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1.
Placenta ; 115: 37-44, 2021 11.
Article in English | MEDLINE | ID: covidwho-1401783

ABSTRACT

INTRODUCTION: The reported effects of SARS-CoV-2 on pregnancy outcomes are conflicting; studies frequently overlook the placenta, which is critical for the health of the mother and infant(s). This study aimed to determine the effect of pandemic stress ± SARS CoV-2 infection on placental histopathology. METHODS: Women were recruited in Canada (n = 69); France (n = 21) or in the UK (n = 25), between March and October 2020. Historic controls (N = 20) were also included. Placenta and fetal membrane samples were collected rapidly after delivery and were fixed and stained for histopathological analysis. Maternal demographical data and obstetric outcomes were recorded. RESULTS: Over 80% of the placentas from SARS-CoV-2+ pregnancies had histopathological abnormalities: predominantly structural (71-86%) or inflammatory (9-22%), depending on geographical location. Excessive fibrin was seen in all sites, whereas deciduitis (Canada), calcifications (UK), agglutinations and chorangiosis (France) predominated in different locations. The frequency of abnormalities was significantly higher than in SARS-CoV-2 negative women (50%, p < 0.05). Demographic and obstetric data were similar in the SARS-CoV-2+ women across all sites - characterised by predominantly Black/Middle Eastern women, and women with elevated body mass index. DISCUSSION: Overall, the frequency of placental abnormalities is increased in SARS-CoV-2+ women, but the incidence of placental abnormalities is also higher in SARS-CoV-2- women that gave birth during the pandemic, which highlights the importance of appropriate control groups to ascertain the roles of pandemic stress and SARS-CoV-2 infection on the placenta and pregnancy outcomes.


Subject(s)
COVID-19 , Placenta Diseases/etiology , Pregnancy Complications, Infectious , Stress, Psychological/complications , Adolescent , Adult , COVID-19/complications , COVID-19/epidemiology , COVID-19/psychology , Canada/epidemiology , Case-Control Studies , Cohort Studies , Female , France/epidemiology , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Male , Maternal-Fetal Relations/psychology , Middle Aged , Pandemics , Placenta/pathology , Placenta/virology , Placenta Diseases/epidemiology , Placenta Diseases/pathology , Pregnancy , Pregnancy Complications, Infectious/pathology , Pregnancy Complications, Infectious/psychology , Pregnancy Outcome/epidemiology , Pregnancy Outcome/psychology , Psychological Distress , SARS-CoV-2/physiology , Stress, Psychological/etiology , Stress, Psychological/pathology , United Kingdom/epidemiology , Young Adult
2.
Placenta ; 109: 72-74, 2021 06.
Article in English | MEDLINE | ID: covidwho-1386464

ABSTRACT

Whether early SARS-CoV-2 definitively increases the risk of stillbirth is unknown, though studies have suggested possible trends of stillbirth increase during the pandemic. This study of third trimester stillbirth does not identify an increase in rates during the first wave of the pandemic period, however investigation of the placental pathology demonstrates trends towards more vascular placental abnormalities.


Subject(s)
COVID-19/epidemiology , Placenta Diseases/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Trimester, Third , Stillbirth/epidemiology , Adult , COVID-19/complications , COVID-19/mortality , Cause of Death , Female , Fetal Death/etiology , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Pandemics , Placenta/pathology , Placenta Diseases/etiology , Placenta Diseases/pathology , Placenta Diseases/virology , Pregnancy , Pregnancy Complications, Infectious/mortality , SARS-CoV-2/physiology , United States/epidemiology , Young Adult
3.
Placenta ; 112: 97-104, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1333705

ABSTRACT

INTRODUCTION: Pregnant women with covid-19 are more likely to experience preterm birth. The virus seems to be associated with a wide range of placental lesions, none of them specific. METHOD: We collected cases of Covid-19 maternal infection during pregnancy associated with poor pregnancy outcomes, for which we received the placenta. We studied clinical data and described pathological findings of placenta and post-mortem examination of fetuses. We performed an immunohistochemical study and RT-PCR of SARS-Cov-2 on placenta samples. RESULTS: We report 5 cases of poor fetal outcome, 3 fetal deaths and 2 extreme premature neonates, one with growth restriction, without clinical and biological sign of SARS-Cov-2 infection. All placenta presented massive perivillous fibrin deposition and large intervillous thrombi associated with strong SARS-Cov-2 expression in trophoblast and SARS-CoV-2 PCR positivity in amniotic fluid or on placenta samples. Chronic histiocytic intervillositis was present in 4/5 cases. Placental ultrasound was abnormal and the sFLT1-PIGF ratio was increased in one case. Timing between mothers' infection and the poor fetal outcome was ≤10 days in 4 cases. The massive placental damage are directly induced by the virus whose receptors are expressed on trophoblast, leading to trophoblast necrosis and massive inflammation in villous chamber, in a similar way it occurs in diffuse alveolar damage in adults infected by SARS-Cov-2. DISCUSSION: SARS-Cov-2 can be associated to a rare set of placental lesions which can lead to fetal demise, preterm birth, or growth restriction. Stronger surveillance of mothers infected by SARS-Cov-2 is required.


Subject(s)
COVID-19/complications , Placenta Diseases/etiology , Premature Birth/etiology , Stillbirth , Adult , COVID-19/diagnosis , COVID-19/pathology , Female , Fetal Death/etiology , France , Humans , Infant, Newborn , Male , Perinatal Death/etiology , Placenta/pathology , Placenta/virology , Placenta Diseases/diagnosis , Placenta Diseases/pathology , Placenta Diseases/virology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/pathology , Pregnancy Outcome , Premature Birth/pathology , Premature Birth/virology , SARS-CoV-2/physiology , Trophoblasts/pathology , Trophoblasts/virology
4.
Eur J Obstet Gynecol Reprod Biol ; 259: 7-11, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1068900

ABSTRACT

BACKGROUND: The pandemic of the severe acute respiratory distress syndrome-associated Coronavirus-2 (SARS-CoV-2) has affected millions around the world. In pregnancy the dangers to the mother and fetus are still being explored. SARS-CoV2 can potentially compromise maternal and neonatal outcomes and this may be dependent on the pregnancy stage during which the infection occurs. OBJECTIVE: The present study was done to find the histopathological alterations in the placenta of SARS-CoV-2 positive pregnancies with either no symptoms or mild coronavirus disease (COVID)-19 related symptoms and its association with neonatal outcomes. STUDY DESIGN: This was a prospective analytical study. Twenty seven asymptomatic or mildly symptomatic SARS-CoV-2 positive pregnant women with a singleton pregnancy delivered between 1st July 2020 and 15th September 2020, were included as cases. An equal number of SARS-CoV-2 negative singleton pregnancies matched for maternal and gestational age during the same period were included as controls. After delivery the histopathological examination of the placenta of these women was done and the findings recorded on a predesigned proforma based on the Amsterdam consensus criteria for evidence of maternal and fetal vascular malperfusion changes. RESULTS: The baseline characteristics were comparable between the cases and controls. The following features of maternal vascular malperfusion (MVM) were significantly higher in the placentae of COVID-19 positive pregnancies: retroplacental hematomas (RPH), accelerated villous maturation (AVM), distal villous hyperplasia (DVH), atherosis, fibrinoid necrosis, mural hypertrophy of membrane arterioles (MHMA), vessel ectasia and persistence of intramural endovascular trophoblast (PIEVT). Fetal vascular malperfusion (FVM) significantly associated with the positive pregnancies were chorioangiosis, thrombosis of the fetal chorionic plate (TFCP), intramural fibrin deposition (IMFD) and vascular ectasia. Additionally, perivillous fibrin deposition was also significantly higher in the placentae of cases. The percentage of spontaneously delivered women was comparable in the two groups. The sex and weight of the newborn and the number of live births were comparable between the two groups. CONCLUSIONS: Asymptomatic or mildly symptomatic SARS-CoV-2 positive pregnant women, with otherwise uncomplicated pregnancies, show evidence of placental injury at a microscopic level. Similar findings have been demonstrated in other studies too. This placental injury apparently does not lead to poor pregnancy outcomes. The extent of this injury in symptomatic cases of COVID-19 pregnancies and its consequences on the outcomes need to be analysed.


Subject(s)
COVID-19/pathology , Placenta Diseases/pathology , Placenta/pathology , Pregnancy Complications, Infectious/pathology , Adult , Birth Weight , COVID-19/complications , COVID-19/physiopathology , Carrier State , Case-Control Studies , Female , Humans , Infant, Newborn , Male , Placenta/blood supply , Placenta Diseases/etiology , Placenta Diseases/physiopathology , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Pregnancy Outcome , Prospective Studies , SARS-CoV-2 , Severity of Illness Index , Young Adult
5.
Am J Physiol Endocrinol Metab ; 319(2): E315-E319, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-612219

ABSTRACT

The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to maternal and newborn health has yet to be determined. Several reports suggest pregnancy does not typically increase the severity of maternal disease; however, cases of preeclampsia and preterm birth have been infrequently reported. Reports of placental infection and vertical transmission are rare. Interestingly, despite lack of SARS-CoV-2 placenta infection, there are several reports of significant abnormalities in placenta morphology. Continued research on pregnant women infected with SARS-CoV-2 and their offspring is vitally important.


Subject(s)
Coronavirus Infections/physiopathology , Infectious Disease Transmission, Vertical , Placenta Diseases/physiopathology , Pneumonia, Viral/physiopathology , Pregnancy Complications, Infectious/physiopathology , Abortion, Spontaneous , Betacoronavirus , COVID-19 , Cesarean Section , Coronavirus Infections/complications , Coronavirus Infections/transmission , Delivery, Obstetric , Female , Fetal Death , Gestational Age , Humans , Infant, Newborn , Pandemics , Placenta Diseases/etiology , Placenta Diseases/pathology , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , Pregnancy , Premature Birth , SARS-CoV-2 , Severity of Illness Index
6.
Pediatr Dev Pathol ; 23(3): 177-180, 2020.
Article in English | MEDLINE | ID: covidwho-244953

ABSTRACT

This study describes the pathology and clinical information on 20 placentas whose mother tested positive for the novel Coronovirus (2019-nCoV) cases. Ten of the 20 cases showed some evidence of fetal vascular malperfusion or fetal vascular thrombosis. The significance of these findings is unclear and needs further study.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/pathology , Placenta Diseases/etiology , Placenta Diseases/pathology , Placenta/pathology , Pneumonia, Viral/complications , Pneumonia, Viral/pathology , Pregnancy Complications, Infectious/pathology , Thrombosis/etiology , Adolescent , Adult , COVID-19 , Female , Fetal Diseases/etiology , Fetal Diseases/pathology , Humans , Infant, Newborn , New York , Pandemics , Pregnancy , Thrombosis/pathology , Young Adult
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