Histopathological and Clinical Analysis of 19 Placentas in Patients Diagnosed with COVID-19 Infection

ABSTRACT

Background: Although there are many studies examining the clinical outcomes of women and their infants diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, during pregnancy, the reasons causing the possible adverse outcomes remain unclear1. This study examines placental pathology from women who contracted COVID-19 during pregnancy at this university hospital institution. Design: This study was centered around all 19 placenta specimens from patients infected with COVID-19 at this university hospital. The American College of Obstetricians and Gynecologists (ACOG) allow for the judgement of the Obstetrics physician to be the predominant factor in the decision of sending the placenta specimen for pathology evaluation. Therefore ACOG and CRICO (a risk retention group for medical practitioners) work in conjunction to recommend that placentas be sent for pathology evaluation when clinically indicated. All 19 placenta specimens that were submitted in this study met at least one of these recommendations and therefore 19 age matched controls without COVID-19 infection were reviewed in order to outline any significant clinical trends. The age matched controls were selected within the same time frame as the COVID-19 specimens, which was June 2020 to August 2021. Results: The interval of initial COVID-19 diagnosis and time of placenta evaluation was documented in each case, with the median time interval being 2 days (minimum 1day to maximum 91 days). The gestational age for each patient was calculated, and the average gestational age was a full term pregnancy of 37.2 weeks. 90% of the patients were identified to be of Hispanic ethnicity and heritage, while the other two patients were of Caucasian descent. 63% of the placental weights from the COVID specimens were 25th percentile or lower, whereas only 21% of the age matched controls were 25th percentile or lower. 63% of the cases were recognized to contain histopathological abnormalities, 10.5% in aged matched controls. 4 cases were found to have intra-placental infarction (figure 1), 2 cases were identified to have chorangiosis, 1 case of villous ischemic change, 1 case of decidual laminar necrosis, 1 case of meconium, and 2 cases of acute chorioamnionitis. Conclusions: In this study on average the placenta weight was identified to be lower than age matched controls and placental abnormalities were identified more often in patients infected with COVID 19 (63% vs. 10.5%). (Table Presented).