학술논문
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
Document Type
Author
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; Gerges, 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; Oyamada Otani, Andre Ricardo; 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
Source
Archives of pathology & laboratory medicine. 146(6):660-676
Subject
Language
English
ISSN
0003-9985
Abstract
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.