tetano
Editor, Senior Moderator
EClinicalMedicine
. 2022 May;47:101389.
doi: 10.1016/j.eclinm.2022.101389. Epub 2022 Apr 15.
SARS-COV2 placentitis and pregnancy outcome: A multicentre experience during the Alpha and early Delta waves of coronavirus pandemic in England
Sophie Stenton[SUP] 1 [/SUP], Jo McPartland[SUP] 2 [/SUP], Rajeev Shukla[SUP] 2 [/SUP], Kerry Turner[SUP] 3 [/SUP], Tamas Marton[SUP] 4 [/SUP], Beata Hargitai[SUP] 4 [/SUP], Andrew Bamber[SUP] 5 [/SUP], Jeremy Pryce[SUP] 6 [/SUP], Cesar L Peres[SUP] 1 [/SUP], Nadia Burguess[SUP] 1 [/SUP], Bart Wagner[SUP] 7 [/SUP], Barbara Ciolka[SUP] 2 [/SUP], William Simmons[SUP] 2 [/SUP], Daniel Hurrell[SUP] 2 [/SUP], Thivya Sekar[SUP] 8 [/SUP], Corina Moldovan[SUP] 9 [/SUP], Claire Trayers[SUP] 10 [/SUP], Victoria Bryant[SUP] 11 [/SUP], Liina Palm[SUP] 8 [/SUP], Marta C Cohen[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Pregnant women with SARS-CoV-2 infection experience higher rates of stillbirth and preterm birth. A unique pattern of chronic histiocytic intervillositis (CHI) and/or massive perivillous fibrin deposition (MPFD) has emerged, coined as SARS-CoV-2 placentitis.
Methods: The aim of this study was to describe a cohort of placentas diagnosed with SARS-CoV-2 placentitis during October 2020-March 2021. Cases with a histological diagnosis of SARS-CoV-2 placentitis and confirmatory immunohistochemistry were reported. Maternal demographic data, pregnancy outcomes and placental findings were collected.
Findings: 59 mothers delivered 61 infants with SARS-CoV-2 placentitis. The gestational age ranged from 19 to 41 weeks with most cases (78.6%) being third trimester. 30 infants (49.1%) were stillborn or late miscarriages. Obese mothers had higher rates of pregnancy loss when compared with those with a BMI <30 [67% (10/15) versus 41% (14/34)]. 47/59 (79[SUP].[/SUP]7%) mothers had a positive SARS-CoV-2 PCR test either at the time of labour or in the months before, of which 12 (25[SUP].[/SUP]5%) were reported to be asymptomatic. Ten reported only CHI, two cases showed MPFD only and in 48 placentas both CHI and MPFD was described.
Interpretation: SARS-CoV2 placentitis is a distinct entity associated with increased risk of pregnancy loss, particularly in the third trimester. Women can be completely asymptomatic and still experience severe placentitis. Unlike 'classical' MPFD, placentas with SARS-CoV-2 are generally normal in size with adequate fetoplacental weight ratios. Further work should establish the significance of the timing of maternal SARS-CoV-2 infection and placentitis, the significance of SARS-CoV2 variants, and rates of vertical transmission associated with this pattern of placental inflammation.
Funding: There was not funding associated with this study.
Keywords: COVID-19; Chronic histiocytic intervillositis; Massive perivillous fibrin deposition; Placentitis; SARS-CoV2; Stillbirth.
. 2022 May;47:101389.
doi: 10.1016/j.eclinm.2022.101389. Epub 2022 Apr 15.
SARS-COV2 placentitis and pregnancy outcome: A multicentre experience during the Alpha and early Delta waves of coronavirus pandemic in England
Sophie Stenton[SUP] 1 [/SUP], Jo McPartland[SUP] 2 [/SUP], Rajeev Shukla[SUP] 2 [/SUP], Kerry Turner[SUP] 3 [/SUP], Tamas Marton[SUP] 4 [/SUP], Beata Hargitai[SUP] 4 [/SUP], Andrew Bamber[SUP] 5 [/SUP], Jeremy Pryce[SUP] 6 [/SUP], Cesar L Peres[SUP] 1 [/SUP], Nadia Burguess[SUP] 1 [/SUP], Bart Wagner[SUP] 7 [/SUP], Barbara Ciolka[SUP] 2 [/SUP], William Simmons[SUP] 2 [/SUP], Daniel Hurrell[SUP] 2 [/SUP], Thivya Sekar[SUP] 8 [/SUP], Corina Moldovan[SUP] 9 [/SUP], Claire Trayers[SUP] 10 [/SUP], Victoria Bryant[SUP] 11 [/SUP], Liina Palm[SUP] 8 [/SUP], Marta C Cohen[SUP] 1 [/SUP]
Affiliations
- PMID: 35465646
- PMCID: PMC9012107
- DOI: 10.1016/j.eclinm.2022.101389
Abstract
Background: Pregnant women with SARS-CoV-2 infection experience higher rates of stillbirth and preterm birth. A unique pattern of chronic histiocytic intervillositis (CHI) and/or massive perivillous fibrin deposition (MPFD) has emerged, coined as SARS-CoV-2 placentitis.
Methods: The aim of this study was to describe a cohort of placentas diagnosed with SARS-CoV-2 placentitis during October 2020-March 2021. Cases with a histological diagnosis of SARS-CoV-2 placentitis and confirmatory immunohistochemistry were reported. Maternal demographic data, pregnancy outcomes and placental findings were collected.
Findings: 59 mothers delivered 61 infants with SARS-CoV-2 placentitis. The gestational age ranged from 19 to 41 weeks with most cases (78.6%) being third trimester. 30 infants (49.1%) were stillborn or late miscarriages. Obese mothers had higher rates of pregnancy loss when compared with those with a BMI <30 [67% (10/15) versus 41% (14/34)]. 47/59 (79[SUP].[/SUP]7%) mothers had a positive SARS-CoV-2 PCR test either at the time of labour or in the months before, of which 12 (25[SUP].[/SUP]5%) were reported to be asymptomatic. Ten reported only CHI, two cases showed MPFD only and in 48 placentas both CHI and MPFD was described.
Interpretation: SARS-CoV2 placentitis is a distinct entity associated with increased risk of pregnancy loss, particularly in the third trimester. Women can be completely asymptomatic and still experience severe placentitis. Unlike 'classical' MPFD, placentas with SARS-CoV-2 are generally normal in size with adequate fetoplacental weight ratios. Further work should establish the significance of the timing of maternal SARS-CoV-2 infection and placentitis, the significance of SARS-CoV2 variants, and rates of vertical transmission associated with this pattern of placental inflammation.
Funding: There was not funding associated with this study.
Keywords: COVID-19; Chronic histiocytic intervillositis; Massive perivillous fibrin deposition; Placentitis; SARS-CoV2; Stillbirth.