Placenta, the Key Witness of COVID-19 Infection in Premature Births.

Adverse perinatal outcomes, such as increased risks of pre-eclampsia, miscarriage, premature birth, and stillbirth have been reported in SARS-CoV-2 infection. For a better understanding of COVID-19 complications in pregnancy, histopathological changes in the placenta, which is the interface between mother and foetus, could be the place to look at. The aim of this study was to determine placental histopathological changes and their role in preterm birth in pregnant women with SARS-CoV-2 infection. We performed a prospective, observational study in a COVID-only hospital, which included 39 pregnant women with SARS-CoV-2 infection and preterm birth compared with a control group of 39 women COVID-19 negative with preterm birth and a placental pathology exam available. The microscopic examination of all placentas revealed placental infarction (64.1% vs. 30.8%), decidual arteriopathy (66.7% vs. 23.1%), intervillous thrombi (53.8% vs. 38.5%), perivillous fibrin deposits (59% vs. 46.2%), inflammatory infiltrate (69.2% vs. 46.2%), chorangiosis (17.9% vs. 10.3%), and accelerated maturation of the villi (23.1% vs. 28.2%).

The Accuracy of Cytology, Colposcopy and Pathology in Evaluating Precancerous Cervical Lesions.

Introduction: Cervical cancer (CC) is the third most common cancer in the world, and Romania has the highest incidence of cervical cancer in Europe. The aim of this study was to evaluate the correlation between cytology, colposcopy, and pathology for the early detection of premalignant cervical lesions in a group of Romanian patients. Methods: This observational type 2 cohort study included 128 women from our unit, "Bucur" Maternity, who were referred for cervical cancer screening. Age, clinical diagnosis, cytology results, colposcopy impression, and biopsy results were considered. Colposcopy was performed by two experienced examiners. The pathological examination was performed by an experienced pathologist. Results: The cytology found high-grade squamous intraepithelial lesions in 60.9% of patients, low-grade squamous intraepithelial lesions in 28.1%, atypical squamous cells for which a high-grade lesion could not be excluded in 9.4%, and atypical squamous cells of undetermined significance, known as repeated LSIL, in 1.6%. The first evaluator identified low-grade lesions in 56.3%, high-grade lesions in 40.6%, and invasion in 3.1% of patients. The second evaluator identified low-grade lesions in 59.4%, high-grade lesions in 32.0%, and invasion in 8.6% of patients. The pathological exam identified low-grade lesions in 64.1%, high-grade lesions in 25%, and carcinoma in 14% of patients. The colposcopic accuracy was greater than the cytologic accuracy. Conclusions: Colposcopy remains an essential tool for the identification of cervical premalignant cancer cells. Standardization of the protocol provided an insignificant interobserver variability and can serve as support for further postgraduate teaching.

The Impact of SARS-CoV-2 Infection on Premature Birth-Our Experience as COVID Center.

Information about the impact of SARS-CoV-2 infection on pregnant women is still limited and raises challenges, even as publications are increasing rapidly. The aim of the present study was to determine the impact of SARS-CoV-2 infection on preterm birth pregnancies. We performed a prospective, observational study in a COVID-only hospital, which included 34 pregnant women with SARS-CoV-2 infection and preterm birth compared with a control group of 48 healthy women with preterm birth. The rate of cesarean delivery was 82% in the study group versus 6% for the control group. We observed a strong correlation between premature birth and the presence of COVID-19 symptoms (cough p = 0.029, fever p = 0.001, and chills p = 0.001). The risk for premature birth is correlated to a lower value of oxygen saturation (p = 0.001) and extensive radiologic pulmonary lesions (p = 0.025). The COVID-19 pregnant women with preterm delivery were older, and experienced an exacerbation of severe respiratory symptoms, decreased saturation of oxygen, increased inflammatory markers, severe pulmonary lesions and decreased lymphocytes.

Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?-A Case Report.

We are reporting a case of a 36 year-old Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) positive hypertensive primigravida with postpartum uterine atony that required emergency subtotal hysterectomy at Saint John Hospital Bucur Maternity Bucharest. The maternity was designated as the Coronavirus Disease 2019 (COVID-19) Maternity for Bucharest and Ilfov County since March 2020. The patient was mildly symptomatic for SARS-CoV-2, infection confirmed with reverse transcription polymerase chain reaction (RT-PCR). The caesarean section was performed and a live male fetus was born, 2630 g and Apgar Score of 9 (the male fetus was negative for SARS-CoV-2). Postpartum hysterectomy with adnexal preservation was performed because of uterine atony. The postoperative evolution was favorable. The patient was discharged with her baby 10 days after birth. Given the limited resources, the placenta, the umbilical cord and the uterus were not tested for SARS-CoV-2. The pathology exam revealed that on the maternal side there were specific uterine atony lesions as well as endometrial and miometrial ischaemia. The placenta had nonspecific findings: chronic ischemic lesions with small villi, fibrin deposits in the materno-fetal interface. The peculiarity of the case is that we report the morphological findings of the placenta and uterus resulted from intrapartum uterine atonia in a patient with gestational arterial hypertension, premature birth and COVID-19. Further studies are required to characterize the pattern of such intricate conditions.