Mechanism of stillbirth, neonatal death is hypoxic-ischemic injury resulting from placental destruction and insufficiency caused by SARS-CoV-2
MONDAY, Feb. 14, 2022 (HealthDay News) — Pregnant women who become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may develop placentitis, which can cause widespread placental destruction resulting in intrauterine and early neonatal deaths, according to a study published online Feb. 10 in the Archives of Pathology & Laboratory Medicine.
David A. Schwartz, M.D., an Atlanta-based pathologist, and colleagues examined the role of the placenta in causing stillbirth and neonatal death following maternal COVID-19 infection and confirmed placental positivity for SARS-CoV-2 in a case-based retrospective analysis. Placental and autopsy pathology findings were reviewed from 64 stillborns and four neonatal deaths with placentas testing positive for SARS-CoV-2 following delivery to unvaccinated mothers with COVID-19.
The researchers identified increased fibrin deposition and villous trophoblast necrosis in all 68 placentas, while 66 had chronic histiocytic intervillositis; all three findings constituted SARS-CoV-2 placentitis. Massive perivillous fibrin deposition was seen in 63 placentas. As a result of SARS-CoV-2 placentitis, severe destructive placental disease had average tissue involvement of 77.7 percent. Multiple intervillous thrombi were seen in 25 of the placentas, and chronic villitis was seen in 22 (37 and 32 percent, respectively). No significant fetal abnormalities were revealed in 19 of the 30 autopsies, except for intrauterine hypoxia and asphyxia. In 16 of 28 cases tested, SARS-CoV-2 was detected from a body specimen, most commonly from nasopharyngeal swabs. SARS-CoV-2 was identified in internal organs in four autopsied stillborns.
“[SARS-CoV-2] causes extensive damage to the placenta and stillbirth occurs from lack of oxygen,” Schwartz said in a statement. “The placental destruction is so severe that whether or not the fetus becomes infected might be irrelevant.”
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