The placental pathology in Coronavirus disease 2019 infected mothers and its impact on pregnancy outcome. (September 2022)

• Record Type: Journal Article
• Authors: Joshi, Bharti; Chandi, Anadeep; Srinivasan, Radhika; Saini, Shiv Sajan; Prasad, G.R.V.; Puri, G.D.; Bhalla, Ashish; Suri, Vanita; Bagga, Rashmi
• Is Part Of: Placenta. Volume 127(2022)
• Page Start: 1
• Page End: 7
• Publication Date: 2022-09
• Subjects: Infectious disease -- Placental pathology -- COVID-19 -- SARS-CoV-2 -- Obstetric complication -- Pregnancy outcome -- Neonatal outcome -- Stillbirths; Placenta -- Periodicals; Reproduction -- Periodicals; Placenta -- Periodicals; Placenta -- Périodiques; Reproduction -- Périodiques; 612.63
• DOI: 10.1016/j.placenta.2022.07.009
• Languages: English
• ISSNs: 0143-4004

Abstract

Abstract: Introduction: This study aims at observing placental pathologies in COVID-19 infected women, and analyzing its impact on pregnancy outcome. Method: This is a descriptive-analytical study done at a tertiary centre of Northern India. All COVID-19 positive pregnant women with gestational age ≥20 weeks, with placental histopathological reporting, were included in this study. A total of 173 COVID-19 pregnant women were included in the study. Results: Placental abnormalities were noticed in 49·16% of total 179 placentae examined. Maternal vascular malperfusion (27·93%) was the most observed placental pathology followed by villous fibrin deposits (22·90%), fetal vasculopathy (16·75%), and acute inflammation (6·70%). Stillbirths were 22 and NICU admissions were seen in 50 neonates. Abnormal placental abnormalities led to higher stillbirths (p value 0·011) and lower Apgar scores at 1 and 5 min (p-value 0·028; p-value 0·002, respectively). Intervillous fibrin deposits had higher risk associated with lower Apgar score at 1 and 5 min [RR 2·05 (95% CI 1·21–3·48, p-value 0·010) and RR 5·52 (95% CI 2·58–11·81, p-value <0·001), respectively]. RP clot/hemorrhage was also associated with lower Apgar score at 1 and 5 min [RR 2·61 (95% CI 1·52–4·49, p-value 0·002) and RR 3.54 (95% CI 1·66–7·55, p-value 0·001), respectively]. Discussion: Placental abnormalities in COVID-19 infection were associated with significant higher incidence of unexplained stillbirths, and lower Apgar scores. Although, this is the largest descriptive-analytical study done so far, comparative studies are required to draw a clear conclusion regarding the impact of COVID-19 infection on human placenta and its effect on pregnancy outcomes. Highlights: The incidence of abnormal placental pathologies in COVID-19 infected mothers is 49.16%. Maternal vascular malperfusion (MVM) is the most observed placental morphologic abnormality. Villous fibrin deposits, RP clots/hemorrhage, villous infarcts results in lower Apgar scores. A higher incidence of silent antepartum is also found in COVID-19 infected mother.