Severe placental lesions due to maternal SARS-CoV-2 infection associated to intrauterine fetal death

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause severe placental lesions leading rapidly to intrauterine fetal death (IUFD). From August 2020 to September 2021, in the pathology department of Toulouse Oncopole, we analyzed 50 placentas from COVID-19–positive unvaccin...

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Bibliographic Details
Published in:	Human pathology Vol. 121; pp. 46 - 55
Main Authors:	Dubucs, Charlotte, Groussolles, Marion, Ousselin, Jessie, Sartor, Agnès, Van Acker, Nathalie, Vayssière, Christophe, Pasquier, Christophe, Reyre, Joëlle, Batlle, Laïa, Favarel clinical research associate, Stèphanie, Duchanois midwife, Delphine, Jauffret clinical research associate, Valèrie, Courtade-Saïdi, Monique, Aziza, Jacqueline
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2022 Elsevier Limited WB Saunders
Subjects:	Antibodies Births Coronaviruses COVID-19 COVID-19 - complications COVID-19 placental lesions Disease transmission Female Fetal Death - etiology Humans Infant, Newborn Infections Intrauterine fetal death Life Sciences Miscarriage Original Contribution Placenta Placenta - pathology Polymerase chain reaction Pregnancy Pregnancy Complications, Infectious - pathology SARS-CoV-2 SARS-Cov-2 infection Severe acute respiratory syndrome coronavirus 2 France United States > US Pregnancy COVID-19 placental lesions SARS-Cov-2 infection Intrauterine fetal death
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Summary:	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause severe placental lesions leading rapidly to intrauterine fetal death (IUFD). From August 2020 to September 2021, in the pathology department of Toulouse Oncopole, we analyzed 50 placentas from COVID-19–positive unvaccinated mothers. The purpose of our study is to describe the clinicopathological characteristics of these placental damages and to understand the pathophysiology. Ten of them (20%) showed placental lesions with positive immunohistochemistry for SARS-CoV-2 in villous trophoblasts. In five cases (10%), we observed massive placental damage associating trophoblastic necrosis, fibrinous deposits, intervillositis, as well as extensive hemorrhagic changes due to SARS-CoV-2 infection probably responsible of IUFD by functional placental insufficiency. In five other cases, we found similar placental lesions but with a focal distribution that did not lead to IUFD but live birth. These lesions are independent of maternal clinical severity of COVID-19 infection because they occur despite mild maternal symptoms and are therefore difficult to predict. In our cases, they occurred 1–3 weeks after positive SARS-CoV-2 maternal real-time polymerase chain reaction testing and were observed in the 2nd and 3rd trimesters of pregnancies. When these lesions are focal, they do not lead to IUFD and can be involved in intrauterine growth restriction. Our findings, together with recent observations, suggest that future pregnancy guidance should include stricter pandemic precautions such as screening for a wider array of COVID-19 symptoms, enhanced ultrasound monitoring, as well as newborn medical surveillance. •Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can generate severe placental lesions.•Some COVID-19–positive unvaccinated mothers show trophoblastic necrosis with positive anti-SARS-CoV-2 immunohistochemitrsy.•SARS-CoV-2 placental lesions can be involved in intrauterine fetal death (10% of cases) when placental damage is massive.•Intrauterine fetal death occurred 1–3 weeks after maternal infection in 2nd and 3rd trimesters of pregnancies.•Severe SARS-CoV-2 placenta lesions occur despite mild maternal COVID-19 symptoms.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 PMCID: PMC8730375
ISSN:	0046-8177 1532-8392
DOI:	10.1016/j.humpath.2021.12.012