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Fetal death and placental lesions after two COVID ‐19 episodes in single pregnancy in unvaccinated woman
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Edité par CCSD ; Wiley-Blackwell -
International audience. Schwartz and Morotti showed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant women can generate specific and severe histopathological placental lesions1. According to Kotlyar et al., around 20% of SARS-CoV-2-positive unvaccinated mothers harbor placental lesions with positive immunohistochemistry for SARS-CoV-2 in villous trophoblasts2. SARS-CoV-2 placental lesions have been associated with intrauterine fetal demise (IUFD) via functional placental insufficiency, with histological manifestations of trophoblast necrosis, massive perivillous fibrin deposition, chronic intervillositis and extensive hemorrhagic changes3, 4. We observed previously that IUFD occurred 1–3 weeks after the mother tested positive for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR), in the second and third trimesters of pregnancy5. Severe placental lesions were noted despite mild maternal coronavirus disease 2019 (COVID-19) symptoms. In a few cases, we found that placental lesions became less inflammatory and richer in fibrin deposits over time, with only focal or even negative immunostaining for SARS-CoV-2, making histological confirmation of infection difficult5. We illustrate this statement with a case in which the mother developed COVID-19 twice during a single pregnancy. [...]
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