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COVID-19 and Women’s Health

Placental Findings Associated with COVID-19

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PURPOSE:

  • Shanes et al. (American Journal of Clinical Pathology) sought to identify placental pathology associated with COVID-19 infection

METHODS:

  • Case control study
  • Histologic evaluation of the placenta was performed
    • Cases: Placentas from pregnant women with confirmed SARS-CoV-2 infection who delivered between March 18, 2020 and May 5, 2020
    • Historical controls
      • Placental samples derived from women who had placental evaluation for maternal/fetal indications (e.g, FGR, chorioamnionitis)
      • History of melanoma | Considered a superior control because evaluation would be performed for potential metastases rather than possible confounding indication (e.g. SGA)
  • Prior to April 7, only patients with moderate to severe disease were tested | Following this date, all women admitted to labor and delivery underwent testing

RESULTS:

  • 16 placentas from women with COVID-19 were evaluated
  • Gestational Age at delivery
    • Term deliveries (37 to 40 weeks): 14
    • 34 week delivery: 1
    • 16 week IUFD: 1
  • Placental size
    • SGA: 5
    • LGA: 1
  • Indication for placental exam
    • SARS-CoV-2: 13
    • Cholestasis in pregnancy and GDM: 1
    • Pregnancy-induced hypertension: 1
    • IUFD (above): 1
  • Timing of COVID-19 diagnosis
    • Remote from delivery (25 to 34 weeks): 4
    • 6 to 7 days prior to delivery: 2
    • At time of admission for delivery: 10
  • Clinical COVID-19 course
    • Symptomatic: 10 patients
    • Oxygen requirement: 2
    • Maternal deaths or requiring intubation: 0
    • All infants had normal Apgar scores and discharged home except for 34 week delivery who was still in NICU
  • 16 week IUFD: Retroplacental hematoma | Removed from analysis of placental findings because controls were all from 3rd trimester deliveries

Placental Findings

  • Placentas from COVID-19 pregnancies were more likely to have ≥1 feature of maternal vascular malperfusion (MVM) compared to
    • Melanoma controls: Odds ratio (OR) 7.3 (P = .001)
    • Other historical controls: OR 3.4 ( P = .046)
  • Individual MVM features were more likely be found in COVID-19 pregnancies
    • Decidual arteriopathy vs both control groups
    • Atherosis and fibrinoid necrosis vs both groups
    • Peripheral villous infarction vs melanoma group
  • Features of fetal malperfusion (FVM) were also more common in the COVID-19 placentas vs both control groups such as delayed villous maturation
  • Findings associated with acute and chronic inflammation were not increased

CONCLUSION:

  • MVM reflects abnormalities in oxygenation within the intervillous space and is associated with adverse perinatal outcomes, including hypertensive disorders and preeclampsia
  • Despite MVM findings, only 1 patient with COVID-19 had hypertension
  • The authors conclude that the changes found in the placentas from pregnant women with COVID-19

…may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology

…these findings suggest that increased antenatal surveillance for women diagnosed with SARS-CoV-2 may be warranted

Learn More – Primary Sources:

Placental Pathology in COVID-19

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Related ObG Topics:

SMFM Guideline Update on COVID-19 in Pregnancy
The UKOSS COVID-19 Pregnancy Registry: Update on 427 Patients Admitted to Hospital
Pregnant Women with COVID-19 and ICU Admissions

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