Placental damage comparison between preeclampsia with COVID-19, COVID-19, and preeclampsia: analysis of caspase-3, caspase-1, and TNF-alpha expression.

ABSTRACT

Background: Some studies have reported that preeclampsia with coronavirus disease 2019 (COVID-19) significantly increases the risk of adverse perinatal outcome until near to three-fold over the normal pregnancy. Preeclampsia pathophysiology in theory, increases the perinatal mortality and morbidity starting from placental injury which is also believed to share the common pathway with COVID-19 infection. Major typical placental injuries for these matters could be apoptotic, necrotic, or pyroptotic. Objective: This study aimed to compare placental damage between those three conditions above in those three typical injuries. Study Design: This was an observational analytic study with cross-sectional setting. Seventy-two pregnant women admitted to hospital consecutively with diagnosis of preeclampsia with COVID-19, Preeclampsia only and COVID-19 only. Diagnosis for preeclampsia was following FIGO criteria with at least one of the severe features. COVID-19 eligible for this study was PCR test confirmative with moderate to severe clinical degree. Placenta were taken after the delivery, and parameters were quantified with immunohistochemistry test for caspase-3, caspase-1, and TNF-alpha representing apoptotic, pyroptotic, and necrotic pathway respectively. Results: Pregnancy with double complications, preeclampsia, and COVID-19, significantly has the highest placental damage on apoptotic, pyroptotic, and necrotic pathway shown from the caspase-3, caspase-1, and TNF-alpha expression in placenta (p <0.05). Moderate to severe degree of COVID-19 resulting higher placental damage compared to preeclampsia in all the three forms (p <0.05). Apoptotic process was the most prominent among other pathways. Conclusion: Preeclampsia with COVID-19 infection showed significant placental damage, with major changes related were apoptosis, inflammation, and necrosis. This data support poor perinatal outcome of pregnancy having preeclampsia and COVID-19 at the same time.