Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury: A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries
Publication date
2022-06-01
Authors
Schwartz, David A
Avvad-Portari, Elyzabeth
Babál, Pavel
Baldewijns, Marcella
Blomberg, Marie
Bouachba, Amine
Camacho, Jessica
Collardeau-Frachon, Sophie
Colson, Arthur
Dehaene, Isabelle
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Article
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Abstract
CONTEXT.—: Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. OBJECTIVE.—: To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). DESIGN.—: Case-based retrospective clinicopathologic analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. RESULTS.—: Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis (32%; 22 of 68). The majority (19; 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. CONCLUSIONS.—: The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.
Keywords
COVID-19, Female, Fibrin, Humans, Hypoxia/pathology, Infant, Newborn, Infectious Disease Transmission, Vertical, Perinatal Death, Placenta/pathology, Pregnancy, Pregnancy Complications, Infectious/pathology, Retrospective Studies, SARS-CoV-2, Stillbirth, Medical Laboratory Technology, Pathology and Forensic Medicine, Journal Article
Citation
Schwartz, D A, Avvad-Portari, E, Babál, P, Baldewijns, M, Blomberg, M, Bouachba, A, Camacho, J, Collardeau-Frachon, S, Colson, A, Dehaene, I, Ferreres, J C, Fitzgerald, B, Garrido-Pontnou, M, Gerges, H, Hargitai, B, Helguera-Repetto, A C, Holmström, S, Irles, C L, Leijonhfvud, Å, Libbrecht, S, Marton, T, McEntagart, N, Molina, J T, Morotti, R, Nadal, A, Navarro, A, Nelander, M, Oviedo, A, Oyamada Otani, A R, Papadogiannakis, N, Petersen, A C, Roberts, D J, Saad, A G, Sand, A, Schoenmakers, S, Sehn, J K, Simpson, P R, Thomas, K, Valdespino-Vázquez, M Y, van der Meeren, L E, Van Dorpe, J, Verdijk, R M, Watkins, J C & Zaigham, M 2022, 'Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury : A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries', Archives of pathology & laboratory medicine, vol. 146, no. 6, pp. 660-676. https://doi.org/10.5858/arpa.2022-0029-SA