Placental Histopathological Alterations in COVID-19 Infected Pregnancies

Year 2023, Volume: 5 Issue: Supplement (1) - Innovations in Medicine and Healthcare in the 100th Year of the Republic, 155 - 9, 19.10.2023

Esra Can , Işıl Turan Bakırcı , Elif Gökçe Devecioğlu Gürşen , Hilal Serap Arıkan

https://doi.org/10.37990/medr.1351631

Abstract

Aim: The ongoing global COVID-19 pandemic, caused by the SARS-CoV-2 virus, has generated significant apprehensions in maternal-fetal medicine. Initially considered to affect the respiratory system primarily, recent findings have indicated that the pandemic has far-reaching implications for various physiological functions, particularly in pregnant individuals. This study focused on examining the influence of COVID-19 on placental histopathology in pregnant women infected with SARS-CoV-2.
Material and Methods: We conducted a comparative study involving two groups of pregnant women with similar demographic characteristics: a group testing positive for COVID-19 (n=31) and a control group of COVID-19-negative pregnant women (n=31). After delivery, placental tissues were collected and subjected to comprehensive histopathological examination to determine any potential alterations in the placenta induced by SARS-CoV-2 infection.
Results: Our study revealed substantial histopathological alterations in pregnant women with COVID-19 placentas. Notably, the COVID-19 group displayed a higher incidence of cesarean deliveries, possibly due to concerns related to maternal-fetal transmission and respiratory complications. Furthermore, neonates born to mothers in the COVID-19 group had significantly lower birth weights. Several placental histopathological changes, including villous fibrin deposits, thrombosis, intervillous hemorrhage, agglutination, avascular fibrotic villi, and syncytial knots, were markedly increased in the COVID-19 group, indicating compromised fetal blood circulation. Although not statistically significant, trends toward elevated villous infarction, fetal vascular malperfusion, and chorioamnionitis were observed.
Conclusion: Our study underscores the potential risks associated with COVID-19 on placental health, maternal well-being, and neonatal outcomes. We must understand the underlying physiological mechanisms behind these pathological changes to provide optimal maternal-fetal care during this ongoing crisis. Comprehensive and multicentric studies are urgently required to confirm and expand our findings.

Keywords

COVID-19, Placental histopathological change, pregnancy

References

• Oğlak SC, Obut M. The risk of vicarious trauma among front-line and non-front-line midwives and nurses. Aegean J Obstet Gynecol. 2020;2:19-22.
• Tunç Ş, Göklü MR, Oğlak SC. COVID-19 in pregnant women: An evaluation of clinical symptoms and laboratory parameters based on the 3 trimesters. Saudi Med J. 2022;43:378-85.
• Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20:533-4. Erratum in: Lancet Infect Dis. 2020;20:e215.
• Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and multiorgan response. Curr Probl Cardiol. 2020;45:100618.
• Göklü MR, Oğlak SC, Gedik Özköse Z, et al. The course of infection with the Delta variant of COVID-19 in pregnancy: Analysis of clinical, laboratory, and neonatal outcomes. J Turk Ger Gynecol Assoc. 2023;24:33-41.
• Wong YP, Khong TY, Tan GC. The effects of COVID-19 on placenta and pregnancy: what do we know so far? Diagnostics (Basel). 2021;11:94.
• Tunç Ş, Oğlak SC, Göklü MR, Gedik Özköse Z. Maternal mortality cases due to COVID-19 pandemic in a tertiary referral hospital. Perinatal Journal. 2022;30:185-94.
• Aktiz Bıçak E, Oğlak SC. Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia. J Obstet Gynaecol. 2023;43:2218915.
• Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020;99:823-9.
• Oğlak SC, Yavuz A, Olmez F, et al. The reduced serum concentrations of β-arrestin-1 and β-arrestin-2 in pregnancies complicated with gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2022;35:10017-24.
• Can E, Oğlak SC, Ölmez F, Bulut H. Serum neutrophil gelatinase-associated lipocalin concentrations are significantly associated with the severity of COVID-19 in pregnant patients. Saudi Med J. 2022;43:559-66.
• Garg R, Agarwal R, Yadav D, et al. Histopathological changes in placenta of severe acute respiratory syndrome Coronavirus 2 (SARS-Cov-2) infection and maternal and perinatal outcome in COVID-19. J Obstet Gynaecol India. 2023;73:44-50.
• Khong TY, Mooney EE, Ariel I, et al. Sampling and definitions of placental lesions: amsterdam placental workshop group consensus statement. Arch Pathol Lab Med. 2016;140:698-713.
• Umar S, Petwal S, Joshi C, et al. Histomorphological evaluation of placenta in SARS-CoV-2 patients: A cross-sectional study. Indian J Pathol Microbiol. 2022;65:860-3.
• Shanes ED, Mithal LB, Otero S, et al. Placental pathology in COVID-19. Am J Clin Pathol. 2020;154:23-32.
• Bobei TI, Sima RM, Gorecki GP, et al. Placenta, the key witness of COVID-19 infection in premature births. Diagnostics (Basel). 2022;12:2323.
• Tasca C, Rossi RS, Corti S, et al. Placental pathology in COVID-19 affected pregnant women: a prospective case-control study. Placenta. 2021;110:9-15.
• Baergen RN, Heller DS. Placental pathology in COVID-19 positive mothers: preliminary findings. Pediatr Dev Pathol. 2020;23:177-80.
• Redline RW. Severe fetal placental vascular lesions in term infants with neurologic impairment. Am J Obstet Gynecol. 2005;192:452-7.