Histopathological Features of Placentas from Mothers Infected with COVID-19 During Pregnancy

Yıl 2025, Cilt: 9 Sayı: 3, 317 - 322, 22.12.2025

Neşe Yeldir , Gamze Sönmez Ünal , Hatice Özer

https://doi.org/10.46332/aemj.1625301

Öz

Purpose: After the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the body, it can cause morphological changes in various tissues, particularly those of the respiratory system. In pregnant individuals with COVID-19, vertical transmission of SARS-CoV-2 may occur and has been associated with pregnancy complications such as miscarriage, fetal malformations, fetal growth restriction, and stillbirth. This study aimed to investigate the histopathological changes observed in the placentas of women infected with COVID-19 during pregnancy.

Materials and Methods: In this study, the histopathological features of the placenta of 29 women with COVID-19 at any period of pregnancy were evaluated.

Results: The women included in the study ranged in age from 18 to 40 years, with a mean age of 30.3. The birth weeks of one patient was the 32nd week, eight patients was the 40th week, and the others were at 36 and 39 weeks. None of the patients had comorbidities. In histopathological examination, calcifications, congestive chorionic villi, intervillous hemorrhage and increase in syncytial knots were common findings. Fibromuscular stenosis was observed in 3 cases and marked distal villous hypoplasia in 2 cases.

Conclusion: The placenta possesses several mechanisms that act as barriers to prevent the transmission of viral infections to the fetus. Studies have demonstrated an increase in placental pathologies, particularly a higher frequency of maternal vascular malperfusion, in pregnant women with COVID-19. Moreover, these studies have shown that placental abnormalities, including both fetal and maternal vascular malperfusion, may occur in the placentas of mothers infected with COVID-19 during pregnancy.

Anahtar Kelimeler

COVID-19 pandemic , placenta , pregnancy complications

Etik Beyan

Approval for this study was obtained from the Non-Interventional Clinical Research Ethics Committee of Sivas Cumhuriyet University Faculty of Medicine (dated 20.10.2021 and numbered 2021-10/22).

Teşekkür

The study was presented as a poster presentation in the best posters session at the 34th European Congress of Pathology.

Gebeliği Sürecinde COVID-19 Enfeksiyonu Geçiren Annelerin Plasentalarının Histopatolojik Özellikleri

Öz

Amaç: Şiddetli akut solunum sendromu koronavirüs 2 (SARS-CoV-2) vücuda alındıktan sonra solunum sistemi başta olmak üzere birçok dokuda morfolojik değişikliklere neden olabilir. COVID-19'lu gebe bireylerde, SARS-CoV-2’nin dikey geçişi mümkün olabilir ve düşük, fetal malformasyonlar, fetal büyüme kısıtlaması veya ölü doğum gibi gebelik komplikasyonlarına neden olabilir. Bu çalışmada COVID-19'lu kadınların plasentalarında meydana gelen değişiklikler araştırılmıştır.

Araçlar ve Yöntem: Bu çalışmada gebeliğin herhangi bir döneminde COVID-19 tanısı alan 29 kadının plasentasının histopatolojik özellikleri değerlendirildi.

Bulgular: Çalışmaya dahil edilen kadınların yaşları 18 ile 40 arasında değişmekte olup, yaş ortalaması 30.3'tür. Bir hastanın doğum haftaları 32. hafta, sekiz hastanın doğum haftası 40. hafta, diğerleri ise 36 ve 39. haftalardı. Hiçbir hastada herhangi bir komorbidite yoktu. Histopatolojik incelemede kalsifikasyonlar, konjestif koryon villuslar, intervillöz kanamalar ve sinsityal düğümlerde artış sık görülen bulgulardı. 3 olguda fibromusküler stenoz, 2 olguda belirgin distal villöz hipoplazi gözlendi.

Sonuç: Plasenta, viral enfeksiyonların fetüse bulaşmasını önlemek için bariyer görevi gören çeşitli mekanizmalara sahiptir. Çalışmalar, COVID-19'lu gebe kadınlarda plasental patolojide, özellikle maternal vasküler malperfüzyon sıklığında bir artış olduğunu göstermiştir. Çalışma ayrıca hamilelik sırasında COVID-19 enfeksiyonu olan annelerin plasentasında fetal ve maternal vasküler malperfüzyon dahil olmak üzere plasental anormalliklerin meydana gelebileceğini gösterdi.

Anahtar Kelimeler

COVID-19 pandemisi , gebelik komplikasyonları , plasenta

Etik Beyan

Bu çalışma için Sivas Cumhuriyet Üniversitesi Tıp Fakültesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan onay alındı ​​(20.10.2021 tarih ve 2021-10/22 sayılı).

Teşekkür

Bu çalışma, 34. Avrupa Patoloji Kongresi'nde en iyi posterler oturumunda sunulmuştur.

Kaynakça

• 1. Shanes ED, Mithal LB, Otero S, et al. Placental pathology in COVID-19. Am J Clin Pathol. 2020;154(1):23-32.
• 2. Siregar MEAG, Siregar HS, Lubis MP, et al. Overview of COVID-19 cases in pregnancy at the Hospital Universitas Sumatera Utara, Indonesia, when the pandemic storm hit in the 2020-2022 period. Afr J Infect Dis. 2023;17(2):19-24.
• 3. Komine-Aizawa S, Takada K, Hayakawa S. Placental barrier against COVID-19. Placenta. 2020;99:45-49.
• 4. Vargas-Hernández VM, Luján-Irastorza JE, Durand-Montaño C. Placental pathology and perinatal risk during the COVID-19 pandemic. Gac Med Mex. 2021;157(5):494-501.
• 5. 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(7):698-713.
• 6. Singh N, Buckley T, Shertz W. Placental pathology in COVID-19: Case series in a community hospital setting. Cureus. 2021;13(1):12522.
• 7. Rad HS, Röhl J, Stylianou N, et al. The effects of COVID-19 on the placenta during pregnancy. Front Immunol. 2021;12:743022.
• 8. Prochaska E, Jang M, Burd I. COVID-19 in pregnancy: placental and neonatal involvement. Am J Reprod Immunol. 2020;84(5):13306.
• 9. Corbetta-Rastelli CM, Altendahl M, Gasper C, et al. Analysis of placental pathology after COVID-19 by timing and severity of infection. Am J Obstet Gynecol MFM. 2023;5(7):100981.
• 10. Şahin O, Altay AY, Aydın E, et al. Effect of asymptomatic COVID-19 infection on the placenta in the third trimester of pregnancy: A prospective case-control study. Turk J Obstet Gynecol. 2022;19(3):178-186.
• 11. Schwartz DA, Avvad-Portari E, Babál P,et al. Placental tissue destruction and insufficiency from COVID-19 causes stillbirth and neonatal death from hypoxic-ischemic injury. Arch Pathol Lab Med. 2022;146(6): 660-676.
• 12. Cornish EF, McDonnell T, Williams DJ. Chronic Inflammatory Placental Disorders Associated With Recurrent Adverse Pregnancy Outcome. Front Immunol. 2022;13:825075.
• 13. Redline RW. Classification of placental lesions. Am J Obstet Gynecol. 2015;213(4):21-28.
• 14. Marton T, Hargitai B, Hunter K, et al. Massive Perivillous Fibrin Deposition and Chronic Histiocytic Intervillositis a Complication of SARS-CoV-2 Infection. Pediatr Dev Pathol. 2021;24(5):450-454.
• 15. Pomorski M, Trzeszcz M, Matera-Witkiewicz A,et al. SARS-CoV-2 Infection and Pregnancy: Maternal and Neonatal Outcomes and Placental Pathology Correlations. Viruses. 2022;14(9):2043.
• 16. Rahmati M, Yon DK, Lee SW, et al. Effects of COVID-19 vaccination during pregnancy on SARS-CoV-2 infection and maternal and neonatal outcomes: A systematic review and meta-analysis. Rev Med Virol. 2023;33(3):2434.
• 17. Zambrano LD. Update: Characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status—United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1641–1647.
• 18. Hansen-Nord E, Lindman J, Ingerslev MD, et al. Severe growth retardation in a newborn as a result of SARS-CoV-2 infection in the mother in the 23rd week of pregnancy. Ugeskr Laeger. 2022;184(46): V01220069.