Maternal thrombocytopenia due to inflammatory changes in the placenta precedes fetal death associated with COVID-19

ABSTRACT

Introduction: Acute coagulopathy, specific placental change, and fetal death are reported in pregnant women with COVID-19;however, the pathogenesis of them remains unknown. We report two cases of stillbirth in pregnant women with COVID-19 who showed acute coagulopathy and their placentas showed characteristic pathological findings due to COVID-19. Case Case 1 A 28-year-old pregnant woman (gravida 3, para 2) who had undergone two cesarean sections had a fever of 39 degree and was positive for SARS-CoV-2 at 26 weeks of gestation. She showed thrombocytopenia and subsequent coagulopathy on day 7, and her fetus was dead on day 9. She underwent a cesarean section after blood transfusion and her coagulability thereafter improved. Case 2 A 35-year-old pregnant woman (gravida 3, para 2) who had no symptoms was positive for SARS-CoV-2 at 20 weeks of gestation. She also presented with thrombocytopenia on day 5. Her fetus was dead, and she went into labor spontaneously and virginally delivered a stillborn baby on day 9. Her coagulability thereafter returned to normal. Placental histology of both cases showed intervillous infiltration of histiocytes, necrosis of trophoblast, and fibrin deposition, and the expression of SARS-CoV-2 spike protein was observed in the syncytiotrophoblasts of the villi. Discussion(s) Specific placental changes related to COVID-19 are thought to be the result of an immune response rather than direct infection with SARS-CoV-2. The placental changes induced by COVID-19 might have caused fetal death. When managing pregnant women with COVID-19, thrombopenia may be a predictive marker of fetal death following placental inflammatory changes. Copyright © 2022