Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury

• Published in: Archives of pathology & laboratory medicine (1976) Vol. 146; no. 6; pp. 660 - 676
• Main Authors: Schwartz, David A, Avvad-Portari, Elyzabeth, Babál, Pavel, Baldewijns, Marcella, Blomberg, Marie, Bouachba, Amine, Camacho, Jessica, Collardeau-Frachon, Sophie, Colson, Arthur, Dehaene, Isabelle, Ferreres, Joan Carles, Fitzgerald, Brendan, Garrido-Pontnou, Marta, Gergis, Hazem, Hargitai, Beata, Helguera-Repetto, A Cecilia, Holmström, Sandra, Irles, Claudine Liliane, Leijonhfvud, Åsa, Libbrecht, Sasha, Marton, Tamás, McEntagart, Noel, Molina, James T, Morotti, Raffaella, Nadal, Alfons, Navarro, Alexandra, Nelander, Maria, Oviedo, Angelica, Otani, Andre Ricardo Oyamada, Papadogiannakis, Nikos, Petersen, Astrid C, Roberts, Drucilla J, Saad, Ali G, Sand, Anna, Schoenmakers, Sam, Sehn, Jennifer K, Simpson, Preston R, Thomas, Kristen, Valdespino-Vázquez, M Yolotzin, van der Meeren, Lotte E, Van Dorpe, Jo, Verdijk, Robert M, Watkins, Jaclyn C, Zaigham, Mehreen
• Format: Journal Article
• Language: English
• Published: United States College of American Pathologists 01.06.2022
• Subjects: Antigens; Autopsies; Autopsy; Coronaviruses; COVID-19; Cytomegalovirus; Death; Disease; Fetuses; Fibrin; Fluorescence in situ hybridization; Genomes; Hybridization; Hypoxia; Immunohistochemistry; Infections; Ischemia; Laboratories; Medicin och hälsovetenskap; Mothers; Neonates; Newborn babies; Pandemics; Pathology; Placenta; Polymerase chain reaction; Population studies; Pregnancy; RNA viruses; RNA-directed DNA polymerase; Severe acute respiratory syndrome coronavirus 2; Stillbirth; Strains (organisms); Viremia; Viruses; Womens health
• ISSN: 0003-9985; 1543-2165; 1543-2165
• DOI: 10.5858/arpa.2022-0029-SA

Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case-based retrospective clinicopathologic 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. Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. 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 of 68) and chronic villitis (32%; 22 of 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. 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.