Macerated stillbirth

Stillbirth is defined as the birth of a viable baby without signs of life. They account for more than 2.5 million intrauterine deaths per year worldwide and are associated with a number of risk factors, the most important of which are maternal and placental factors. Autopsy provides information that may be of use in determining time since death, gestational age of the fetus, mode of death, cause of fetal demise, and the likelihood of recurrence. The format of the autopsy is guided by parental consent, but even when consent is limited, valuable information may be obtained by careful consideration of antemortem test results, imaging, and genetic testing. Where there is a delay between death and delivery, fetuses are affected by maceration, which may increase the technical complexity of the autopsy and impart a number of artefactual changes, which should not be misinterpreted as genuine pathology. The most common pathologies encountered at autopsy are placental abnormalities, changes related to maternal disorders, malformations, and central nervous system pathology. © Springer Nature Switzerland AG 2022. All rights reserved.

Fetal death from SARS-CoV-2 mediated acute placental failure.

INTRODUCTION: We demonstrate the nonlinear severity of symptoms of SARS-CoV-2 infection in the mother leading to fetal death after acute placental failure. METHODS: Careful clinical evaluation, real-time RT-PCR molecular microbiologic testing, isolation of a viable virus, and autopsy with histologic results were used to investigate the possible vertical transmission of SARS-CoV-2 infection from mother to fetus. RESULTS: Histologic changes in the placenta correlate with SARS-CoV-2 infection. Total nucleic acid isolated from vaginal swabs, fresh placental tissue, and deparaffinized tissue showed a high viral load of SARS-CoV-2. Complete genome sequencing confirmed the presence of the SARS-CoV-2 Delta variant. DISCUSSION: Several methods have been used to confirm SARS-CoV-2-mediated acute placental failure, all of which were conclusive. It should be noted that careful periodic fetal well-being checks are required in women infected with SARS-CoV-2, regardless of the severity of symptoms. Most of the cases described with fetal death occurred in the third trimester.

The coronavirus conundrum, the pregnant woman, her child. Part 2 / La incógnita del coronavirus, la gestante, su niño - Continuación

Resumen Cuando apareció la enfermedad por el coronavirus SARS-CoV-2, no esperábamos su rápida expansión en el mundo y las graves consecuencias que traería. Se ha ido conociendo al virus morfológicamente y su accionar en el ambiente y en el organismo del ser humano, su mayor predisposición de enfermar a poblaciones vulnerables, como el adulto mayor, poblaciones con comorbilidad como obesidad, diabetes, hipertensión e inmunodepresión, predilección por el sexo masculino, mayor prevalencia en países con mayor pobreza, promiscuidad, zonas deprimidas económicamente, entre otros. Se ha tenido que improvisar y descartar diversos tratamientos en aquellos pacientes con enfermedad COVID-19 moderada y severa. Eventualmente se está disminuyendo la frecuencia de muertes con medidas de protección personal, distanciamiento social, cuarentena de emergencia, y combinación de medicamentos y administración de oxígeno. Pero aún no hay cura, y se está a la expectativa en la aparición de la vacuna. Con relación a la mujer, ella es comprometida en menor proporción y severidad por la enfermedad COVID-19, pero debe cumplir las medidas de prevención, especialmente si es frágil y tiene comorbilidades. Se ha postergado temporalmente su evaluación preventiva y las intervenciones quirúrgicas si no son de emergencia. En la gestante se está encontrando aumento de prematuridad, gestaciones frustras, lesiones placentarias y presencia del virus en anexos placentarios, con casos de morbilidad severa y muerte maternas. En este artículo se hace una puesta al día resumida sobre la situación de la enfermedad COVID-19 en el mundo y el Perú, enfatizando el cuidado de la mujer y de la gestante.

Abstract When COVID-19 appeared, we did not expect its rapid expansion throughout the world nor the serious consequences it would bring. We currently understand more about the virus' morphology and its activity in the environment and within the human body, as well as its greater predisposition to affect vulnerable populations, such as the elderly and persons with comorbidities like obesity, diabetes, hypertension and immunosuppression. This virus shows a predilection for men, and a higher prevalence in countries with greater poverty, promiscuity and economically depressed areas, among others. Various treatments have been tested and discarded in patients with moderate and severe disease. The frequency of deaths is decreasing due to personal protection measures, social distancing, emergency quarantine, and combination of medications and supplemental oxygen. However, there is still no cure, and we are waiting for the appearance of the vaccine. Women are less frequently and less severely affected; however, they should follow preventive measures, especially if frail with comorbidities. Preventive medical consultations and non-emergency surgical procedures have been temporarily postponed. Pregnant women are experiencing an increase in prematurity, fetal deaths, placental lesions and presence of the virus in placental adnexa, with cases of severe morbidity and maternal death. This article is an update on the situation of COVID-19 in the world and in Peru, emphasizing the care of women and pregnant women.

Fetal death as an outcome of acute respiratory distress in pregnancy, during the COVID-19 pandemic: a population-based cohort study in Bahia, Brazil.

BACKGROUND: Fetal loss is one of the most serious adverse outcomes of pregnancy. Since the onset of the COVID-19 pandemic, Brazil has recorded an unprecedented number of hospitalizations of pregnant women due to acute respiratory distress (ARD), thereby, we aimed to assess the risk of fetal deaths associated to ARD during pregnancy in Bahia state, Brazil, in the context of the COVID-19 pandemic. METHODS: This is an observational population-based retrospective cohort study, developed with women at or after 20 weeks of pregnancy, residents in Bahia, Brazil. Women who had acute respiratory distress (ARD) in pregnancy during the COVID-19 pandemic (Jan 2020 to Jun 2021) were considered 'exposed'. Women who did not have ARD in pregnancy, and whose pregnancy occurred before the onset of the COVID-19 pandemic (Jan 2019 to Dec 2019) were considered 'non-exposed'. The main outcome was fetal death. We linked administrative data (under mandatory registration) on live births, fetal deaths, and acute respiratory syndrome, using a probabilistic linkage method, and analyzed them with multivariable logistic regression models. RESULTS: 200,979 pregnant women participated in this study, 765 exposed and 200,214 unexposed. We found four times higher chance of fetal death in women with ARD during pregnancy, of all etiologies (adjusted odds ratio [aOR] 4.06 confidence interval [CI] 95% 2.66; 6.21), and due to SARS-CoV-2 (aOR 4.45 CI 95% 2.41; 8.20). The risk of fetal death increased more when ARD in pregnancy was accompanied by vaginal delivery (aOR 7.06 CI 95% 4.21; 11.83), or admission to Intensive Care Unit (aOR 8.79 CI 95% 4.96; 15.58), or use of invasive mechanical ventilation (aOR 21.22 CI 95% 9.93; 45.36). CONCLUSION: Our findings can contribute to expanding the understanding of health professionals and managers about the harmful effects of SARS-CoV-2 on maternal-fetal health and alerts the need to prioritize pregnant women in preventive actions against SARS-CoV-2 and other respiratory viruses. It also suggests that pregnant women, infected with SARS-CoV-2, need to be monitored to prevent complications of ARD, including a careful assessment of the risks and benefits of early delivery to prevent fetal death.

Pregnancy and Severe ARDS with COVID-19: Epidemiology, Diagnosis, Outcomes and Treatment.

Pregnancy-related acute respiratory distress syndrome (ARDS) is fast becoming a growing and clinically relevant subgroup of ARDS amidst global outbreaks of various viral respiratory pathogens that include H1N1-influenza, severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS), and the most recent COVID-19 pandemic. Pregnancy is a risk factor for severe viral-induced ARDS and commonly associated with poor maternal and fetal outcomes including fetal growth-restriction, preterm birth, and spontaneous abortion. Physiologic changes of pregnancy further compounded by mechanical and immunologic alterations are theorized to impact the development of ARDS from viral pneumonia. The COVID-19 sub-phenotype of ARDS share overlapping molecular features of maternal pathogenicity of pregnancy with respect to immune-dysregulation and endothelial/microvascular injury (i.e., preeclampsia) that may in part explain a trend toward poor maternal and fetal outcomes seen with severe COVID-19 maternal infections. To date, current ARDS diagnostic criteria and treatment management fail to include and consider physiologic adaptations that are unique to maternal physiology of pregnancy and consideration of maternal-fetal interactions. Treatment focused on lung-protective ventilation strategies have been shown to improve clinical outcomes in adults with ARDS but may have adverse maternal-fetal interactions when applied in pregnancy-related ARDS. No specific pharmacotherapy has been identified to improve outcomes in pregnancy with ARDS. Adjunctive therapies aimed at immune-modulation and anti-viral treatment with COVID-19 infection during pregnancy have been reported but data in regard to its efficacy and safety is currently lacking.

SARS-CoV-2 infection in pregnancy and risk of stillbirth

The COVID-19 pandemic has changed the lives of millions of people across the globe. As of November 2021, WHO has reported more than 250 million confirmed cases of SARS-CoV-2 infection with more than 5 million deaths. Despite the continuous efforts being made by the medical community to address the fundamental questions posed by the SARS-CoV-2 infection in pregnant women and its impact over the mother and the offspring. The aim of this paper is to assess the evidence accumulated since the emergence of the pandemic concerning the impact of SARS-CoV-2 infection on the mother and fetus, especially addressing the risks of intrauterine death in SARS-CoV-2 positive mothers. We searched different databases up to November 2021 for variations of the sentence: "SARS-CoV-2 infection and COV-ID-19 and pregnancy and fetal death, stillbirth, intrauterine death". The changing physiological and immune responses during pregnancy make a pregnant woman more prone to developing severe forms of COVID-19, causing sometimes serious pregnancy complications such as fetal loss. At times mild general symptoms related to COVID-19 can cause serious fetal complications, suggesting that placental changes are responsible for fetal outcome. Infection with non-Delta variant increases the risk of fetal loss in the third trimester two times compared to healthy population, while Delta variant increases this risk four times. The exact mechanism of vertical transmission is still to be established and these aspects need further research especially assessing COVID-19 variant particularities. © 2021, Amaltea Medical Publishing House. All rights reserved.

Hemangioma of the umbilical cord: A case report on a rare entity.

Several hundred cases of placental hemangiomas have been reported in the literature. However, the umbilical cord is extremely uncommon as a site of occurrence. We present a case of postnatal discovery of giant hemangioma of the umbilical cord (HUM) in a Coronavirus Disease 2019 (COVID 19) positive mother. To our knowledge, this is the first reported case of HUM synchronous to a maternal infection with COVID 19. We aim, through this case and a review of the literature, to study the clinicopathological characteristics of this singular entity. Our patient, a 37-year-old woman, presented to the Department Of Obstetrics And Gynecology for respiratory distress and loss of fetal movements. Ultrasound examination concluded to intrauterine fetal desmise. After stabilization of the patient, a cesarean section was performed. A macerated fetus was extracted. Placenta showed a giant mass attached to the cord. It was submitted for pathological examination. Gross examination showed that the umbilical cord was inserted eccentrically with a fusiform dilation. Near its placental end, three cohesive solid angiomatous nodules were noted. Microscopic examination revealed lobules of dilated blood-filled capillaries set in a myxoid stroma. The diagnosis of HUM have been established. HUM arise from endothelial cells of the umbilical vessels. Their etiology, physio-pathology and pathways of tumorigenesis are not yet well defined. Further studies are needed to explore the pathways of tumorigenesis and to determin the implication of COVID-19 in HUM.

Impact of COVID-19 on maternal and perinatal outcomes in Harare, Zimbabwe: a comparative maternal audit

Background: The COVID-19 pandemic lockdown resulted in the disruption of health services in Zimbabwe. The objectives of this study were two-fold. First, the study sought to determine the impact of the lockdown on maternal and perinatal outcomes at two tertiary hospitals in Harare, Zimbabwe, using a maternal audit. Second, the study sought to estimate the potential effect of COVID-19 related decreases in coverage of maternal and newborn health interventions on maternal, and neonatal mortality in Zimbabwe using the Lives Saved Tool (LiST).

Intrauterine fetal death during COVID-19 pregnancy: Typical fetal heart rate changes, coagulopathy, and placentitis.

Although various perinatal outcomes in coronavirus disease 2019 (COVID-19) pregnancies have been reported, the fetal and neonatal consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remain unclear. Several reports of miscarriages and stillbirths have been recorded, but vertical transmission by SARS-CoV-2 is considered very rare, and the cause remains unknown. We report a case of a 22-year-old uncomplicated Japanese woman infected with SARS-CoV-2 during the second trimester, resulting in intrauterine fetal death due to placental insufficiency associated with COVID-19 placentitis. This report emphasizes the importance of longitudinal assessment of fetal well-being by fetal heart rate monitoring and early detection of maternal coagulation dysfunction representing SARS-CoV-2 inflammation to manage COVID-19 in pregnancy.

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.

Case Report: SARS-CoV-2 Gamma Isolation From Placenta of a Miscarriage in Midwest, Brazil.

The present study investigated a SARS-CoV-2 infection in placenta and fetal samples from an early pregnancy miscarriage in Midwest Brazil. The Gamma variant was isolated and fully sequenced from the placenta sample, but not from fetal samples. Our findings highlight potential adverse perinatal outcomes caused by SARS-CoV-2 Gamma infection during pregnancy.

Maternal and perinatal outcomes with COVID-19: a systematic review of 1008 pregnancies isolation department in Zliten medical center

Background: As the COVID-19 outbreak unfolds, more and more pregnant women are infected with SARS-CoV-2, concerns have been raised about its clinical manifestations in pregnancy and the potential risk of vertical transmission from mother to fetus in pregnant women. Hence, in this review, we summarize the latest research progress related to COVID-19 epidemiology and the reported data of pregnant women with COVID-19. Patients and methods: We searched databases for all case reports and series from 20 February 2020 to 30 April 2021. Multiple terms and combinations were used including COVID-19, pregnancy, maternal mortality, maternal morbidity, complications, clinical manifestations, neonatal morbidity, intrauterine fetal death, neonatal mortality and SARS-CoV-2. and quantitative real-time polymerase chain reaction (PCR) or dual fluorescence PCR-confirmed SARS-CoV-2 infection. Unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, cases with suspected COVID-19 that were not confirmed by a laboratory test, and unreported maternal or perinatal outcomes were excluded. Data on clinical manifestations, maternal and perinatal outcomes including vertical transmission were extracted and analyzed.

SARS-CoV-2 pandemic and pregnancy: the Italian obstetric surveillance system contribution during the first wave in Italy

Introduction: Since the beginning of the pandemic, the Italian Obstetric Surveillance System (ItOSS) coordinated research activities to support health professionals and decision makers. The aim of this paper is to describe the results of the populationbased prospective study on SARS-CoV-2 infection among pregnant women during the first pandemic wave. Materials and methods: From the end of February 2020, ItOSS launched a prospective population-based cohort study enrolling all SARSCoV- 2 pregnant women admitted to any Italian hospital. Anamnestic and clinical information was collected in a structured form and entered in a web-based secure system by trained clinicians of any maternity unit.

Covid-19 as a possible risk factor of intrauterine fetal death.

OBJECTIVE: To summarize information about possible effects of covid-19 on intrauterine fetal death and present three cases of intrauterine fetal death in women with recent covid-19 infection. METHODS: Review of available information about pregnancy with covid-19 and comparison with own observation of cases during spring 2021. CONCLUSION: Covid-19 influences risk of intrauterine fetal death, preeclampsia/eclampsia or HELLP syndrome. Coagulation changes and drop of platelets is considered as one of the causes of intrauterine fetal death due to fetal vascular malperfusion.

Severe placental lesions due to maternal SARS-CoV-2 infection associated to intrauterine fetal death.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause severe placental lesions leading rapidly to intrauterine fetal death (IUFD). From August 2020 to September 2021, in the pathology department of Toulouse Oncopole, we analyzed 50 placentas from COVID-19-positive unvaccinated mothers. The purpose of our study is to describe the clinicopathological characteristics of these placental damages and to understand the pathophysiology. Ten of them (20%) showed placental lesions with positive immunohistochemistry for SARS-CoV-2 in villous trophoblasts. In five cases (10%), we observed massive placental damage associating trophoblastic necrosis, fibrinous deposits, intervillositis, as well as extensive hemorrhagic changes due to SARS-CoV-2 infection probably responsible of IUFD by functional placental insufficiency. In five other cases, we found similar placental lesions but with a focal distribution that did not lead to IUFD but live birth. These lesions are independent of maternal clinical severity of COVID-19 infection because they occur despite mild maternal symptoms and are therefore difficult to predict. In our cases, they occurred 1-3 weeks after positive SARS-CoV-2 maternal real-time polymerase chain reaction testing and were observed in the 2nd and 3rd trimesters of pregnancies. When these lesions are focal, they do not lead to IUFD and can be involved in intrauterine growth restriction. Our findings, together with recent observations, suggest that future pregnancy guidance should include stricter pandemic precautions such as screening for a wider array of COVID-19 symptoms, enhanced ultrasound monitoring, as well as newborn medical surveillance.

[Intrauterine fetal demise in extensive SARS-CoV-2-associated placental maternal vascular malperfusion in the setting of SARS-CoV-2 placentitis (severe acute respiratory syndrome coronavirus 2)]. / Intrauteriner Fruchttod bei massiver SARS-CoV-2-assoziierter ("severe acute respiratory syndrome coronavirus 2") plazentarer maternaler Malperfusion im Rahmen einer SARS-CoV-2-Plazentitis.

We report a case of a placenta with extensive maternal vascular malperfusion and chronic histiocytic intervillositis corresponding to SARS-CoV­2 placentitis in the context of fetal demise at 31 weeks of gestation. Placental swamp and PCR of the placental parenchyma, umbilical cord and amnion-chorion membrane showed SARS-CoV-2- and B­betacoronavirus-specific RNA. Maternal vascular malperfusion has been described in cases of SARS-CoV­2 infection; however, the manifested severity of this case in the setting of a severe SARS-CoV­2 placentitis is rare. It emphasizes the need of a maternal prophylactic anticoagulation.

Incidence of postpartum depression in a tertiary care hospital in Navi Mumbai amid COVID-19 pandemic

Introduction: Coronavirus disease-2019 (COVID-19) pandemic has changed health care drastically, especially looking at how obstetrics functions. This places mothers in a situation of greater psychological vulnerability and heightens the risk of postpartum depression and disrupted mother-infant bonding, which may be weighted or worsened by the balance of the couple. We expect this impact to be even greater in vulnerable mothers in the context of dysfunctioning social services. This study intends to identify the incidence of postpartum depression in women delivering during COVID-19 pandemic among lockdown protocols in a tertiary center in Navi Mumbai and identify its sociocultural triggers so that strategies may be evolved to reduce the morbidity costs attributable to the mother and child in the future. Materials and methods: This study was a cross-sectional study, performed over a period of 2 months from June 2020 to August 2020 at DY Patil School of Medicine and Dr DY Patil Hospital, a teaching hospital in Western India. Two hundred postnatal mothers were recruited for the study in the postpartum period from 1 to 6 weeks after delivery. A specially designed questionnaire was used to record various determinants to assess the risk factors, which could contribute to postpartum depression. A predesigned and pretested questionnaire (EDPS-Edinburgh Postnatal Depression Scale) was used to detect the depressive symptoms in postnatal mothers. The results for qualitative data were presented in frequency and percentage. Binary logistic regression was used to predict the contribution of each independent risk factor to arrive at the depression level, which happens to be the dependent risk factor in this study. The statistical analysis was done by using SPSS 21.0. The significant level was used at p < 0.05.

Caesarean Section in Preventing Stillbirths in Pregnancy Complicated with COVID-19: a Narrative Review.

INTRODUCTION: COVID-19 is a complex syndrome caused by SARS-Cov-2. It mainly affects the respiratory system, but it could cause serious harm during pregnancy. An increase in stillbirths and preterm births has been highlighted by many authors. Although WHO and Royal College of Obstetrics and Gynecology don't recommend elective cesarean section in women with confirmed infection, cesarean sections were performed by many clinicians. This short narrative review aims to analyze pieces of evidence found in literature about the effectiveness of cesarean section in preventing stillbirths in COVID-19 positive mothers. METHODS: Studies included in the present review were retrieved searching MEDLINE (last access August 5th, 2021) with the following keywords: "pregnant woman with covid-19", "Caesarean section", "Ab-dominal Delivery" and "Stillbirth". Studies regarding the mode of delive-ry in pregnant women infected with COVID-19 and neonatal outcomes were included. Studies about biology, anesthesiology and necroscopy were excluded. Filters for "human" and "English" were applied. RESULTS: Searching MEDLINE, 24 references were found. Other 103 articles were found searching bibliography. Two references were excluded after duplicate removal, 77 references after the title screen and 27 after the abstract screen. The final number of references included was 23. Most of the included studies were case reports. Most of them were from China. DISCUSSION: Many authors highlighted the increased risk of fetal death in pregnancies complicated with SARS-Cov-2 infection, but it is not clear if Caesarean Section could reduce this risk. Pieces of evidence show that most clinicians choose to perform an elective cesarean section mostly because of maternal conditions or the fear of possible vertical transmission. Data show that mode of delivery doesn't affect the neonatal outcome and Caesarean Section doesn't reduce the positivity rate among neonates. Different opinions were found about the possible infection of amniotic fluid, cord blood and placenta. The risk of vertical transmission is considered moderate or low by most of the authors. Positivity to SARS-Cov-2 isn't an indication of elective cesarean section by itself, but this mode of delivery should be optioned in patients with other obstetrical indications or with severe conditions due to COVID. The recent increase in stillbirths could be related to the overall deterioration of maternal conditions.

An update on COVID-19 and pregnancy.

Physiological, mechanical, and immunologic alterations in pregnancy could potentially affect the susceptibility to and the severity of COVID-19 during pregnancy. Owing to the lack of comparable incidence data and the challenges with disentangling differences in the susceptibility from different exposure risks, the data are insufficient to determine whether pregnancy increases the susceptibility to SARS-CoV-2 infection. The data support pregnancy as a risk factor for severe disease associated with COVID-19; some of the best evidence comes from the United States Centers for Disease Control and Prevention COVID-19 surveillance system, which reported that pregnant persons were more likely to be admitted to an intensive care unit, require invasive ventilation, require extracorporeal membrane oxygenation, and die than nonpregnant women of reproductive age. Although the intrauterine transmission of SARS-CoV-2 has been documented, it appears to be rare. It is possibly related to low levels of SARS-CoV-2 viremia and the decreased coexpression of angiotensin-converting enzyme 2 and transmembrane serine protease 2 needed for SARS-CoV-2 entry into cells in the placenta. Evidence is accumulating that SARS-CoV-2 infection during pregnancy is associated with a number of adverse pregnancy outcomes including preeclampsia, preterm birth, and stillbirth, especially among pregnant persons with severe COVID-19 disease. In addition to the direct impact of COVID-19 on pregnancy outcomes, there is evidence that the pandemic and its effects on healthcare systems have had adverse effects such as increased stillbirths and maternal deaths on the pregnancy outcomes. These trends may represent widening disparities and an alarming reversal of recent improvements in maternal and infant health. All the 3 COVID-19 vaccines currently available in the United States can be administered to pregnant or lactating persons, with no preference for the vaccine type. Although the safety data in pregnancy are rapidly accumulating and no safety signals in pregnancy have been detected, additional information about the birth outcomes, particularly among persons vaccinated earlier in pregnancy, are needed.