Severe COVID-19 in pregnant women: Analysis of placental features and perinatal outcomes
Author:
Farias Arcos Júnior Gelson1ORCID, Pulcineli Vieira Francisco Rossana1, Kill Beatriz1, Verzinhasse Peres Stela1, B. C. Gibelli Maria Augusta2, Ibidi Silvia Maria2, Brunow de Carvalho Werther2, Braz Simões Angélica3, Brizot Maria de Lourdes1, Schultz Regina4, Azevedo Carvalho Mariana1ORCID, , Waissman Adriana Lippi, Bassi Aline Scalisse, de Souza Ana Claudia Rodrigues Lopes Amaral, Farche Ana Claudia Silva, Igai Ana Maria Kondo, Martins Carlos Eduardo do Nascimento, Paganoti Cristiane de Freitas, Domingues Danielle Rodrigues, Mikami Fernanda Cristina Ferreira, Baptista Fernanda Spadotto, Cippiciani Jacqueline Kobayashi, Albertini Jéssica Gorrão Lopes, de Andrade Joelma Queiroz, Niigaki Juliana Ikeda, Pereira Lucinda Cristina, Galletta Marco Aurélio Knippel, Miyadahira Mariana Yumi, Barbosa Mariana Vieira, de Barros Monica Fairbanks, Garavazzo Sckarlet Ernandes Biancolin, Martinelli Silvio, Arrym Tiago Pedromonico, Gomez Ursula Trovato, Franco Veridiana Freire
Affiliation:
1. Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo , Sao Paulo , Brazil 2. Divisao de Neonatologia, Instituto da Crianca do Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo , Sao Paulo , Brazil 3. Servico de Anatomia Patologica do Hospital Universitario da USP , Sao Paulo , Brazil 4. Divisao de Anatomia Patologica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
Abstract
Abstract
Objectives
Changes in placental features, such as maternal and fetal vascular malperfusion, are associated with SARS-CoV-2 infection. The anatomopathologic study of the placenta is crucial for understanding pregnancy and fetal complications. To that end, this study aimed to describe placental features and analyze the association between placental findings and perinatal outcomes in a cohort of pregnant women with severe COVID-19.
Methods
This nested study within a prospective cohort study consisted of 121 singleton pregnant women with a diagnosis of severe COVID-19. Placental pathologic findings were described, and the associations between severe COVID-19 and clinical parameters and perinatal outcomes were assessed.
Results
The prevalence of maternal vascular malperfusion was 52.1%, followed by fetal vascular malperfusion at 21.5%, ascending intrauterine infections at 11.6%, and inflammatory lesions at 11.6%. Other lesions were observed in 39.7% of the placentas examined. Inflammatory lesions were an independent factor (P = .042) in 5-minute Apgar scores below 7. Ascending infection was associated with fetal death (P = .027).
Conclusions
Maternal vascular malperfusion was the most prevalent placental feature in patients with severe COVID-19. Chorangiosis is associated with poor perinatal outcomes.
Publisher
Oxford University Press (OUP)
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