Stillbirth due to SARS-CoV-2 placentitis without evidence of intrauterine transmission to fetus: association with maternal risk factors.

OBJECTIVES: To describe the placental pathology, fetal autopsy findings and clinical characteristics of pregnancies that resulted in stillbirth owing to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) placentitis, and to identify potential risk factors. METHODS: This was a prospective multicenter study of non-vaccinated pregnant women affected by coronavirus disease 2019 (COVID-19) in Greece from April 2020 to August 2021. A total of 165 placentas were examined histologically and six cases of stillbirth associated with SARS-CoV-2 placentitis were retrieved. Complete fetal autopsy was performed in three of these cases. Gross, histopathological, immunohistochemical, molecular and electron microscopy examinations were carried out in the stillbirth placentas and fetal organs. The histological findings of cases with SARS-CoV-2 placentitis were compared with those in 159 cases with maternal COVID-19 which resulted in a live birth. Regression analysis was used to identify predisposing risk factors for SARS-CoV-2 placentitis. RESULTS: The placentas of all six stillborn cases showed severe and extensive histological changes typical of SARS-CoV-2 placentitis, characterized by a combination of marked intervillositis with a mixed inflammatory infiltrate and massive perivillous fibrinoid deposition with trophoblast damage, associated with intensely positive immunostaining for SARS-CoV-2 spike protein, the presence of virions on electron microscopy and positive reverse-transcription polymerase chain reaction test of placental tissues. The histological lesions obliterated over 75% of the maternal intervillous space, accounting for intrauterine fetal death. Similar histological lesions affecting less than 25% of the placenta were observed in seven liveborn neonates, while the remaining 152 placentas of COVID-19-affected pregnancies with a live birth did not show these findings. Complete fetal autopsy showed evidence of an asphyctic mode of death without evidence of viral transmission to the fetus. The mothers had mild clinical symptoms or were asymptomatic, and the interval between maternal COVID-19 diagnosis and fetal death ranged from 3 to 15 days. Statistically significant predisposing factors for SARS-CoV-2 placentitis included thrombophilia and prenatally diagnosed fetal growth restriction (FGR). Multiple sclerosis was seen in one case. CONCLUSIONS: SARS-CoV-2 placentitis occurred uncommonly in COVID-19-affected pregnancies of non-vaccinated mothers and, when extensive, caused fetal demise, with no evidence of transplacental fetal infection. Thrombophilia and prenatally detected FGR emerged as independent predisposing factors for the potentially lethal SARS-CoV-2 placentitis. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

COVID-19 impact on the health and emotional well-being of the general population

A tremendous number of studies describe results on the evolution of the COVID-19 impact on infected patients, hospital admissions, deaths, mental health and well-being of the population. However, there are hardly any reports on its impact and evolution since the beginning of the pandemic with clinical, contextual and individual perception information. Our work describes the research project called Health Care and Social Survey (ESSOC, Encuesta Sanitaria y SOCial). It arises from the need to provide specific, reliable, early, and timely data on the impact of COVID-19 that can be considered when making decisions to prepare and provide an effective Public Health response in the different affected populations. It is linked to official statistical operations included in the Andalusian Regional Government and has also been granted a favorable opinion by the Research Ethics Committee. The ESSOC is based on a Real-World Data design. It integrates observational data extracted from multiple sources including information based on surveys and clinical, epidemiological, population, and environmental registries. The surveys have an overlapping panel design with a total of over 22,000 effective interviews being carried out over three years from the beginning of the state of alarm in Spain. Their geographical scope is the Autonomous Region of Andalusia (8.4MM people, the fifth most populated region in Europe), and the population scopes are general population, population residing in disadvantaged areas, and population over the age of 55. The conceptual approach of this study encompasses all aspects affecting health that will contribute to an extraordinary increase in the current knowledge of the impact of the COVID-19 pandemic. Its results will be very useful for cross-disciplinary comparisons in population-based studies, and the methodology developed will serve as a model to be applied in other epidemiological studies. Key messages It is needed to provide specific, reliable, early, and timely data on the impact of COVID-19 that can be considered when making decisions to prepare and provide an effective Public Health response. Our research project integrates observational data extracted from multiple sources including information based on surveys and clinical, epidemiological, population, and environmental registries.