast, presence of severe placental lesions was significantly associated with neonatal intensive care, cesarean section, prematurity, IUFD, intrauterine growth restriction (IUGR), gestational age, maternal hypofibrinogenemia and thrombocytopenia. No cases of severe placental lesions were observed in vaccinated patients or in those with the Omicron variant. DISCUSSION In these patients, severe placental lesions due to SARS-Cov-2 were significantly associated with the presence of coagulation abnormalities (hypofibrinogenemia and thrombocytopenia), IUGR and gestational age. These results support laboratory and ultrasound monitoring of these parameters in pregnant women with SARS-Cov-2 infection, especially during the second trimester, to predict potential negative fetal outcomes.
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Affiliation(s)
- Elise Damman
- Medipath Montpellier, 80 rue de Pythagore, 34170, Castelnau-Le-Lez, France
| | - Alexis Trecourt
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Benoit de la Fournière
- Department of Gynecology and Obstetrics, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Frédérique Lebreton
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Lucie Gaillot-Durand
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Axel Fichez
- Department of Gynecology and Obstetrics, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Lauriane Chauvy
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Cyrielle Thonnon
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Gregory Destras
- Department of Virology, Infective Agents Institute, National Reference Center for Respiratory Viruses, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Fabienne Allias
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France.
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9
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Hisey JC, Patterson BM, Tsai AJ, Khan AM. COVID-19 via intrauterine transmission in a critically ill preterm infant: A case report. J Neonatal Perinatal Med 2022; 15:837-844. [PMID: 36155532 DOI: 10.3233/npm-221094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A preterm infant was born emergently at 29 weeks gestation to a mother with active coronavirus disease 2019 (COVID-19). Clinical presentation and evaluation were consistent with in utero transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The neonate experienced progressive, refractory respiratory failure and catastrophic intracranial hemorrhage which ultimately led to limitation of care.
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Affiliation(s)
- J C Hisey
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - B M Patterson
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - A J Tsai
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - A M Khan
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
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10
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Dagelic A, Stefanovic V, Resic Karara J, Kuzmic Prusac I, Roje D, Kosovic I, Zekic Tomas S. Does COVID-19 infection acquired in different pregnancy trimester influence placental pathology? J Perinat Med 2022:jpm-2022-0452. [PMID: 36423330 DOI: 10.1515/jpm-2022-0452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the morphological characteristics of the placentas from COVID-19 positive mothers in regard to the trimester of COVID-19 infection onset and low weight molecular heparin (LMWH) treatment. METHODS Placentas were collected in the period April 1st till September 1st 2021 after delivery at Department of Obstetrics and Gynecology University Hospital Split, Croatia, and sent for pathological examination. Medical history and pathology reports were used to collect the data. Pregnant women were divided based on the onset of COVID-19 infection and stratified into low molecular weight heparin (LMWH)+ or LMWH-. Depending on the data distribution, the following test were used: chi-squared test. Student's t-test, Mann-Whitney U test, ANOVA and Kruskal-Wallis test. RESULTS In 38% of patients the onset of COVID-19 infection was the 1st trimester of pregnancy, in 27% in the 2nd and 35% of women were infected in the 3rd trimester The fetal vascular malperfusion (FVM) occurrence was statistically significantly higher in the LMWH- group and if the onset of infection was in the 2nd trimester, while the perivillous fibrin deposition was most likely to happen if the COVID-19 infection that occured in the 1st trimester of pregnancy. CONCLUSIONS The onset of COVID-19 infection has the influence on trophoblast damage and subsequent morphological appearance of the placenta. LMWH use in COVID positive pregnant women decreases the rate of the FVM in examined placentas.
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Affiliation(s)
- Andrea Dagelic
- Department of Obstetrics and Gynecology, University Hospital Centre Split, Split, Croatia
| | - Vedran Stefanovic
- Fetomaternal Medical Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jasminka Resic Karara
- Department of Obstetrics and Gynecology, University Hospital Centre Split, Split, Croatia
| | | | - Damir Roje
- Department of Obstetrics and Gynecology, University Hospital Centre Split, Split, Croatia
| | - Indira Kosovic
- Department of Obstetrics and Gynecology, University Hospital Centre Split, Split, Croatia
| | - Sandra Zekic Tomas
- Department of Pathology, University Hospital Centre Split, Split, Croatia
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11
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Sichitiu J, Bourgon N, Guilleminot T, Bessieres B, Leruez-Ville M, Ville Y. Third trimester placentitis: an underreported complication of SARS-CoV-2 infection. Am J Obstet Gynecol MFM 2022; 4:100703. [PMID: 35931366 PMCID: PMC9345653 DOI: 10.1016/j.ajogmf.2022.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
SARS-CoV-2-related placentitis shows distinctive histologic characteristics, and its impact on perinatal outcomes is increasingly under scrutiny. We present two such cases in the third trimester displaying mild maternal clinical symptoms and associated with maternal coagulopathy, reduced fetal movements, and nonreassuring fetal heart rate tracing. Both cases resulted in emergency cesarean deliveries. Our cases and a review of the literature highlight that SARS-CoV-2 undermines placental function and thus greatly impacts late-term pregnancies, even in the absence of severe systemic disease.
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Affiliation(s)
- Joanna Sichitiu
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Sichitiu, Bourgon, and Ville).
| | - Nicolas Bourgon
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Sichitiu, Bourgon, and Ville); University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville)
| | - Tiffany Guilleminot
- University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville); Virology Laboratory, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Ms Guilleminot and Dr Leruez-Ville)
| | - Bettina Bessieres
- University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville); Department of Histology, Embryology and Cytogenetics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Dr Bessieres)
| | - Marianne Leruez-Ville
- University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville); Virology Laboratory, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Ms Guilleminot and Dr Leruez-Ville)
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Sichitiu, Bourgon, and Ville); University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville)
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12
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Cardiovascular Complications of COVID-19 among Pregnant Women and Their Fetuses: A Systematic Review. J Clin Med 2022; 11:jcm11206194. [PMID: 36294520 PMCID: PMC9604883 DOI: 10.3390/jcm11206194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background: COVID-19 is a viral infectious disease leading to a spectrum of clinical complications, especially cardiovascular. Evidence shows that this infection can potentially accompany a worse outcome in pregnant women. Cardiovascular complications in mothers and their fetuses are reported by previous studies. Objective: In this systematic review, we aim to investigate the cardiovascular complications of COVID-19 during pregnancy in the mothers and fetus, according to the published literature. Method: We systematically searched the online databases of PubMed, Scopus, Web of Science, and Google Scholar, using relevant keywords up to April 2022. We included all observational studies reporting cardiovascular complications among COVID-19-affected pregnant women and their fetuses. Results: We included 74 studies containing 47582 pregnant COVID-19 cases. Pre-eclampsia, hypertensive disorders, cardiomyopathy, heart failure, myocardial infarction, thrombosis formation, alterations in maternal–fetal Doppler patterns, and maternal and fetal arrhythmia were reported as cardiovascular complications. The highest incidences of pre-eclampsia/eclampsia among COVID-19 pregnant cases, reported by studies, were 69% and 62%, and the lowest were 0.5% and 3%. The highest and lowest incidences of fetal bradycardia were 20% and 3%, and regarding fetal tachycardia, 5.4% and 1%, respectively. Conclusion: SARS-CoV-2 infection during pregnancy can potentially be associated with cardiovascular complications in the mother, particularly pre-eclampsia and heart failure. Moreover, SARS-CoV-2 infection during pregnancy can potentially cause cardiovascular complications in the fetus, particularly arrhythmia.
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13
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SARS-CoV-2 Infection during Pregnancy and Histological Alterations in the Placenta. Diagnostics (Basel) 2022; 12:diagnostics12092258. [PMID: 36140659 PMCID: PMC9498066 DOI: 10.3390/diagnostics12092258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Despite the high number of cases of COVID-19 during pregnancy, SARS-CoV-2 congenital infection is rare. The role of the placenta as a barrier preventing the transmission of SARS-CoV-2 from the mother to the fetus is still being studied. This study aimed to evaluate the impact of SARS-CoV-2 infection on placental tissue. (2) Methods: This was a transversal monocentric observational study. In the study, we included pregnant women with COVID-19 who delivered at “Sfântul Pantelimon” Clinical Emergency Hospital between 1 April 2020 and 30 March 2022. Histological analyses, both macroscopic and microscopic, were performed for placentas that came from these cases. (3) Results: To date, a characteristic placental lesion has not been clearly demonstrated, but most findings include features of maternal and fetal vascular malperfusion, which probably reflect the reduction in placental blood flow due to low oxygen level from the hypoxic respiratory disease and underlying hypercoagulable state induced by the COVID-19 infection. (4) Conclusions: The histopathological aspects found in placentas that came from COVID-19-positive pregnant women are common for many other diseases, but when they are found together, they are highly suggestive for viral infectious involvement of the placenta.
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14
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Futterman ID, McLaren R, Friedmann H, Musleh N, Haberman S. Use of Machine Learning to Identify Clinical Variables in Pregnant and Non-pregnant Women with SARS-CoV-2 Infection. Methods Inf Med 2022; 61:61-67. [PMID: 36096142 DOI: 10.1055/s-0042-1756282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of the study is to identify the important clinical variables found in both pregnant and non-pregnant women who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, using an artificial intelligence (AI) platform. MATERIALS AND METHODS This was a retrospective cohort study of all women between the ages of 18 to 45, who were admitted to Maimonides Medical Center between March 10, 2020 and December 20, 2021. Patients were included if they had nasopharyngeal PCR swab positive for SARS-CoV-2. Safe People Artificial Intelligence (SPAI) platform, developed by Gynisus, Inc., was used to identify key clinical variables predicting a positive test in pregnant and non-pregnant women. A list of mathematically important clinical variables was generated for both non-pregnant and pregnant women. RESULTS Positive results were obtained in 1,935 non-pregnant women and 1,909 non-pregnant women tested negative for SARS-CoV-2 infection. Among pregnant women, 280 tested positive, and 1,000 tested negative. The most important clinical variable to predict a positive swab result in non-pregnant women was age, while elevated D-dimer levels and presence of an abnormal fetal heart rate pattern were the most important clinical variable in pregnant women to predict a positive test. CONCLUSION In an attempt to better understand the natural history of the SARS-CoV-2 infection we present a side-by-side analysis of clinical variables found in pregnant and non-pregnant women who tested positive for COVID-19. These clinical variables can help stratify and highlight those at risk for SARS-CoV-2 infection and shed light on the individual patient risk for testing positive.
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Affiliation(s)
- Itamar D Futterman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Rodney McLaren
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maimonides Medical Center, Brooklyn, New York.,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Thomas Jefferson University Hospital - Jefferson Health, Philadelphia, Pennsylvania
| | | | | | - Shoshana Haberman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maimonides Medical Center, Brooklyn, New York
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15
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Correlation between Pregnancy Outcome and Placental Pathology in COVID-19 Pregnant Women. Infect Dis Obstet Gynecol 2022; 2022:8061112. [PMID: 36046178 PMCID: PMC9420637 DOI: 10.1155/2022/8061112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Vertical transmission of several viruses during pregnancy has been shown to cause adverse fetal outcomes. The question about the possibility of a similar outcome in association with SARS-CoV-2 has been raised in recently published articles. Indeed, the rate of transmission through the placenta to the fetus reported in women with COVID-19 has been shown to form a minority. The aim of this study was to explore the possible histopathological changes in the placenta of pregnant women with COVID-19 after delivery and those changes in the umbilical cord. Methods A case-control study including a total of 50 full-term pregnant women with COVID-19 and 60 control pregnant females. Histopathological evaluation of placental tissues and umbilical cords were reported. Results The main findings in the umbilical cord were increased thickness of vessels, thrombus formation, endothelins, and narrow lumen; except for the increased thickness of blood vessels, these findings were more frequently seen in women with COVID-19, in comparison with control women in a significant manner (p < 0.05). Increased thickness of blood vessels was more significantly observed in the control group compared to the COVID-19 group (p < 0.01). Findings of the placenta included avascular villi, fibrin, thrombosis, and meconium macrophage in various combinations. Except for fibrin as the sole findings, all other findings including combinations were more frequently encountered in the study group in comparison to the control group (p < 0.05). Conclusion Pregnant women with COVID-19 have significant pathological alterations in the placenta and umbilical cord. These findings reflect the capability of SARS-CoV-2 in causing immunological reactions to the placenta, either directly or indirectly, and these pathologies may be linked to the higher rate of adverse neonatal outcomes and maternal admission to the intensive care unit.
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16
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Parcial ALN, Salomão NG, Portari EA, Arruda LV, de Carvalho JJ, de Matos Guedes HL, Conde TC, Moreira ME, Batista MM, Paes MV, Rabelo K, Gomes-Silva A. SARS-CoV-2 Is Persistent in Placenta and Causes Macroscopic, Histopathological, and Ultrastructural Changes. Viruses 2022; 14:1885. [PMID: 36146692 PMCID: PMC9500736 DOI: 10.3390/v14091885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 is a virus that belongs to the Betacoronavirus genus of the Coronaviridae family. Other coronaviruses, such as SARS-CoV and MERS-CoV, were associated with complications in pregnant women. Therefore, this study aimed to report the clinical history of five pregnant women infected with SARS-CoV-2 (four symptomatic and one asymptomatic who gave birth to a stillborn child) during the COVID-19 pandemic. They gave birth between August 2020 to January 2021, a period in which there was still no vaccination for COVID-19 in Brazil. In addition, their placental alterations were later investigated, focusing on macroscopic, histopathological, and ultrastructural aspects compared to a prepandemic sample. Three of five placentas presented SARS-CoV-2 RNA detected by RT-PCRq at least two to twenty weeks after primary pregnancy infection symptoms, and SARS-CoV-2 spike protein was detected in all placentas by immunoperoxidase assay. The macroscopic evaluation of the placentas presented congested vascular trunks, massive deposition of fibrin, areas of infarctions, and calcifications. Histopathological analysis showed fibrin deposition, inflammatory infiltrate, necrosis, and blood vessel thrombosis. Ultrastructural aspects of the infected placentas showed a similar pattern of alterations between the samples, with predominant characteristics of apoptosis and detection of virus-like particles. These findings contribute to a better understanding of the consequences of SARS-CoV-2 infection in placental tissue, vertical transmission.
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Affiliation(s)
- André Luiz N. Parcial
- Interdisciplinary Laboratory of Medical Research, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation, Rio de Janeiro 21040900, Brazil
| | - Natália Gedeão Salomão
- Interdisciplinary Laboratory of Medical Research, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation, Rio de Janeiro 21040900, Brazil
| | - Elyzabeth Avvad Portari
- Pathological Anatomy, Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro 22250020, Brazil
| | - Laíza Vianna Arruda
- Interdisciplinary Laboratory of Medical Research, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation, Rio de Janeiro 21040900, Brazil
| | - Jorge José de Carvalho
- Laboratory of Ultrastructure and Tissue Biology, Rio de Janeiro State University, Rio de Janeiro 20551030, Brazil
| | - Herbert Leonel de Matos Guedes
- Interdisciplinary Laboratory of Medical Research, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation, Rio de Janeiro 21040900, Brazil
| | | | - Maria Elizabeth Moreira
- Pathological Anatomy, Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro 22250020, Brazil
| | - Marcelo Meuser Batista
- Pathological Anatomy, Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro 22250020, Brazil
| | - Marciano Viana Paes
- Interdisciplinary Laboratory of Medical Research, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation, Rio de Janeiro 21040900, Brazil
| | - Kíssila Rabelo
- Laboratory of Ultrastructure and Tissue Biology, Rio de Janeiro State University, Rio de Janeiro 20551030, Brazil
| | - Adriano Gomes-Silva
- Interdisciplinary Laboratory of Medical Research, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation, Rio de Janeiro 21040900, Brazil
- Mycobacteriosis Clinical Research Laboratory, National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro 21040900, Brazil
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Gesaka SR, Obimbo MM, Wanyoro A. Coronavirus disease 2019 and the placenta: A literature review. Placenta 2022; 126:209-223. [PMID: 35872511 PMCID: PMC9293390 DOI: 10.1016/j.placenta.2022.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/13/2022] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been implicated in the clinical pathology of multiple organs and organ systems. Due to the novelty of the disease, there is a need to review emerging literature to understand the profile of SARS-CoV-2 in the placenta. This review sought to evaluate the literature on the mediators, mechanism of entry, pathogenesis, detection, and pathology of SARS-CoV-2 in the placenta. Systematic literature searches found 96 eligible studies. Our review revealed that SARS-CoV-2 canonical mediators, angiotensin-converting enzyme-2 (ACE2), and transmembrane serine protease-2 (TMPRSS2) are variably expressed in various placenta compartments, including the villous cytotrophoblasts, syncytiotrophoblasts (STBs), and extravillous trophoblasts (EVTs) throughout pregnancy. Placental SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs), including basigin (BSG/CD147), dipeptidyl peptidase-4 (DPP4/CD26), cathepsin B/L (CTL B/L), furin, interferon-induced transmembrane protein (IFITM1-3), and lymphocyte antigen 6E (LY6E) may increase or reduce the permissiveness of the placenta to SARS-CoV-2. EVTs express genes that code for proteins that may drive viral pathogenesis in the placenta. Viral RNA, proteins, and particles were detected primarily in the STBs by in situ hybridization, immunohistochemistry, electron microscopy, and polymerase chain reaction. Placental pathology in SARS-CoV-2-infected placentas included maternal and fetal vascular malperfusion and a generally nonspecific inflammatory-immune response. The localization of SARS-CoV-2 receptors, proteases, and genes involved in coding proteins that drive viral pathogenesis in the placenta predisposes the placenta to SARS-CoV-2 infection variably in all pregnancy trimesters, with antecedent placental pathology. There is a need for further studies to explicate the mechanism of entry and pathogenesis of SARS-CoV-2 in the placenta.
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Affiliation(s)
- Samwel R Gesaka
- Basic Clinical and Translational (BCT) Research Laboratory, University of Nairobi, Nairobi, Kenya.
| | - Moses M Obimbo
- Basic Clinical and Translational (BCT) Research Laboratory, University of Nairobi, Nairobi, Kenya; Department of Human Anatomy, University of Nairobi, Nairobi, Kenya; Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
| | - Anthony Wanyoro
- Basic Clinical and Translational (BCT) Research Laboratory, University of Nairobi, Nairobi, Kenya; Department of Obstetrics and Gynecology, Kenyatta University, Nairobi, Kenya.
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18
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Resta L, Vimercati A, Cazzato G, Fanelli M, Scarcella SV, Ingravallo G, Colagrande A, Sablone S, Stolfa M, Arezzo F, Lettini T, Rossi R. SARS-CoV-2, Placental Histopathology, Gravity of Infection and Immunopathology: Is There an Association? Viruses 2022; 14:v14061330. [PMID: 35746801 PMCID: PMC9227044 DOI: 10.3390/v14061330] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: As the pandemic months progress, more and more evidence shows that the placenta acts as a “barrier” to SARS-CoV-2, although rare cases of vertical transmission have been described. (2) Methods: In an attempt to investigate whether the symptoms’ severity was related to different placental histological characteristics and the immune microenvironment, we subdivided 29 placentas from 29 mothers positive for SARS-CoV-2 into two groups, depending on the symptomatology (moderate/severe vs. asymptomatic/mild), performing immunohistochemical investigations for CD4 + and CD8 + T lymphocytes, as well as for CD68 + macrophage. We also evaluated the immuno-expression of the ACE2 receptor at the placental level. These two groups were compared to a control group of 28 placentas from 28 SARS-CoV-2-negative healthy mothers. (3) Results: The symptoms (likely to be related to viremia) were statistically significantly correlated (p < 0.05) with histopathological changes, such as maternal malperfusion, decidual arteriopathy, blood vessel thrombus of fetal relevance. Furthermore, the immuno-expression of ACE2 was significantly lower in SARS-CoV-2-positive groups vs. control group (p = 0.001). (4) Conclusions: There is still much to study and discover regarding the relationship between SARS-CoV-2 and histological changes in placentas and how the latter might contribute to various neonatal clinical outcomes, such as prematurity.
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Affiliation(s)
- Leonardo Resta
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.R.); (M.F.); (S.V.S.); (G.I.); (A.C.); (M.S.); (T.L.); (R.R.)
| | - Antonella Vimercati
- Section of Ginecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.V.); (F.A.)
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.R.); (M.F.); (S.V.S.); (G.I.); (A.C.); (M.S.); (T.L.); (R.R.)
- Correspondence: ; Tel.: +39-34-0520-3641
| | - Margherita Fanelli
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.R.); (M.F.); (S.V.S.); (G.I.); (A.C.); (M.S.); (T.L.); (R.R.)
| | - Sara Vincenza Scarcella
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.R.); (M.F.); (S.V.S.); (G.I.); (A.C.); (M.S.); (T.L.); (R.R.)
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.R.); (M.F.); (S.V.S.); (G.I.); (A.C.); (M.S.); (T.L.); (R.R.)
| | - Anna Colagrande
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.R.); (M.F.); (S.V.S.); (G.I.); (A.C.); (M.S.); (T.L.); (R.R.)
| | - Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Mary Stolfa
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.R.); (M.F.); (S.V.S.); (G.I.); (A.C.); (M.S.); (T.L.); (R.R.)
| | - Francesca Arezzo
- Section of Ginecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.V.); (F.A.)
| | - Teresa Lettini
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.R.); (M.F.); (S.V.S.); (G.I.); (A.C.); (M.S.); (T.L.); (R.R.)
| | - Roberta Rossi
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.R.); (M.F.); (S.V.S.); (G.I.); (A.C.); (M.S.); (T.L.); (R.R.)
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Response to "Diffuse trophoblast damage is the hallmark of SARS-CoV-2-associated fetal demise.". Mod Pathol 2022; 35:850-851. [PMID: 34845304 PMCID: PMC8629101 DOI: 10.1038/s41379-021-00975-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/18/2023]
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Almohammadi NH. A review of the main placenta histopathological findings reported in coronavirus disease 2019. J Taibah Univ Med Sci 2022; 17:165-173. [PMID: 35250425 PMCID: PMC8879984 DOI: 10.1016/j.jtumed.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 12/30/2022] Open
Abstract
Several studies have reported that pregnant women are more susceptible to contracting the SARS-CoV-2 disease. However, SARS-CoV-2 infection studies have limited evidence regarding its impact on pregnancy, particularly its pathological effects on the maternal–fetal interface. This review emphasized the placental structures and immunomodulatory defense mechanism against the viral infection COVID and highlighted the spectrum of reported histopathological changes from SARS-CoV-2-infected mothers' placenta to contribute to the knowledge of the nature of this placental pathology. Further studies where collaborations that seek to maximize sample numbers analyzed can be performed to improve the generalizability and reliability of the findings. This can lead to improved knowledge on the relationship between placental dysfunction and pathology from maternal SARS-CoV-2 infection. Consequently, this can help improve maternity care delivery during the pandemic.
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Affiliation(s)
- Nawal H. Almohammadi
- Department of Pathology, Faculty of Medicine, Taibah University, Madinah, KSA
- Department of Histopathology, Prince Sultan Armed Forces Hospital, Madinah, KSA
- Department of Pathology, Faculty of Medicine, Taibah University, P.O. Box 334, Madina, KSA.
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21
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Khalil A, Samara A, Chowdhury T, O'Brien P. Does COVID-19 cause pre-eclampsia? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:146-152. [PMID: 34766403 PMCID: PMC8661727 DOI: 10.1002/uog.24809] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 06/02/2023]
Affiliation(s)
- A. Khalil
- Fetal Medicine Unit, St George's HospitalSt George's University of LondonLondonUK
- Vascular Biology Research CentreMolecular and Clinical Sciences Research Institute, St George's University of LondonLondonUK
- Fetal Medicine Unit, Liverpool Women's HospitalUniversity of LiverpoolLiverpoolUK
| | - A. Samara
- Division of Clinical Paediatrics, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Astrid Lindgren, Children's HospitalKarolinska University HospitalStockholmSweden
| | - T. Chowdhury
- Fetal Medicine Unit, St George's HospitalSt George's University of LondonLondonUK
| | - P. O'Brien
- University College London Hospitals NHS Foundation TrustLondonUK
- The Royal College of Obstetricians and GynaecologistsLondonUK
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22
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Dadgar S, Mahmoudinia M, Akbari A, Zandieh E, Attaranzadeh A, Hoseinpour S, Jahanpak N, Tavanaee Sani A, Mohammadi SA. Placental infection with SARS-CoV-2, analysis of 16 cases and literature review. Arch Gynecol Obstet 2022; 305:1359-1367. [PMID: 35088195 PMCID: PMC8794612 DOI: 10.1007/s00404-021-06372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022]
Abstract
Purpose Since December 2019, the whole world has been affected by coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)]. However, the effects of COVID-19 infection on pregnancy and fetal transmission are still unclear. Therefore, this study was conducted to evaluate placenta samples regarding detection of SARS-CoV-2 RNA in women affected with COVID-19.
Method This study was a part of a cohort study carried out on pregnant women with a diagnosis of COVID-19 infection who had been admitted to the Imam Reza Hospital in Mashhad, Iran, from March 20 to August 5, 2020. Clinical and laboratory information of all the patients was collected and chest computed tomography (CT) scans were reviewed. Totally, 16 placental tissue were prepared for real time polymerase chain reaction (RT-PCR) testing. All samples were tested by PowerChek PCR real-time kit (South Korea) with 2 target genes (E gene and Rd Rp gene), and Pishtaz Teb kit, (Iran) with 2 target genes (N gene and RdRp gene).
Result In the first RT-PCR kit by PowerChek kit, 6 samples were positive for a single gene (E gene) and 2 samples were positive for both genes (E gene and Rd Rp gene). In the second RT-PCR kit by Pishtaz Teb kit, 3 samples were positive for two genes (N gene and RdRp gene).
Conclusion This present study showed that infection of placenta with SARS-CoV-2 may occur in pregnancy. However, whether this infection leads to neonatal infection and serious complication in pregnancy remains unclear.
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Affiliation(s)
- Salmeh Dadgar
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihe Mahmoudinia
- Department of Obstetrics, Faculty of Medicines, Maternal and Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Azam Akbari
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elaheh Zandieh
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Armin Attaranzadeh
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajjad Hoseinpour
- Department of Molecular Genetic, Medical Laboratory, Imam Hosein Hospital, Mashhad, Iran
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23
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Dini P, Aminimoghaddam S, Mirzaasgari Z, Rahimian N, Khotbehsara ST, Abolmaali M. Spontaneous Intracerebral Hemorrhage (ICH) associated with pregnancy and SARS-CoV-2 infection: a case report. BMC Pregnancy Childbirth 2022; 22:14. [PMID: 34986833 PMCID: PMC8731675 DOI: 10.1186/s12884-021-04345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) is predominately known as a respiratory disease associated with pneumonia, acute respiratory distress syndrome and multiorgan failure. However, extra-pulmonary complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly being recognized. In this regard, some studies implied the hemostatic and vascular involvements in patients with SARS-CoV-2 infection. Case presentation We describe a case of spontaneous Intracerebral Hemorrhage (ICH) in a pregnant patient with COVID-19 and history of cesarean section a week before the occurrence of ICH. The patient underwent emergent craniotomy with acceptable outcome. Hemorrhagic events, including ICH, may happen during COVID-19 infection with several possible mechanisms. Conclusion COVID-19 patients, especially high-risk groups, are at a risk of intracranial hemorrhage. Therefore, close follow-up must be maintained and hemorrhagic events must be kept in mind in these cases.
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Affiliation(s)
- Parisa Dini
- Department of Gynecology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Aminimoghaddam
- Department of Gynecology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Mirzaasgari
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran.,Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Rahimian
- Department of Internal Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Meysam Abolmaali
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran. .,School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Young EM, Green O, Stewart J, King Y, O'Donoghue K, Walker KF, Thornton JG. COVID-19 and pregnancy: A comparison of case reports, case series and registry studies. Eur J Obstet Gynecol Reprod Biol 2021; 268:135-142. [PMID: 34920270 PMCID: PMC8647390 DOI: 10.1016/j.ejogrb.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Selection, outcome and publication biases are well described in case reports and case series but may be less of a problem early in the appearance of a new disease when all cases might appear to be worth publishing. OBJECTIVE To use a prospectively collected database of primary sources to compare the reporting of COVID-19 in pregnancy in case reports, case series and in registries over the first 8 months of the pandemic. STUDY DESIGN MEDLINE, Embase and Maternity and Infant Care databases were searched from 22 March to 5 November 2020, to create a curated list of primary sources. Duplicate reports were excluded. Case reports, case series and registry studies of pregnant women with confirmed COVID-19, where neonatal outcomes were reported, were selected and data extracted on neonatal infection status, neonatal death, neonatal intensive care unit admission, preterm birth, stillbirth, maternal critical care unit admission and maternal death. RESULTS 149 studies comprising 41,658 mothers and 8,854 neonates were included. All complications were more common in case reports, and in retrospective series compared with presumably prospective registry studies. Extensive overlap is likely in registry studies, with cases from seven countries reported by multiple registries. The UK Obstetric Surveillance System was the only registry to explicitly report identification and removal of duplicate cases, although five other registries reported collection of patient identifiable data which would facilitate identification of duplicates. CONCLUSIONS Since it is likely that registries provide the least biased estimates, the higher rates seen in the other two study designs are probably due to selection or publication bias. However even some registry studies include self- or doctor-reported cases, so might be biased, and we could not completely exclude overlap of cases in some registries.
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Affiliation(s)
- Eloise M Young
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Oleia Green
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Joel Stewart
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Yasmin King
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, College Road, University College, Cork, Ireland
| | - Kate F Walker
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Jim G Thornton
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England.
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Roberts DJ, Edlow AG, Romero RJ, Coyne CB, Ting DT, Hornick JL, Zaki SR, Das Adhikari U, Serghides L, Gaw SL, Metz TD. A standardized definition of placental infection by SARS-CoV-2, a consensus statement from the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development SARS-CoV-2 Placental Infection Workshop. Am J Obstet Gynecol 2021; 225:593.e1-593.e9. [PMID: 34364845 PMCID: PMC8340595 DOI: 10.1016/j.ajog.2021.07.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 01/04/2023]
Abstract
Pregnant individuals infected with SARS-CoV-2 have higher rates of intensive care unit admission, oxygen requirement, need for mechanical ventilation, and death than nonpregnant individuals. Increased COVID-19 disease severity may be associated with an increased risk of viremia and placental infection. Maternal SARS-CoV-2 infection is also associated with pregnancy complications such as preeclampsia and preterm birth, which can be either placentally mediated or reflected in the placenta. Maternal viremia followed by placental infection may lead to maternal-fetal transmission (vertical), which affects 1% to 3% of exposed newborns. However, there is no agreed-upon or standard definition of placental infection. The National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a group of experts to propose a working definition of placental infection to inform ongoing studies of SARS-CoV-2 during pregnancy. Experts recommended that placental infection be defined using techniques that allow virus detection and localization in placental tissue by one or more of the following methods: in situ hybridization with antisense probe (detects replication) or a sense probe (detects viral messenger RNA) or immunohistochemistry to detect viral nucleocapsid or spike proteins. If the abovementioned methods are not possible, reverse transcription polymerase chain reaction detection or quantification of viral RNA in placental homogenates, or electron microscopy are alternative approaches. A graded classification for the likelihood of placental infection as definitive, probable, possible, and unlikely was proposed. Manuscripts reporting placental infection should describe the sampling method (location and number of samples collected), method of preservation of tissue, and detection technique. Recommendations were made for the handling of the placenta, examination, and sampling and the use of validated reagents and sample protocols (included as appendices).
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Affiliation(s)
| | - Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Roberto J Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD; Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
| | - Carolyn B Coyne
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC; Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC
| | - David T Ting
- Department of Medicine and Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Stephanie L Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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Sevilla‐Montoya R, Hidalgo‐Bravo A, Estrada‐Gutiérrez G, Villavicencio‐Carrisoza O, Leon‐Juarez M, Villegas‐Mota I, Espino‐y‐Sosa S, Monroy‐Muñoz IE, Martinez‐Portilla RJ, Poon LC, Cardona‐Pérez JA, Helguera‐Repetto AC. Evidence of possible SARS-CoV-2 vertical transmission according to World Health Organization criteria in asymptomatic pregnant women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:900-908. [PMID: 34580942 PMCID: PMC8661610 DOI: 10.1002/uog.24787] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vertical transmission has been investigated extensively. Recently, the World Health Organization (WHO) published strict criteria to classify the timing of mother-to-child transmission of SARS-CoV-2 into different categories. The aim of this study was to investigate the possibility of vertical transmission in asymptomatic SARS-CoV-2-positive women. METHODS Pregnant women attending for delivery at a perinatology center in Mexico City, Mexico, who had a SARS-CoV-2-positive nasopharyngeal swab 24-48 h before delivery, were asymptomatic at the time of the test and had an obstetric indication for Cesarean section were eligible for inclusion in this study. Amniotic fluid was collected during Cesarean delivery, and neonatal oral and rectal swabs were collected at birth and at 24 h after birth. SARS-CoV-2 detection was carried out using real-time reverse-transcription polymerase chain reaction in all samples. Relevant medical information was retrieved from clinical records. The WHO criteria for classifying the timing of mother-to-child transmission of SARS-CoV-2 were applied to the study population. RESULTS Forty-two SARS-CoV-2-positive asymptomatic pregnant women fulfilled the inclusion criteria. Twenty-five (59%) women developed mild disease after discharge. Neonatal death occurred in three (7%) cases, of which one had a positive SARS-CoV-2 test at birth and none had coronavirus disease 2019-related symptoms. There were five (12%) cases with strong evidence of intrauterine transmission of SARS-CoV-2, according to the WHO criteria, as amniotic fluid samples and neonatal samples at birth and at 24 h after birth were positive for SARS-CoV-2. Our results also showed that 40-60% of infected neonates would have been undetected if only one swab (oral or rectal) was tested. CONCLUSION This study contributes evidence to reinforce the potential for vertical transmission of SARS-CoV-2 even in asymptomatic women and highlights the importance of testing more than one neonatal sample in order to increase the detection rate of SARS-CoV-2 in affected cases. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R. Sevilla‐Montoya
- Department of Genetics and Human GenomicsNational Institute of PerinatologyMexico CityMexico
| | - A. Hidalgo‐Bravo
- Department of Genetics and Genomic MedicineNational Institute of Rehabilitation Luis Guillermo Ibarra IbarraMexico CityMexico
| | - G. Estrada‐Gutiérrez
- Dirección de InvestigaciónInstituto Nacional de Perinatología Isidro Espinosa de los ReyesMexico CityMexico
| | - O. Villavicencio‐Carrisoza
- Departamento de Inmuno‐BioquímicaInstituto Nacional de Perinatología Isidro Espinosa de los ReyesMexico CityMexico
- Programa de posgrado en Biomedicina y Biotecnología MolecularEscuela Nacional de Ciencias Biológicas del Instituto Politécnico NacionalMexico CityMexico
| | - M. Leon‐Juarez
- Departamento de Inmuno‐BioquímicaInstituto Nacional de Perinatología Isidro Espinosa de los ReyesMexico CityMexico
| | - I. Villegas‐Mota
- Unidad de enfermedades infecciosas y epidemiología, Instituto Nacional de Perinatología Isidro Espinosa de los ReyesMexico CityMexico
| | - S. Espino‐y‐Sosa
- Subdirección de Investigación ClínicaInstituto Nacional de Perinatología Isidro Espinosa de los ReyesMexico CityMexico
| | - I. E. Monroy‐Muñoz
- Department of Genetics and Human GenomicsNational Institute of PerinatologyMexico CityMexico
| | - R. J. Martinez‐Portilla
- Subdirección de Investigación ClínicaInstituto Nacional de Perinatología Isidro Espinosa de los ReyesMexico CityMexico
| | - L. C. Poon
- Department of Obstetrics and GynaecologyPrince of Wales Hospital, The Chinese University of Hong KongShatin, Hong Kong SAR
| | - J. A. Cardona‐Pérez
- Dirección General, Instituto Nacional de Perinatología Isidro Espinosa de los ReyesMexico CityMexico
| | - A. C. Helguera‐Repetto
- Departamento de Inmuno‐BioquímicaInstituto Nacional de Perinatología Isidro Espinosa de los ReyesMexico CityMexico
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Di Girolamo R, Khalil A, Alameddine S, D'Angelo E, Galliani C, Matarrelli B, Buca D, Liberati M, Rizzo G, D'Antonio F. Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2021; 3:100468. [PMID: 34425296 PMCID: PMC8379009 DOI: 10.1016/j.ajogmf.2021.100468] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to report the spectrum of placental pathology findings in pregnancies complicated by SARS-CoV-2 infection. DATA SOURCES MEDLINE, Embase, Google Scholar, and the Web of Science databases were searched up to August 11, 2021. STUDY ELIGIBILITY CRITERIA Histopathologic anomalies included maternal vascular malperfusion, fetal vascular malperfusion, acute inflammatory pathology, chronic inflammatory pathology, increased perivillous fibrin, and intervillous thrombosis. Moreover, subanalyses of symptomatic women only and high-risk pregnancies were performed. METHODS Histopathologic analysis of the placenta included gross examination, histopathology on hematoxylin and eosin, immunohistochemistry, fluorescence in situ hybridization, quantitative reverse transcription-polymerase chain reaction on placental tissue, and transmission electron microscope. Random-effect meta-analyses were used to analyze the data. RESULTS A total of 56 studies (1008 pregnancies) were included. Maternal vascular malperfusion was reported in 30.7% of placentas (95% confidence interval, 20.3-42.1), whereas fetal vascular malperfusion was observed in 27.08 % of cases (95% confidence interval, 19.2-35.6). Acute and chronic inflammatory pathologies were reported in 22.68% (95% confidence interval, 16.9-29.0) and 25.65% (95% confidence interval, 18.4-33.6) of cases, respectively. Increased perivillous fibrin was observed in 32.7% (95% confidence interval, 24.1-42.0) of placentas undergoing histopathologic analysis, whereas intervillous thrombosis was observed in 14.6% of cases (95% confidence interval, 9.7-20.2). Other placental findings, including a basal plate with attached myometrial fibers, microscopic accretism, villous edema, increased circulating nucleated red blood cells, or membranes with hemorrhage, were reported in 37.5% of cases (95% confidence interval, 28.0-47.5), whereas only 17.5% of cases (95% confidence interval, 10.9-25.2) did not present any abnormal histologic findings. The subanalyses according to maternal symptoms owing to SARS-CoV-2 infection or the presence of a high-risk pregnancy showed a similar distribution of the different histopathologic anomalies to that reported in the main analysis. Moreover, the risk of placental histopathologic anomalies was higher when considering only case-control studies comparing women with SARS-CoV-2 infection with healthy controls. CONCLUSION In pregnant women with SARS-CoV-2 infection, a significant proportion of placentas showed histopathologic findings, suggesting placental hypoperfusion and inflammation. Future multicenter prospective blinded studies are needed to correlate these placental lesions with pregnancy outcomes.
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Affiliation(s)
- Raffaella Di Girolamo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom (XX Khalil); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom (Dr Khalil)
| | - Sara Alameddine
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Emanuela D'Angelo
- Center for Advanced Studies and Technology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Dr D'Angelo)
| | - Carmen Galliani
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Barbara Matarrelli
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Danilo Buca
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Marco Liberati
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ospedale Cristo Re Roma, University of Rome Tor Vergata, Rome, Italy (Dr Rizzo)
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio).
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28
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Tjon JK, Lakeman P, van Leeuwen E, Waisfisz Q, Weiss MM, Tan-Sindhunata GMB, Nikkels PGJ, van der Voorn PJP, Salomons GS, Burchell GL, Linskens IH, van der Knoop BJ, de Vries JIP. Fetal akinesia deformation sequence and massive perivillous fibrin deposition resulting in fetal death in six fetuses from one consanguineous couple, including literature review. Mol Genet Genomic Med 2021; 9:e1827. [PMID: 34636181 PMCID: PMC8606203 DOI: 10.1002/mgg3.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/02/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background Massive perivillous fibrin deposition (MPFD) is associated with adverse pregnancy outcomes and is mainly caused by maternal factors with limited involvement of fetal or genetic causes. We present one consanguineous couple with six fetuses developing Fetal Akinesia Deformation Sequence (FADS) and MPFD, with a possible underlying genetic cause. This prompted a literature review on prevalence of FADS and MPFD. Methods Fetal ultrasound examination, motor assessment, genetic testing, postmortem examination, and placenta histology are presented (2009–2019). Literature was reviewed for the association between congenital anomalies and MPFD. Results All six fetuses developed normally during the first trimester. Thereafter, growth restriction, persistent flexed position, abnormal motility, and contractures in 4/6, consistent with FADS occurred. All placentas showed histologically confirmed MPFD. Genetic analyses in the five available cases showed homozygosity for two variants of unknown significance in two genes, VARS1 (OMIM*192150) and ABCF1 (OMIM*603429). Both parents are heterozygous for these variants. From 63/1999 manuscripts, 403 fetal outcomes were mobilized. In 14/403 fetuses, congenital abnormalities in association with MPFD were seen of which two fetuses with contractures/FADS facial anomalies. Conclusion The low prevalence of fetal contractures/FADS facial anomalies in association with MPFD in the literature review supports the possible fetal or genetic contribution causing FADS and MPFD in our family. This study with literature review supports the finding that fetal, fetoplacental, and/or genetic components may play a role in causing a part of MPFDs.
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Affiliation(s)
- Jill K Tjon
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Phillis Lakeman
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Quinten Waisfisz
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjan M Weiss
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gita M B Tan-Sindhunata
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter G J Nikkels
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Gajja S Salomons
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - George L Burchell
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ingeborg H Linskens
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bloeme J van der Knoop
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Diffuse trophoblast damage is the hallmark of SARS-CoV-2-associated fetal demise. Mod Pathol 2021; 34:1704-1709. [PMID: 34006935 PMCID: PMC8130566 DOI: 10.1038/s41379-021-00827-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 02/04/2023]
Abstract
Placental pathology in SARS-CoV-2-infected pregnancies seems rather unspecific. However, the identification of the placental lesions due to SARS-CoV-2 infection would be a significant advance in order to improve the management of these pregnancies and to identify the mechanisms involved in a possible vertical transmission. The pathological findings in placentas delivered from 198 SARS-CoV-2-positive pregnant women were investigated for the presence of lesions associated with placental SARS-CoV-2 infection. SARS-CoV-2 infection was investigated in placental tissues through immunohistochemistry, and positive cases were further confirmed by in situ hybridization. SARS-CoV-2 infection was also investigated by RT-PCR in 33 cases, including all the immunohistochemically positive cases. Nine cases were SARS-CoV-2-positive by immunohistochemistry, in situ hybridization, and RT-PCR. These placentas showed lesions characterized by villous trophoblast necrosis with intervillous space collapse and variable amounts of mixed intervillous inflammatory infiltrate and perivillous fibrinoid deposition. Such lesions ranged from focal to massively widespread in five cases, resulting in intrauterine fetal death. Two of the stillborn fetuses showed some evidence of SARS-CoV-2 positivity. The remaining 189 placentas did not show similar lesions. The strong association between trophoblastic damage and placenta SARS-CoV-2 infection suggests that this lesion is a specific marker of SARS-CoV-2 infection in placenta. Diffuse trophoblastic damage, massively affecting chorionic villous tissue, can result in fetal death associated with COVID-19 disease.
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Marton T, Hargitai B, Hunter K, Pugh M, Murray P. Massive Perivillous Fibrin Deposition and Chronic Histiocytic Intervillositis a Complication of SARS-CoV-2 Infection. Pediatr Dev Pathol 2021; 24:450-454. [PMID: 34082613 DOI: 10.1177/10935266211020723] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An emerging complication of COVID-19 (SARS-CoV-2) infection is reported. A 23-year-old patient presented with high temperature and reduced fetal movements at 25 + 5/40 weeks of gestation. RT-PCR proved maternal COVID-19 infection. Ultrasound examination confirmed intrauterine death. Placenta histology showed necrosis of the villous trophoblast, associated with Chronic Histiocytic Intervillositis (CHI) and Massive Perivillous Fibrin Deposition (MPFD) with up to 90% - of the intervillous spaces being involved. Immunohistochemistry showed CD68 positive histiocytes in the intervillous spaces and the villous trophoblast was positive for the COVID-19 spike protein. RNA scope signal was indicative of the presence of the viral genome and active viral replication in the villous trophoblastic cells, respectively. MPFD is a gradually developing end-stage disease with various etiology, including autoimmune and alloimmune maternal response to antigens expressed at the feto-maternal interface and frequently accompanies chronic alloimmune villitis or histiocytic intervillositis. Covid-19 infection is associated with similar pattern of histological changes of the placenta leading to placental insufficiency and fetal death. This case report supports maternal- fetal vertical transmission of SARS-CoV-2 virus leading to placental insufficiency and fetal demise. MPFD and CHI appear to be the typical placental histology for SARS-CoV-2 virus infection associated fetal demise.
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Affiliation(s)
- T Marton
- Division of Perinatal Pathology, Department of Cellular Pathology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - B Hargitai
- Division of Perinatal Pathology, Department of Cellular Pathology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - K Hunter
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - M Pugh
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - P Murray
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
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Di Girolamo R, Khalil A, Alameddine S, D'Angelo E, Galliani C, Matarrelli B, Buca D, Liberati M, Rizzo G, D'Antonio F. Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2021. [PMID: 34425296 DOI: 10.1016/j.ajogmf.2021.100468.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to report the spectrum of placental pathology findings in pregnancies complicated by SARS-CoV-2 infection. DATA SOURCES MEDLINE, Embase, Google Scholar, and the Web of Science databases were searched up to August 11, 2021. STUDY ELIGIBILITY CRITERIA Histopathologic anomalies included maternal vascular malperfusion, fetal vascular malperfusion, acute inflammatory pathology, chronic inflammatory pathology, increased perivillous fibrin, and intervillous thrombosis. Moreover, subanalyses of symptomatic women only and high-risk pregnancies were performed. METHODS Histopathologic analysis of the placenta included gross examination, histopathology on hematoxylin and eosin, immunohistochemistry, fluorescence in situ hybridization, quantitative reverse transcription-polymerase chain reaction on placental tissue, and transmission electron microscope. Random-effect meta-analyses were used to analyze the data. RESULTS A total of 56 studies (1008 pregnancies) were included. Maternal vascular malperfusion was reported in 30.7% of placentas (95% confidence interval, 20.3-42.1), whereas fetal vascular malperfusion was observed in 27.08 % of cases (95% confidence interval, 19.2-35.6). Acute and chronic inflammatory pathologies were reported in 22.68% (95% confidence interval, 16.9-29.0) and 25.65% (95% confidence interval, 18.4-33.6) of cases, respectively. Increased perivillous fibrin was observed in 32.7% (95% confidence interval, 24.1-42.0) of placentas undergoing histopathologic analysis, whereas intervillous thrombosis was observed in 14.6% of cases (95% confidence interval, 9.7-20.2). Other placental findings, including a basal plate with attached myometrial fibers, microscopic accretism, villous edema, increased circulating nucleated red blood cells, or membranes with hemorrhage, were reported in 37.5% of cases (95% confidence interval, 28.0-47.5), whereas only 17.5% of cases (95% confidence interval, 10.9-25.2) did not present any abnormal histologic findings. The subanalyses according to maternal symptoms owing to SARS-CoV-2 infection or the presence of a high-risk pregnancy showed a similar distribution of the different histopathologic anomalies to that reported in the main analysis. Moreover, the risk of placental histopathologic anomalies was higher when considering only case-control studies comparing women with SARS-CoV-2 infection with healthy controls. CONCLUSION In pregnant women with SARS-CoV-2 infection, a significant proportion of placentas showed histopathologic findings, suggesting placental hypoperfusion and inflammation. Future multicenter prospective blinded studies are needed to correlate these placental lesions with pregnancy outcomes.
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Affiliation(s)
- Raffaella Di Girolamo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom (XX Khalil); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom (Dr Khalil)
| | - Sara Alameddine
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Emanuela D'Angelo
- Center for Advanced Studies and Technology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Dr D'Angelo)
| | - Carmen Galliani
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Barbara Matarrelli
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Danilo Buca
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Marco Liberati
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio)
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ospedale Cristo Re Roma, University of Rome Tor Vergata, Rome, Italy (Dr Rizzo)
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy (Ms Di Girolamo, Ms Alameddine, Ms Galliani, Ms Matarrelli, Mr Buca, Dr Liberati, and Dr D'Antonio).
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Watkins JC, Torous VF, Roberts DJ. Defining Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Placentitis: A Report of 7 Cases with Confirmatory In Situ Hybridization, Distinct Histomorphologic Features, and Evidence of Complement Deposition. Arch Pathol Lab Med 2021; 145:1341-1349. [PMID: 34338723 DOI: 10.5858/arpa.2021-0246-sa] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT -Case reports and rare case series have demonstrated variable placental pathology in the setting of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In rare small studies demonstrating infection of the placental parenchyma, histologic manifestations have included variable degrees of histiocytic intervillositis, perivillous fibrin deposition, and syncytiotrophoblast necrosis. OBJECTIVE -To characterize the placental pathological features of SARS-CoV-2 infected placentas, irrespective of fetal-maternal transmission, and to examine the frequency of C4d activation in such cases. DESIGN -Retrospective study of seven placentas from mothers with active SARS-CoV-2 infection and placental infection as demonstrated by RNA in situ hybridization. RESULTS -Six placentas were from live-born neonates (5 singletons, 1 non-fused diamniotic-dichorionic twin placenta), and one was from a stillbirth. Five of the eight neonates (including the stillbirth) tested negative for SARS-CoV-2, and all were negative for neonatal infection. The remaining three neonates were well at time of discharge. All placentas were positive for SARS-CoV-2 infection by RNA in situ hybridization and demonstrated variable degrees of histiocytic intervillositis, perivillous fibrin deposition, and trophoblast necrosis. Three cases demonstrated features of fetal vascular malperfusion. CD68 highlighted intervillous histiocytes. C4d expression was present along the villous borders in 6 of 7 cases. CONCLUSIONS -SARS-CoV-2 placentitis is defined by the triad of histiocytic intervillositis, perivillous fibrin deposition, and trophoblast necrosis. The features may occur in cases without confirmed transplacental transmission. The damage caused by SARS-CoV-2 placentitis is likely mediated by complement activation.
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Affiliation(s)
- Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Vanda F Torous
- Department of Pathology, Massachusetts General Hospital, Boston, MA
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Bouachba A, Allias F, Nadaud B, Massardier J, Mekki Y, Bouscambert Duchamp M, Fourniere BDLA, Huissoud C, Trecourt A, Collardeau-Frachon S. Placental lesions and SARS-Cov-2 infection: Diffuse placenta damage associated to poor fetal outcome. Placenta 2021; 112:97-104. [PMID: 34329973 PMCID: PMC8280612 DOI: 10.1016/j.placenta.2021.07.288] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/29/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022]
Abstract
Introduction Pregnant women with covid-19 are more likely to experience preterm birth. The virus seems to be associated with a wide range of placental lesions, none of them specific. Method We collected cases of Covid-19 maternal infection during pregnancy associated with poor pregnancy outcomes, for which we received the placenta. We studied clinical data and described pathological findings of placenta and post-mortem examination of fetuses. We performed an immunohistochemical study and RT-PCR of SARS-Cov-2 on placenta samples. Results We report 5 cases of poor fetal outcome, 3 fetal deaths and 2 extreme premature neonates, one with growth restriction, without clinical and biological sign of SARS-Cov-2 infection. All placenta presented massive perivillous fibrin deposition and large intervillous thrombi associated with strong SARS-Cov-2 expression in trophoblast and SARS-CoV-2 PCR positivity in amniotic fluid or on placenta samples. Chronic histiocytic intervillositis was present in 4/5 cases. Placental ultrasound was abnormal and the sFLT1-PIGF ratio was increased in one case. Timing between mothers’ infection and the poor fetal outcome was ≤10 days in 4 cases. The massive placental damage are directly induced by the virus whose receptors are expressed on trophoblast, leading to trophoblast necrosis and massive inflammation in villous chamber, in a similar way it occurs in diffuse alveolar damage in adults infected by SARS-Cov-2. Discussion SARS-Cov-2 can be associated to a rare set of placental lesions which can lead to fetal demise, preterm birth, or growth restriction. Stronger surveillance of mothers infected by SARS-Cov-2 is required.
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Affiliation(s)
- Amine Bouachba
- Institut de Pathologie Multisite des Hospices Civils de Lyon, 69677, Bron Cedex, Lyon, France; SOFFOET-Société Française de Fœtopathologie, 75014, Paris, France.
| | - Fabienne Allias
- SOFFOET-Société Française de Fœtopathologie, 75014, Paris, France; Institut de Pathologie, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Bénite, Lyon, France
| | - Beatrice Nadaud
- Institut de Pathologie Multisite des Hospices Civils de Lyon, 69677, Bron Cedex, Lyon, France; SOFFOET-Société Française de Fœtopathologie, 75014, Paris, France
| | - Jerome Massardier
- SOFFOET-Société Française de Fœtopathologie, 75014, Paris, France; Service de gynécologie-obstétrique de l'Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, 69677, Bron Cedex, Lyon, France
| | - Yahia Mekki
- Institut des Agents Infectieux des Hospices Civils de Lyon, Service de Virologie, 69004, Lyon, France
| | - Maude Bouscambert Duchamp
- Institut des Agents Infectieux des Hospices Civils de Lyon, Service de Virologie, 69004, Lyon, France
| | - Benoit De LA Fourniere
- Service de Gynécologie-obstétrique de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France
| | - Cyril Huissoud
- Service de Gynécologie-obstétrique de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008, France
| | - Alexis Trecourt
- Institut de Pathologie Multisite des Hospices Civils de Lyon, 69677, Bron Cedex, Lyon, France
| | - Sophie Collardeau-Frachon
- Institut de Pathologie Multisite des Hospices Civils de Lyon, 69677, Bron Cedex, Lyon, France; SOFFOET-Société Française de Fœtopathologie, 75014, Paris, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008, France
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Bertero L, Borella F, Botta G, Carosso A, Cosma S, Bovetti M, Carosso M, Abbona G, Collemi G, Papotti M, Cassoni P, Benedetto C. Placenta histopathology in SARS-CoV-2 infection: analysis of a consecutive series and comparison with control cohorts. Virchows Arch 2021; 479:715-728. [PMID: 33934229 PMCID: PMC8088311 DOI: 10.1007/s00428-021-03097-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/14/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
Infection by SARS-CoV-2 has been shown to involve a wide range of organs and tissues, leading to a kaleidoscope of clinical conditions. Within this spectrum, an involvement of the fetal-maternal unit could be expected, but, so far, the histopathological evaluation of placentas delivered by women with SARS-CoV-2 infection did not show distinct hallmarks. A consecutive series of 11 placentas, delivered by 10 women with COVID-19 admitted to our Obstetrics and Gynecology clinic have been investigated and compared to a control cohort of 58 pre-COVID-19 placentas and 28 placentas delivered by women who had a previous cesarean section. Four out of eleven placentas showed changes consistent with chronic villitis/villitis of unknown etiology (VUE), while in one case, chronic histiocytic intervillositis was diagnosed. Thrombo-hemorrhagic alterations were observed in a subset of cases. Compared to the control cohort, chronic villitis/VUE (p < 0.001), chronic deciduitis (p = 0.023), microvascular thrombosis (p = 0.003), presence of infarction areas (p = 0.047) and of accelerated villous maturation (p = 0.005) showed higher frequencies in placentas delivered by women with COVID-19. Chronic villitis/VUE (p = 0.003) and accelerated villous maturation (p = 0.019) remained statistically significant by restricting the analysis to placentas delivered after a previous cesarean section. The observed differences in terms of pathological findings could be consistent with SARS-CoV-2 pathogenesis, but just a subset of alterations remained statistically significant after adjusting for a previous cesarean section. A careful consideration of potential confounders is warranted in future studies exploring the relationship between COVID-19 and pregnancy.
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Affiliation(s)
- Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Fulvio Borella
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Giovanni Botta
- Pathology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Andrea Carosso
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Stefano Cosma
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Marialuisa Bovetti
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Marco Carosso
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Giancarlo Abbona
- Pathology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Giammarco Collemi
- Pathology Unit, Department of Medical Sciences, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy.
| | - Chiara Benedetto
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
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35
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Schwartz DA, Levitan D. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infecting Pregnant Women and the Fetus, Intrauterine Transmission and Placental Pathology During the Coronavirus Disease 2019 (COVID-19) Pandemic: It's Complicated. Arch Pathol Lab Med 2021; 145:925-928. [PMID: 33878167 DOI: 10.5858/arpa.2021-0164-ed] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/06/2022]
Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA (Schwartz); Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA (Levitan)
| | - Daniel Levitan
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA (Schwartz); Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA (Levitan)
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Abu-Amara J, Szpecht D, Al-Saad SR, Karbowski LM. Contracting COVID-19 in the first and second trimester of pregnancy: what we know - a concise qualitative systematic review. Arch Med Sci 2021; 17:1548-1557. [PMID: 34900033 PMCID: PMC8641503 DOI: 10.5114/aoms/133121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Recent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies. As the coherence of results seems to vary, especially in relation to first and second trimester pregnancies, a concise qualitative systematic review can shed light on the most recent data. MATERIAL AND METHODS A structured systematic search was performed to collect all COVID-19 pregnancy-related articles published between January 1 and September 16, 2020. Two independent reviewers evaluated studies using the STROBE statement in combination with the CERQual quality assessment of findings. RESULTS In total 1387 articles were screened and finally 22 studies were evaluated (179 1st/2nd trimesters of pregnant women with COVID-19). The majority of reported mothers who contracted COVID-19 during 1st/2nd trimesters are yet to complete their pregnancy. CONCLUSIONS Evidently a limited amount of data is available. Usually, mothers and newborns are discharged from the hospital without any serious complications. Further observations are imperative.
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Affiliation(s)
| | - Dawid Szpecht
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
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Seymen CM. Being pregnant in the COVID-19 pandemic: Effects on the placenta in all aspects. J Med Virol 2021; 93:2769-2773. [PMID: 33559937 PMCID: PMC8013594 DOI: 10.1002/jmv.26857] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
The coronavirus disease 2019 (COVID‐19), which had spread to the world from Wuhan (China) in late December, was announced as a pandemic by the World Health Organization in March 2020. In addition to acute respiratory syndrome symptoms, this virus also affects nonrespiratory organs, according to existing data. ACE2 and TMPRSS2, which play a critical role in the entrance of SARS‐COV‐2 into the cell, are coexpressed in placental development stages, so the placenta also carries a risk for this virus. Many studies have shown that this virus causes some histopathological changes in the placenta. The vertical transmission of the virus is not yet clear, but available data have shown that the indirect effects of the virus can be seen on the fetus. This article focuses on revealing the effects of the virus on the placenta in all aspects. The placenta also shows antiviral activity due to placental growth factors, cytokines, and chemokines, so the use of placental extracts as therapeutic agents in the treatment of COVID‐19 needs authority regulations and clinical guidelines.
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Affiliation(s)
- C Merve Seymen
- Department of Histology and Embryology, Gazi University, Institute of Health Sciences, Ankara, Turkey
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Samara A, Herlenius E. Is There an Effect of Fetal Mesenchymal Stem Cells in the Mother-Fetus Dyad in COVID-19 Pregnancies and Vertical Transmission? Front Physiol 2021; 11:624625. [PMID: 33679426 PMCID: PMC7928412 DOI: 10.3389/fphys.2020.624625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022] Open
Abstract
Because of the polysystemic nature of coronavirus disease 2019 (COVID-19), during the present pandemic, there have been serious concerns regarding pregnancy, vertical transmission, and intrapartum risk. The majority of pregnant patients with COVID-19 infection present with mild or asymptomatic course of the disease. Some cases were hospitalized, and few needed intensive care unit admission, or mechanical ventilation. There have also been scarce case reports where neonates required mechanical ventilation post COVID-19 pregnancies. Without approved therapies other than dexamethasone, advanced mesenchymal cell therapy is one immunomodulatory therapeutic approach that is currently explored and might hold great promise. We suggest that the circulating fetal stem cells might have an immune-protective effect to mothers and contribute to the often mild and even asymptomatic post-COVID-19 pregnancies. Thus, COVID-19 pregnancies come forth as a paradigm to be further and more comprehensively approached, to understand both the mechanism and action of circulating stem cells in immunoprotection and hypoxia in microcirculation.
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Affiliation(s)
- Athina Samara
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden
| | - Eric Herlenius
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden
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Martinez‐Portilla RJ, Gil MM, Poon LC. Scientific effort in combating COVID-19 in obstetrics and gynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:189-194. [PMID: 33428290 PMCID: PMC8013175 DOI: 10.1002/uog.23584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- R. J. Martinez‐Portilla
- Clinical Research DivisionNational Institute of Perinatology “Isidro Espinosa de los Reyes”, Mexico CityMexico
- Iberoamerican Research Network in ObstetricsGynecology and Translational MedicineMexico CityMexico
- Fetal Medicine Research Center, BCNatalBarcelona Center for Maternal–Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de BarcelonaBarcelonaCataloniaSpain
| | - M. M. Gil
- Obstetrics and Gynecology DepartmentHospital Universitario de Torrejón, Torrejón de ArdozMadridSpain
- School of Health SciencesUniversidad Francisco de Vitoria (UFV), Pozuelo de AlarcónMadridSpain
| | - L. C. Poon
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong Kong SAR
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Wong YP, Khong TY, Tan GC. The Effects of COVID-19 on Placenta and Pregnancy: What Do We Know So Far? Diagnostics (Basel) 2021; 11:diagnostics11010094. [PMID: 33435547 PMCID: PMC7827584 DOI: 10.3390/diagnostics11010094] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/25/2020] [Accepted: 01/07/2021] [Indexed: 12/11/2022] Open
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has inflicted a serious health crisis globally. This virus is associated with a spectrum of respiratory illness ranging from asymptomatic, mild to severe pneumonia, and acute respiratory distress syndrome. Accumulating evidence supports that COVID-19 is not merely a respiratory illness per se, but potentially affects other organ systems including the placenta. SARS-CoV-2 gains access to human cells via angiotensin-converting enzyme 2 (ACE-2). The abundance of ACE-2 on the placental cell surface, especially the syncytiotrophoblasts, could potentially contribute to vertical transplacental transmission to the fetus following maternal COVID-19 infection. Intriguingly, despite the placentas being tested positive for SARS-CoV-2, there are very few newborns that manifest virus-induced diseases. The protective effects of the placental barrier to viral infection, limiting the spread of the virus to newborn infants, remain a mystery. The detrimental role of COVID-19 in pregnancies is largely debatable, although COVID-19 maternal infection has been implicated in unfavorable pregnancy outcomes. In this review, we summarize the pathological features manifested in placenta due to COVID-19 maternal infection that have been previously reported, and relate them to the possible disease manifestation. The potential mechanistic pathways associated with transplacental viral transmission and adverse pregnancy outcomes are also discussed.
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Affiliation(s)
- Yin Ping Wong
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
- Correspondence: (Y.P.W.); (G.C.T.); Tel.: +60-391-455-364 (Y.P.W); +60-391-455-362 (G.C.T.)
| | - Teck Yee Khong
- Department of Pathology, SA Pathology, Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia;
| | - Geok Chin Tan
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
- Correspondence: (Y.P.W.); (G.C.T.); Tel.: +60-391-455-364 (Y.P.W); +60-391-455-362 (G.C.T.)
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Schwartz DA, Morotti D. Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2. Viruses 2020; 12:v12111308. [PMID: 33203131 PMCID: PMC7697563 DOI: 10.3390/v12111308] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 02/07/2023] Open
Abstract
The mechanism(s) by which neonates testing positive for coronavirus disease 2019 (COVID-19) acquire their infection has been largely unknown. Transmission of the etiological agent, SARS-CoV-2, from mother to infant has been suspected but has been difficult to confirm. This communication summarizes the spectrum of pathology findings from pregnant women with COVID-19 based upon the infection status of their infants and addresses the potential interpretation of these results in terms of the effects of SARS-CoV-2 on the placenta and the pathophysiology of maternal-fetal infection. Placentas from pregnant women with COVID-19 and uninfected neonates show significant variability in the spectrum of pathology findings. In contrast, placentas from infected maternal-neonatal dyads are characterized by the finding of mononuclear cell inflammation of the intervillous space, termed chronic histiocytic intervillositis, together with syncytiotrophoblast necrosis. These placentas show prominent positivity of syncytiotrophoblast by SARS-CoV-2, fulfilling the published criteria for transplacental viral transmission as confirmed in fetal cells through identification of viral antigens by immunohistochemistry or viral nucleic acid using RNA in situ hybridization. The co-occurrence of chronic histiocytic intervillositis and trophoblast necrosis appears to be a risk factor for placental infection with SARS-CoV-2 as well as for maternal-fetal viral transmission, and suggests a potential mechanism by which the coronavirus can breach the maternal-fetal interface.
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Affiliation(s)
- David A. Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence:
| | - Denise Morotti
- Pathology Unit and Medical Genetics Laboratory, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
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