Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury: A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries

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Schwartz, D. A. | Avvad-Portari, E. | Babál, P. | Baldewijns, M. | Blomberg, M. | Bouachba, A. | Camacho, J. | Collardeau-Frachon, S. | Colson, A. | Dehaene, I. | Ferreres, J. C. | Fitzgerald, B. | Garrido-Pontnou, M. | Gergis, H. | Hargitai, B. | Helguera-Repetto, A. C. | Holmström, S. | Irles, C. L. | Leijonhfvud, Å | Libbrecht, S. | Marton, T. | Mcentagart, N. | Molina, J. T. | Morotti, R. | Nadal, A. | Navarro, A. | Nelander, M. | Oviedo, A. | Oyamada Otani, A. R. | Papadogiannakis, N. | Petersen, A. C. | Roberts, D. J. | Saad, A. G. | Sand, A. | Schoenmakers, S. | Sehn, J. K. | Simpson, P. R. | Thomas, K. | Valdespino-Vázquez, M. Y. | Meeren, L. E., van Der | van Dorpe, J. | Verdijk, R. M. | Watkins, J. C. | Zaigham, M.

Edité par CCSD ; College of American Pathologists -

International audience. CONTEXT.—: Perinatal death is an increasingly important problem as the 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 SARS-CoV-2. DESIGN.—: Case-based retrospective clinico-pathological 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.—: All 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis, the three findings constituting SARS-CoV-2 placentitis. 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%; 25/68) and chronic villitis (32%; 22/68). 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.

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