HELLP syndrome and COVID-19: A minor revision of a possible new "COVID-19-linked HELLP-like syndrome".

To report the characteristics described in the literature on a possible new "COVID-19-linked HELLP-like syndrome" in pregnant women with COVID-19: its association with the severity; prevalence; clinical; laboratory; pathophysiological and therapeutic management differences from the classic HELLP syndrome and their impact on outcomes. Observational, cohort, case-control, case-series and case-report studies were included. Data were extracted independently by the authors of the study, to ensure accuracy, consistency and performed the quality assessment. The database search resulted in 77 references, of which two satisfied the eligibility criteria. In these 2 studies we found a possible "COVID-19-linked HELLP-like syndrome", associated with severe COVID-19. There is a high possibility of the existence of "COVID-19-linked HELLP-like syndrome" and its association with severe COVID-19 in pregnant women, with a prevalence of 28,6%. Some characteristics of "COVID-19-linked HELLP-like syndrome" and the classic HELLP syndrome are similar. Differential diagnosis indicated two different types of therapeutic management: conservative for "COVID-19-linked HELLP-like syndrome" and delivery for the HELLP syndrome. HELLP clinical management is mandatory for both.

SARS-CoV-2 in asymptomatic pregnant women in South Brazil: RT-PCR and serological detection.

OBJECTIVES: This study aims to detect the SARS-CoV-2 infection prevalence in asymptomatic pregnant women. METHODS: A group of 195 asymptomatic pregnant women who attended the prenatal care outclinic and to the obstetric emergency department was tested concomitantly for SARS-CoV-2 by RT-PCR and serological tests. RESULTS: The virus was detected by RT-PCR in two (1.02%) cases and 17 (8.71%) patients had antibodies detected by immunochromatographic tests. CONCLUSIONS: Due to the high risk of this emerging infection in the health of pregnant women, fetuses and newborns, we suggest the universal screening of all pregnant women admitted to hospital through the combined method RT-PCR and serological.

Association Between COVID-19 Pregnant Women Symptoms Severity and Placental Morphologic Features.

Since the beginning of the pandemic, few papers describe the placenta's morphological and morphometrical features in SARS-CoV-2-positive pregnant women. Alterations, such as low placental weight, accelerated villous maturation, decidual vasculopathy, infarcts, thrombosis of fetal placental vessels, and chronic histiocytic intervillositis (CHI), have been described. Objective: To analyze clinical data and the placental morphological and morphometric changes of pregnant women infected with SARS-CoV-2 (COVID-19 group) in comparison with the placentas of non-infected pregnant women, matched for maternal age and comorbidities, besides gestational age of delivery (Control group). Method: The patients in the COVID-19 and the Control group were matched for maternal age, gestational age, and comorbidities. The morphological analysis of placentas was performed using Amsterdam Placental Workshop Group Consensus Statement. The quantitative morphometric evaluation included perimeter diameter and number of tertiary villi, number of sprouts and knots, evaluation of deposition of villous fibrin, and deposition of intra-villous collagen I and III by Sirius Red. Additionally, Hofbauer cells (HC) were counted within villi by immunohistochemistry with CD68 marker. Results: Compared to controls, symptomatic women in the COVID-19 group were more likely to have at least one comorbidity, to evolve to preterm labor and infant death, and to have positive SARS-CoV-2 RNA testing in their concepts. Compared to controls, placentas in the COVID-19 group were more likely to show features of maternal and fetal vascular malperfusion. In the COVID-19 group, placentas of symptomatic women were more likely to show CHI. No significant results were found after morphometric analysis. Conclusion: Pregnant women with symptomatic SARS-CoV-2 infection, particularly with the severe course, are more likely to exhibit an adverse fetal outcome, with slightly more frequent histopathologic findings of maternal and fetal vascular malperfusion, and CHI. The morphometric changes found in the placentas of the COVID-19 group do not seem to be different from those observed in the Control group, as far as maternal age, gestational age, and comorbidities are paired. Only the deposition of villous fibrin could be more accentuated in the COVID-19 group (p = 0.08 borderline). The number of HC/villous evaluated with CD68 immunohistochemistry did not show a difference between both groups.