Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury-Reference-Cited by-同舟云学术

Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury

Published:2022-02-10 Issue:6 Volume:146 Page:660-676
ISSN:1543-2165
Container-title:Archives of Pathology & Laboratory Medicine
language:en
Short-container-title:

Author:

Schwartz David A.¹,Avvad-Portari Elyzabeth²,Babál Pavel³,Baldewijns Marcella⁴,Blomberg Marie⁵,Bouachba Amine⁶⁷,Camacho Jessica⁸,Collardeau-Frachon Sophie⁷⁹,Colson Arthur¹⁰,Dehaene Isabelle¹¹,Ferreres Joan Carles¹²¹³,Fitzgerald Brendan¹⁴,Garrido-Pontnou Marta⁸¹⁵,Gergis Hazem¹⁶,Hargitai Beata¹⁷,Helguera-Repetto A. Cecilia¹⁸,Holmström Sandra¹⁹,Irles Claudine Liliane²⁰,Leijonhfvud Åsa²¹,Libbrecht Sasha²²,Marton Tamás²³,McEntagart Noel²⁴,Molina James T.²⁵,Morotti Raffaella²⁶,Nadal Alfons²⁷²⁸,Navarro Alexandra⁸,Nelander Maria²⁹,Oviedo Angelica³⁰,Otani Andre Ricardo Oyamada³¹,Papadogiannakis Nikos³²³³,Petersen Astrid C.³⁴,Roberts Drucilla J.³⁵,Saad Ali G.³⁶,Sand Anna³⁷³⁸,Schoenmakers Sam³⁹,Sehn Jennifer K.⁴⁰,Simpson Preston R.⁴¹,Thomas Kristen⁴²,Valdespino-Vázquez M. Yolotzin⁴³,van der Meeren Lotte E.⁴⁴⁴⁵,Van Dorpe Jo⁴⁶,Verdijk Robert M.³⁹,Watkins Jaclyn C.³⁵,Zaigham Mehreen⁴⁷⁴⁸

Affiliation:

1. From Schwartz is in consultative practice of Perinatal Pathology, Atlanta, Georgia.

2. From the Department of Pathology, Fernandes Figueira Institute, FIOCRUZ, Rio de Janeiro, Brazil (Avvad-Portari).

3. From the Department of Pathology, Faculty of Medicine, Comenius University, Bratislava, Slovakia (Babál).

4. From the Department of Pathology, University Hospitals Leuven, Leuven, Belgium (Baldewijns).

5. From the Department of Obstetrics and Gynecology and the Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden (Blomberg).

6. From the Institut de Pathologie Multisite des Hospices Civils de Lyon, Lyon, France (Bouachba).

7. From SOFFOET–Société Française de Fœtopathologie, Paris, France (Bouachba, Collardeau-Frachon).

8. From the Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Camacho, Garrido-Pontnou, Navarro).

9. From the Department of Pathology, Hopital Femme-Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France (Collardeau-Frachon).

10. From the Department of Obstetrics, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium (Colson).

11. From the Department of Obstetrics and Gynaecology (Dehaene), Ghent University Hospital, Ghent, Belgium.

12. From the Pathology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Barcelona, Spain (Ferreres).

13. From the Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Sabadell, Spain (Ferreres).

14. From the Department of Pathology, Cork University Hospital, Wilton, Cork, Republic of Ireland (Fitzgerald).

15. From the Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain (Garrido-Pontnou).

16. From the Department of Obstetrics and Gynaecology, Doncaster and Bassetlaw NHS Teaching Hospitals, Women's Hospital, Doncaster, United Kingdom (Gergis).

17. From the Division of Perinatal Pathology, Department of Cellular Pathology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Hargitai).

18. From the Department of Immunobiochemistry (Helguera-Repetto), National Institute of Perinatology, Mexico City, Mexico.

19. From the Department of Obstetrics and Gynaecology, Halland Hospital, Varberg, Sweden (Holmström).

20. From the Department of Physiology and Cellular Development, National Institute of Perinatology “Isidro Espinosa de los Reyes,” Mexico City, Mexico (Irles).

21. From the Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science Helsingborg, Lund University, Lund, Sweden (Leijonhfvud).

22. From the Department of Pathological Anatomy, Antwerp University Hospital, Edegem, Belgium (Libbrecht).

23. From the Cellular Pathology Department, Birmingham Women's Hospital, Birmingham, United Kingdom (Marton).

24. From Histopathology, Rotunda Hospital, Dublin, Republic of Ireland (McEntagart).

25. From Pathology and Laboratory Medicine (Molina).

26. From the Department of Pathology and Pediatrics, Autopsy Service, Yale University School of Medicine, New Haven, Connecticut (Morotti).

27. From the Pathology Department, Hospital Clínic, Barcelona, Spain (Nadal).

28. From the Department of Basic Clinical Practice, School of Medicine, Universitat de Barcelona, and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (Nadal).

29. From the Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (Nelander).

30. From the Department of Pathology and Laboratory Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico (Oviedo).

31. From Laboratório Ferdinando Costa, São Paulo, Brazil (Otani).

32. From the Department of Laboratory Medicine, Division of Pathology (Papadogiannakis).

33. From the Departments of Pathology (Papadogiannakis), Karolinska University Hospital, Stockholm, Sweden.

34. From the Department of Pathology, Aalborg University Hospital, Aalborg, Denmark (Petersen).

35. From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Roberts, Watkins).

36. From Pediatric Pathology and Neuropathology, Department of Pathology, University of Miami Miller School of Medicine/Jackson Health System/Holtz Children's Hospital, Miami, Florida (Saad).

37. From the Department of Women's and Children's Health (Sand), Karolinska Institute, Stockholm, Sweden.

38. From the Department of Obstetrics and Gynaecology, Karolinska University Hospital, Solna, Stockholm, Sweden (Sand).

39. From the Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands (Schoenmakers, Verdijk).

40. From the Department of Pathology, St Louis University School of Medicine, St Louis, Missouri (Sehn).

41. From the Department of Pathology (Simpson), CHRISTUS Hospital St Elizabeth, Beaumont, Texas.

42. From the Department of Pathology, NYU Langone Health–Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, New York (Thomas).

43. From the Department of Anatomical Pathology (Valdespino-Vázquez), National Institute of Perinatology, Mexico City, Mexico.

44. From the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (van der Meeren).

45. From the Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (van der Meeren).

46. From the Department of Pathology (Van Dorpe), Ghent University Hospital, Ghent, Belgium.

47. From Obstetrics & Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden (Zaigham).

48. From the Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden (Zaigham).

Abstract

Context.— Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. Objective.— To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Design.— Case-based retrospective clinicopathologic analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. Results.— Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis (32%; 22 of 68). The majority (19; 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. Conclusions.— The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.

Publisher

Archives of Pathology and Laboratory Medicine

Subject

Medical Laboratory Technology,General Medicine,Pathology and Forensic Medicine

Link

https://meridian.allenpress.com/aplm/article-pdf/146/6/660/3065052/i1543-2165-146-6-660.pdf

Reference104 articles.

1. Schwartz DA, Dhaliwal A. Infections in pregnancy with COVID-19 and other respiratory RNA virus diseases are rarely, if ever, transmitted to the fetus: experiences with coronaviruses, parainfluenza, metapneumovirus respiratory syncytial virus, and influenza. Arch Pathol Lab Med. 2020; 144(8): 920– 928. doi:10.5858/arpa.2020-0211-SA

2. Schwartz DA, Graham AL. Potential maternal and infant outcomes from coronavirus 2019-nCoV (SARS-CoV-2) infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses. 2020; 12(2): 194. doi:10.3390/v12020194

3. Zhang L, Jiang Y, Wei M, et al. Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province [in Chinese]. Zhonghua Fu Chan Ke Za Zhi. 2020; 55: 166– 171. doi:10.3760/cma.j.cn112141-20200218-00111

4. Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med. 200;144(7): 799– 805. doi:10.5858/arpa.2020-0901-SA

5. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226): 809– 815. doi:10.1016/S0140-6736(20)30360-3

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