TY - JOUR
T1 - Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury
T2 - A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries
AU - Schwartz, David A.
AU - Avvad-Portari, Elyzabeth
AU - Babál, Pavel
AU - Baldewijns, Marcella
AU - Blomberg, Marie
AU - Bouachba, Amine
AU - Camacho, Jessica
AU - Collardeau-Frachon, Sophie
AU - Colson, Arthur
AU - Dehaene, Isabelle
AU - Ferreres, Joan Carles
AU - Fitzgerald, Brendan
AU - Garrido-Pontnou, Marta
AU - Gerges, Hazem
AU - Hargitai, Beata
AU - Helguera-Repetto, A. Cecilia
AU - Holmström, Sandra
AU - Irles, Claudine Liliane
AU - Leijonhfvud, Åsa
AU - Libbrecht, Sasha
AU - Marton, Tamás
AU - McEntagart, Noel
AU - Molina, James T.
AU - Morotti, Raffaella
AU - Nadal, Alfons
AU - Navarro, Alexandra
AU - Nelander, Maria
AU - Oviedo, Angelica
AU - Oyamada Otani, Andre Ricardo
AU - Papadogiannakis, Nikos
AU - Petersen, Astrid C.
AU - Roberts, Drucilla J.
AU - Saad, Ali G.
AU - Sand, Anna
AU - Schoenmakers, Sam
AU - Sehn, Jennifer K.
AU - Simpson, Preston R.
AU - Thomas, Kristen
AU - Valdespino-Vázquez, M. Yolotzin
AU - van der Meeren, Lotte E
AU - Van Dorpe, Jo
AU - Verdijk, Robert M.
AU - Watkins, Jaclyn C.
AU - Zaigham, Mehreen
N1 - © 2022 College of American Pathologists.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - 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.
AB - 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.
KW - COVID-19/complications
KW - Female
KW - Fibrin
KW - Humans
KW - Hypoxia/pathology
KW - Infant, Newborn
KW - Infectious Disease Transmission, Vertical
KW - Perinatal Death/etiology
KW - Placenta/pathology
KW - Pregnancy
KW - Pregnancy Complications, Infectious/mortality
KW - Retrospective Studies
KW - SARS-CoV-2
KW - Stillbirth
U2 - 10.5858/arpa.2022-0029-SA
DO - 10.5858/arpa.2022-0029-SA
M3 - Journal article
C2 - 35142798
SN - 0003-9985
VL - 146
SP - 660
EP - 676
JO - Archives of pathology & laboratory medicine
JF - Archives of pathology & laboratory medicine
IS - 6
ER -