1. 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
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Schwartz, David A., Avvad-Portari, Elyzabeth, Babal, Pavel, Baldewijns, Marcella, Blomberg, Marie, Bouachba, Amine, Camacho, Jessica, Collardeau-Frachon, Sophie, Colson, Arthur, Dehaene, Isabelle, Ferreres, Joan Carles, Fitzgerald, Brendan, Garrido-Pontnou, Marta, Gergis, Hazem, Hargitai, Beata, Cecilia Helguera-Repetto, A., Holmstrom, Sandra, Irles, Claudine Liliane, Leijonhfvud, Asa, Libbrecht, Sasha, Marton, Tamas, McEntagart, Noel, Molina, James T., Morotti, Raffaella, Nadal, Alfons, Navarro, Alexandra, Nelander, Maria, Oviedo, Angelica, Otani, Andre Ricardo Oyamada, Papadogiannakis, Nikos, Petersen, Astrid C., Roberts, Drucilla J., Saad, Ali G., Sand, Anna, Schoenmakers, Sam, Sehn, Jennifer K., Simpson, Preston R., Thomas, Kristen, Yolotzin Valdespino-Vazquez, M., Van der Meeren, Lotte E., Van Dorpe, Jo, Verdijk, Robert M., Watkins, Jaclyn C., Zaigham, Mehreen, Augusta University - Medical College of Georgia, University System of Georgia (USG), Fernandes Figueira Institute [Rio de Janeiro, Brazil] (2FI), Comenius University in Bratislava, University Hospitals Leuven [Leuven], Linköping University (LIU), Hospices Civils de Lyon (HCL), Société Française de Foetopathologie [Paris] (SOFFOET), Vall d'Hebron University Hospital [Barcelona], Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain = Catholic University of Louvain (UCL), Ghent University Hospital, Hospital Universitari Parc Taulí de Sabadell [Barcelona, Spain] (HUPTS), Universitat Autònoma de Barcelona (UAB), University College Cork (UCC), Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust [Doncaster, UK] (DBTH), Birmingham Women's and Children's NHS Foundation Trust, National Institute of Perinatology [Mexico City, Mexico] (NIP), Halland Hospital [Varberg, Sweden] (2H), National Institute of Perinatology 'Isidro Espinosa de los Reyes' [Mexico City, Mexico] (NIP-IER), Hôpital de Helsingborg [Lund, Sweden] (2H), Lund University [Lund], Antwerp University Hospital [Edegem] (UZA), Rotunda Hospital [Dublin, Republic of Ireland] (RH), Beaumont Pathology Associates [Beaumont, TX, USA] (BPA), Department of Neuroscience, Yale University School of Medicine, Yale School of Medicine [New Haven, Connecticut] (YSM), Hospital Clinic [Barcelona, Spain], Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Uppsala University, Burrell College of Osteopathic Medicine [Las Cruces, New Mexico] (BCOM), Laboratório Ferdinando Costa [São Paulo, Brazil] (LFC), Karolinska University Hospital [Stockholm], Aalborg University [Denmark] (AAU), Massachusetts General Hospital [Boston], Harvard Medical School [Boston] (HMS), University of Miami Leonard M. Miller School of Medicine (UMMSM), Karolinska Institute, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), CHRISTUS Hospital St Elizabeth [Beaumont, TX, USA] (CHRISTUS HSE), New York University Langone Medical Center (NYU Langone Medical Center), NYU System (NYU), Leiden University Medical Center (LUMC), University Medical Center [Utrecht], Skane University Hospital [Lund], Skane University Hospital [Malmo], CarMeN, laboratoire, and Obstetrics & Gynecology
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Fibrin ,Pregnancy Complications, Infectious/mortality ,Infectious Medicine ,SARS-CoV-2 ,[SDV]Life Sciences [q-bio] ,Infant, Newborn ,Infektionsmedicin ,Placenta/pathology ,Stillbirth ,Infectious Disease Transmission, Vertical ,[SDV] Life Sciences [q-bio] ,Pregnancy ,Perinatal Death/etiology ,COVID-19/complications ,Humans ,Female ,Hypoxia/pathology ,Retrospective Studies - 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.
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- 2022