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Altuntaş ŞL, Güneş A, Kaplan AA, Ayşit N, Keskin İ. Unravelling the impact of COVID-19 on pregnancy: In aspect of placental histopathology and umbilical cord macrophage immunoactivity with neonatal outcomes. J Reprod Immunol 2024; 162:104207. [PMID: 38301595 DOI: 10.1016/j.jri.2024.104207] [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: 08/11/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024]
Abstract
COVID-19 has turned into a global pandemic since it was first detected in 2019, causing serious public health problems. Our objective was to investigate the impact of COVID-19 on pregnant women and newborns, who belong to the vulnerable segments of society. Our study involved the histopathological examination of placentas and umbilical cords from two groups of pregnant women. Group I consisted of pregnant women who had never tested positive for COVID-19 during their pregnancy (n: 20). Group II consisted of pregnant women who had contracted COVID-19, exhibited moderate and mild symptoms, and recovered from the disease before giving birth (n: 23). Furthermore, we employed immunofluorescence techniques to detect macrophage activity in the umbilical cord. Prenatal assessments were based on maternal complete blood counts and coagulation assays (n:40 in both groups). Newborn conditions were evaluated using birth weight, height, head circumference, and APGAR (n:40 in both groups). Our analyses reveal that COVID-19 causes placental and umbilical cord inflammation and maternal and foetal vascular malperfussion. Our immunofluorescence investigations demonstrate a notable increase in macrophage numbers and the macrophage-to-total cell ratio within the COVID-19 group. In this aspect, this study provides the initial report incorporating macrophage activity results from Warton's jelly in pregnants who have recovered from COVID-19. We have also ascertained that COVID-19 abbreviates gestation periods and concurrently diminishes maternal haemoglobin concentrations. Consequently, COVID-19 with mild and moderate symptoms during pregnancy, causes significant changes to the placenta and umbilical cord, but propitiously does not cause a significant difference in the neonatal outcomes.
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Affiliation(s)
- Şükriye Leyla Altuntaş
- Department of Gynecology and Obstetrics, School of Medicine, Istanbul Medipol University, Istanbul, Türkiye
| | - Arzu Güneş
- Department of Histology and Embryology, School of Medicine, Istanbul Medipol University, Istanbul, Türkiye; Graduate School of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye.
| | - Arife Ahsen Kaplan
- Department of Histology and Embryology, School of Medicine, Istanbul Medipol University, Istanbul, Türkiye; Health Science and Technologies Research Institute (SABITA), Istanbul Medipol University, Istanbul, Türkiye
| | - Neşe Ayşit
- Health Science and Technologies Research Institute (SABITA), Istanbul Medipol University, Istanbul, Türkiye; Department of Medical Biology, School of Medicine, Istanbul Medipol University, Istanbul, Türkiye
| | - İlknur Keskin
- Department of Histology and Embryology, School of Medicine, Istanbul Medipol University, Istanbul, Türkiye
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Tóth EL, Orbán-Kálmándi R, Bagoly Z, Lóczi L, Deli T, Török O, Molnár S, Baráth S, Singh P, Hevessy Z, Katona É, Fagyas M, Szabó AÁ, Molnár S, Krasznai ZT. Case report: Complex evaluation of coagulation, fibrinolysis and inflammatory cytokines in a SARS-CoV-2 infected pregnant woman with fetal loss. Front Immunol 2024; 15:1329236. [PMID: 38449857 PMCID: PMC10915050 DOI: 10.3389/fimmu.2024.1329236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/22/2024] [Indexed: 03/08/2024] Open
Abstract
Background SARS-CoV-2 infection during pregnancy increases the risk of severe obstetrical complications. Detailed evaluation of COVID-19-associated coagulopathy in a pregnancy with stillbirth hasn't been described so far. Besides knowledge gaps in the pathomechanism leading to stillbirth in COVID-19 pregnancies, currently, no prognostic biomarker is available to identify pregnant patients who are at imminent risk of COVID-19-associated maternal and fetal complications, requiring immediate medical attention. Case Here we report the case of a 28-year-old SARS-CoV-2 infected pregnant patient, admitted to our hospital at 28 weeks of gestation with intrauterine fetal loss. The presence of SARS-CoV-2 placentitis was confirmed by immunohistological evaluation of the placenta. She had only mild upper respiratory symptoms and her vital signs were within reference throughout labor and postpartum. The stillborn infant was delivered per vias naturales. Fibrinogen concentrate was administered before and after labor due to markedly decreased fibrinogen levels (1.49 g/l) at admission and excessive bleeding during and after delivery. Although coagulation screening tests were not alarming at admission, the balance of hemostasis was strikingly distorted in the patient. As compared to healthy age- and gestational age-matched pregnant controls, increased D-dimer, low FVIII activity, low FXIII level, marked hypocoagulability as demonstrated by the thrombin generation assay, together with shortened clot lysis and decreased levels of fibrinolytic proteins were observed. These alterations most likely have contributed to the increased bleeding observed during labor and in the early postpartum period. Interestingly, at the same time, only moderately altered inflammatory cytokine levels were found at admission. Serum ACE2 activity did not differ in the patient from that of age- and gestational age-matched healthy controls, suggesting that despite previous speculations in the literature, ACE2 may not be used as a potential biomarker for the prediction of COVID-19 placentitis and threatening fetal loss in SARS-CoV-2-infected pregnancies. Conclusions Although based on this case report no prognostic biomarker could be identified for use in pregnant patients with imminent risk of fetal loss associated with COVID-19 placentitis, the above-described hemostasis alterations warrant awareness of postpartum hemorrhagic complications and could be helpful to identify patients requiring intensified medical attention.
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Affiliation(s)
- Eszter Lilla Tóth
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Molecular Medicine, University of Debrecen, Debrecen, Hungary
| | - Rita Orbán-Kálmándi
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsa Bagoly
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Linda Lóczi
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Kálmán Laki Doctoral School, University of Debrecen, Debrecen, Hungary
| | - Tamás Deli
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Olga Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sarolta Molnár
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándor Baráth
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Parvind Singh
- Kálmán Laki Doctoral School, University of Debrecen, Debrecen, Hungary
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsanna Hevessy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Éva Katona
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklós Fagyas
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Ádám Szabó
- Kálmán Laki Doctoral School, University of Debrecen, Debrecen, Hungary
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szabolcs Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoárd Tibor Krasznai
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Chilaka VN, Navti O, Opoku A, Okunoye GO, Babarinsa I, Odukoya OA, Bako A, Sulaiman AKP, Mohan M. Managing Labour in Women with COVID-19. J Clin Med 2023; 12:3980. [PMID: 37373674 DOI: 10.3390/jcm12123980] [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: 04/12/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Since first reported in December 2019 in Wuhan, China, COVID-19 caused by Severe Acute Respiratory Syndrome (SARS) Corona virus2 (SARS CoV-2) quickly spread to become a pandemic that has caused significant morbidity and mortality. The rapidity of the spread of the virus and the high mortality at the outset threatened to overwhelm health systems worldwide, and, indeed, this significantly impacted maternal health, especially since there was minimal experience to draw from. Experience with Covid 19 has grown exponentially as the unique needs of pregnant and labouring women with COVID-19 infection have become more evident. Managing COVID-19 parturients requires a multidisciplinary team consisting of anaesthesiologists, obstetricians, neonatologists, nursing staff, critical care staff, infectious disease and infection control experts. There should be a clear policy on triaging patients depending on the severity of their condition and the stage of labour. Those at high risk of respiratory failure should be managed in a tertiary referral centre with facilities for intensive care and assisted respiration. Staff and patients in delivery suites and operating rooms should be protected by enforcing infection protection principles such as offering dedicated rooms and theatres to SARS CoV-2 positive patients and using personal protective equipment. All hospital staff must be trained in infection control measures which should be updated regularly. Breastfeeding and care of the new-born must be part of the healthcare package offered to COVID-19 parturient mothers.
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Affiliation(s)
- Victor Ngozi Chilaka
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
| | - Osric Navti
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
| | - Albert Opoku
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
| | - Gbemisola O Okunoye
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
- Sidra Medicine Qatar, Doha P.O. Box 26999, Qatar
- University of Health & Allied Sciences, Ho, Ghana
| | - Isaac Babarinsa
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Qatar University College of Medicine, Doha P.O. Box 2713, Qatar
| | | | - Abdulmalik Bako
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
- Qatar University College of Medicine, Doha P.O. Box 2713, Qatar
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