Krishna Govindan1, Jithesh Girijakumar2, Sreekumari Radha3, Priyasree Jayasimham4, Reshma Pallikara Kunjunny5
BACKGROUND
The coronavirus disease 2019 (Covid-19), caused by severe acute respiratory
syndrome-coronavirus-2 (SARS-CoV-2), is a global public health emergency. Data
on the effect of coronavirus disease 2019 in pregnancy is limited to few case series.
The purpose of this study was to describe the histopathological findings in the
placentas of women with Covid-19 during pregnancy.
METHODS
Pregnant women with Covid-19 who delivered between August 1, 2020 and May
10, 2021, at Government Medical College, Trivandrum were considered for the
study. Handling of specimens were carried out using Indian council of medical
research (ICMR) guidelines for Covid-19 specimens. Placentas underwent routine
clinical examination and processing. Clinical information was retrieved from the
medical records. Histological examination was performed and features classified
into maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM).
RESULTS
50 placentas from patients with severe acute respiratory syndrome coronavirus 2
were examined [33 patients delivered at term, 12 patients were preterm, 4 cases
were intrauterine fetal demise and 1 case was medical termination of pregnancy
(MTP)]. Patients with risk factors for maternal and fetal vascular malperfusion
were excluded. 8 cases showed features of maternal vascular malperfusion and
11 cases showed features of fetal vascular malperfusion. Among intra uterine fetal
death (IUFD) cases, 2 cases showed features of vascular malperfusion, 7 cases
showed low grade acute inflammatory pathology which needs further studies with
a greater number of cases to establish relationship with Covid-19 virus.
CONCLUSIONS
Covid-19 placentas showed increased rates of maternal and fetal vascular
malperfusion. These changes may reflect a hypercoagulable state influencing
placental pathology and hence an increased antenatal surveillance for women
diagnosed with SARS–CoV-2 infection may be warranted. Further studies with
control groups are necessary to determine the reproducibility and significance of
these initial findings.
