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Hamilton ST, Loo C, Weber MA, John R, Shand A, Rawlinson WD. SARS-CoV-2 infection of the placenta is associated with extensive fibrin deposition which may cause adverse pregnancy outcomes. Pathology 2024; 56:437-441. [PMID: 37806945 DOI: 10.1016/j.pathol.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Stuart T Hamilton
- Serology and Virology Division, NSW Health Pathology East (Randwick Campus), Prince of Wales Hospital, Sydney, NSW, Australia; School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Christine Loo
- Department of Anatomical Pathology, NSW Health Pathology East (Randwick Campus), Prince of Wales Hospital, Sydney, NSW, Australia
| | - Martin A Weber
- Department of Anatomical Pathology, NSW Health Pathology East (Randwick Campus), Prince of Wales Hospital, Sydney, NSW, Australia; School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Roshini John
- Obstetrics and Gynaecology, Shoalhaven District Memorial Hospital, Nowra, NSW, Australia
| | - Antonia Shand
- Royal Hospital for Women, Sydney, NSW, Australia; Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - William D Rawlinson
- Serology and Virology Division, NSW Health Pathology East (Randwick Campus), Prince of Wales Hospital, Sydney, NSW, Australia; School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia; School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia.
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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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Sessa R, Filardo S, Masciullo L, Di Pietro M, Angeloni A, Brandolino G, Brunelli R, D’Alisa R, Viscardi MF, Anastasi E, Porpora MG. SARS-CoV-2 Infection in Pregnancy: Clues and Proof of Adverse Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2616. [PMID: 36767980 PMCID: PMC9915124 DOI: 10.3390/ijerph20032616] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) represents one of the most threatening viral infections in the last decade. Amongst susceptible individuals, infected pregnant women might be predisposed to severe complications. Despite the extensive interest in SARS-CoV-2 research, the clinical course of maternal infection, the vertical transmission and the neonatal outcomes have not been completely understood yet. The aim of our study was to investigate the association between SARS-CoV-2 infection, obstetric outcomes and vertical transmission. METHODS A prospective observational study was performed, enrolling unvaccinated pregnant patients positive for SARS-CoV-2 (cases) and matched with uninfected pregnant women (controls). Maternal and neonatal nasopharyngeal swabs, maternal and cord blood, amniotic fluid and placenta tissue samples were collected; blood samples were tested for anti-S and anti-N antibodies, and histologic examination of placental tissues was performed. RESULTS The cases showed a significant association with the development of some obstetric complications, such as intrauterine growth restriction and pregnancy-associated hypothyroidism and diabetes, as compared to controls; their newborns were more likely to have a low birth weight and an arterial umbilical pH less than 7. The viral genome was detected in maternal and cord blood and placental samples in six cases. CONCLUSIONS Pregnant women positive for SARS-CoV-2 infection are more likely to develop severe obstetric outcomes; their newborns could have a low birth weight and arterial pH. Vertical transmission seems a rare event, and further investigation is strongly needed.
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Affiliation(s)
- Rosa Sessa
- Microbiology Section, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Simone Filardo
- Microbiology Section, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Luisa Masciullo
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Marisa Di Pietro
- Microbiology Section, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Gabriella Brandolino
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Rossella D’Alisa
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Maria Federica Viscardi
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Emanuela Anastasi
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, 00161 Rome, Italy
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Mixed Intervillositis in SARS-CoV-2 Infection Associated with Fetal Death: A Case Report. Case Rep Obstet Gynecol 2022; 2022:5404952. [PMID: 36506700 PMCID: PMC9733999 DOI: 10.1155/2022/5404952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 10/30/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been shown in epidemiological studies to be associated with an increased risk of stillbirth. Several histopathologic features of placental SARS-CoV-2 infection have been proposed as potential causes of fetal death. We present a case of an otherwise healthy G3P1 women with mild symptoms of SARS-CoV-2 infection at 23 6/7 weeks of gestation. At 25 2/7 weeks, she presented with signs and symptoms of preterm labor and decreased fetal movements. Fetal death was diagnosed at admission. Placental pathology showed pronounced placental mixed intervillositis. Inflammatory infiltrate caused extreme narrowing of intervillous space leading to placental malfunction and fetal death. Placental tissue SARS-CoV-2 infection was confirmed by positive immunohistochemistry staining of syncytiotrophoblasts with spike protein antibody. The case presented suggests that SARS-CoV-2 associated inflammatory placental changes pose an elevated risk for the fetus.
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Sessa R, Masciullo L, Filardo S, Di Pietro M, Brandolino G, Brunelli R, Galoppi P, Terrin G, Viscardi MF, Anastasi E, Porpora MG. SARS-CoV-2 vertical transmission in a twin-pregnant woman: a case report. Int J Infect Dis 2022; 125:192-194. [PMID: 36272699 PMCID: PMC9579137 DOI: 10.1016/j.ijid.2022.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
SARS-CoV-2 has affected millions of people around the world in recent years. Among susceptible patients, pregnant women seem to be prone to serious complications. The possibility of SARS-CoV-2 vertical transmission represents one of the most debated topics in the literature, providing inconclusive results. We present a case of a confirmed vertical transmission in a monochorial diamniotic twin pregnancy complicated by a selective intrauterine growth restriction and gestational diabetes mellitus. The analysis of different biological specimens identifies the presence of the SARS-CoV-2 genome in the umbilical cord blood of both twins, and the placental histologic examination confirmed indirect signs of viral infection, supporting the hypothesis that a transplacental infection can occur. Despite the devastating impact that SARS-CoV-2 has worldwide, neonatal infections have been infrequently reported, but they can occur under certain biologic conditions. Deep knowledge of the biological mechanisms underlying the risk of SARS-CoV-2 vertical transmission might be useful to understand the pathophysiological bases and the possible long-term implication of a mother-to-child vertical transmission.
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Affiliation(s)
- Rosa Sessa
- Department of Public Health and Infectious Diseases, Microbiology Section, “Sapienza” University of Rome, Rome, Italy
| | - Luisa Masciullo
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Simone Filardo
- Department of Public Health and Infectious Diseases, Microbiology Section, “Sapienza” University of Rome, Rome, Italy,Corresponding author
| | - Marisa Di Pietro
- Department of Public Health and Infectious Diseases, Microbiology Section, “Sapienza” University of Rome, Rome, Italy
| | - Gabriella Brandolino
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Paola Galoppi
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Maria Federica Viscardi
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Emanuela Anastasi
- Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urology, “Sapienza” University of Rome, Rome, Italy
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