SARS-CoV-2 placentitis – report of two cases and review of the literature

Česká verzia

Authors: M. Daumová ^1,2 ; Hadravská Š. ^1,2; Peteříková Straková A. ¹; Vaněček T. ^1,2; Matas M. ³; Korečko V. ⁴
Authors place of work: Šiklův ústav patologie, LF UK a FN Plzeň ¹; Bioptická laboratoř s. r. o., Plzeň ²; Neonatologické oddělení, LF UK a FN Plzeň ³; Gynekologicko-porodnická klinika LF UK a FN Plzeň ⁴
Published in the journal: Ceska Gynekol 2022; 87(2): 111-117
Category: Case Report
doi: https://doi.org/10.48095/cccg2022111

Summary

Covid-19 disease caused by severe acute respiratory syndrome 2 coronavirus (SARS-CoV-2) continues to be a global public health problem. Since the pandemic outbreak in early 2020, a number of cases have been reported in pregnant women whose infection has led to severe complications including preterm birth, miscarriage, intrauterine growth restriction or intrauterine fetal demise. The results of the current studies suggest that the transplacental transmission of infection from mother to fetus is a rare event and that the complications listed above are more likely due to damage of placental tissue. In this article, we describe two cases of SARS-CoV-2 placentitis with special consideration to the morphology and differential diagnosis of this newly defined entity.

Keywords:

Placenta – SARS-CoV-2 – COVID-19 – placentitis – histiocytic intervillositis

Zdroje

1. Wastnedge EA, Reynolds RM, van Boeckel SR et al. Pregnancy and COVID-19. Physiol Rev 2021; 101 (1): 303–318. doi: 10.1152/physrev. 00024.2020.

2. Jafari M, Pormohammad A, Sheikh Neshin SA et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: a systematic review and meta-analysis. Rev Med Virol 2021; 31 (5): 1–16. doi: 10.1002/rmv.2208.

3. Juan J, Gil MM, Rong Z et al. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound Obstet Gynecol 2020; 56 (1): 15–27. doi: 10.1002/uog.22088.

4. Richtmann R, Torloni MR, Oyamada Otani AR et al. Fetal deaths in pregnancies with SARS- -CoV-2 infection in Brazil: a case series. Case Rep Womens Health 2020; 27: e00243. doi: 10.1016/j.crwh.2020.e00243.

5. Watkins JC, Torous VF, Roberts DJ. Defining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) placentitis. Arch Pathol Lab Med 2021; 145 (11): 1341–1349. doi: 10.5858/ arpa.2021-0246-SA.

6. Liu Z, Xiao X, Wei X et al. Composition and divergence of coronavirus spike proteins and host ACE2 receptors predict potential intermediate hosts of SARS-CoV-2. J Med Virol 2020; 92 (6): 595–601. doi: 10.1002/jmv.25726.

7. Wong YP, Khong TY, Tan GC. The effects of COVID-19 on placenta and pregnancy: what do we know so far? Diagnostics 2021; 11 (1): 94. doi: 10.3390/diagnostics11010094.

8. Baergen RN, Heller DS. Placental pathology in covid-19 positive mothers: preliminary findings. Pediatr Dev Pathol 2020; 23 (3): 177–180. doi: 10.1177/1093526620925569.

9. Shanes ED, Mithal LB, Otero S et al. Placental pathology in COVID-19. Am J Clin Pathol 2020; 154 (1): 23–32. doi: 10.1093/ajcp/aqaa089.

10. Kuhrt K, McMicking J, Nanda S et al. Placental abruption in a twin pregnancy at 32 weeks’ gestation complicated by coronavirus disease 2019 without vertical transmission to the babies. Am J Obstet Gynecol MFM 2020; 2 (3): 100135. doi: 10.1016/j.ajogmf.2020.100135.

11. Hecht JL, Quade B, Deshpande V et al. SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: a series of 19 placentas from COVID--19-positive mothers. Mod Pathol 2020; 33 (11): 2092–2103. doi: 10.1038/s41379-020-06 39-4.

12. Menter T, Mertz KD, Jiang S et al. Placental pathology findings during and after SARS--CoV-2 infection: features of villitis and malperfusion. Pathobiology 2021; 88 (1): 69–77. doi: 10.1159/000511324.

13. 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. doi: 10.5858/arpa.2015-0225-CC.

14. Sharps MC, Hayes DJ, Lee S et al. A structured review of placental morphology and histopathological lesions associated with SARS- -CoV-2 infection. Placenta 2020; 101: 13–29. doi: 10.1016/j.placenta.2020.08.018.

15. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135 (23): 2033–2040. doi: 10.1182/blood.2020006000.

16. Ashary N, Bhide A, Chakraborty P et al. Single-cell RNA-seq identifies cell subsets in human placenta that highly expresses factors driving pathogenesis of SARS-CoV-2. Front Cell Dev Biol 2020; 8: 783. doi: 10.3389/fcell.2020.00 783.

17. Ernst LM. Maternal vascular malperfusion of the placental bed. APMIS 2018; 126 (7): 551–560. doi: 10.1111/apm.12833.

18. Redline RW, Ravishankar S. Fetal vascular malperfusion, an update. APMIS 2018; 126 (7): 561–569. doi: 10.1111/apm.12849.

19. Schwartz DA, Baldewijns M, Benachi A et al. Chronic histiocytic intervillositis with trophoblast necrosis is a risk factor associated with placental infection from coronavirus disease 2019 (COVID-19) and intrauterine maternal-fetal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in live-born and stillborn infants. Arch Pathol Lab Med 2021; 145 (5): 517–528. doi: 10.5858/arpa.2020-07 71-SA.

20. Chandrasekharan P, Vento M, Trevisanuto D et al. Neonatal resuscitation and postresuscitation care of infants born to mothers with wuspected or confirmed SARS-CoV-2 infection. Am J Perinatol 2020; 37 (8): 813–824. doi: 10.1055/s-0040-1709688.

21. Dong L, Tian J, He S et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020; 323 (18): 1846–1848. doi: 10.1001/jama.2020. 4621.

22. Zamaniyan M, Ebadi A, Aghajanpoor S et al. Preterm delivery, maternal death, and vertical transmission in a pregnant woman with COVID--19 infection. Prenat Diagn 2020; 40 (13): 1759–1761. doi: 10.1002/pd.5713.

23. Vivanti AJ, Vauloup-Fellous C, Prevot S et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun 2020; 11 (1): 3572. doi: 10.1038/s41467-020-17436-6.

24. Schwartz DA, Dhaliwal A. Infections in pregnancy with COVID-19 and other respiratory RNA virus diseases are rarely, if ever, transmitted to the fetus: expiriences with coronaviruses, HPIV, hMPV and influenza. Arch Pathol Lab Med 202. doi: 10.5858/arpa.2020-0211-SA. Online ahead of print.

25. Libbrecht S, Van Cleemput J, Vandekerckhove L et al. A rare but devastating cause of twin loss in a near-term pregnancy highlighting the features of severe SARS-CoV-2 placentitis. Histopathology 2021; 79 (4): 674–676. doi: 10.1111/his.14402.

26. Taglauer E, Benarroch Y, Rop K et al. Consistent localization of SARS-CoV-2 spike glycoprotein and ACE2 over TMPRSS2 predominance in placental villi of 15 COVID-19 positive maternal-fetal dyads. Placenta 2020; 100: 69–74. doi: 10.1016/j.placenta.2020.08.015.

27. Facchetti F, Bugatti M, Drera E et al. SARS--CoV-2 vertical transmission with adverse effects on the newborn revealed through integrated immunohistochemical, electron microscopy and molecular analyses of Placenta. EBioMedicine 2020; 59: 102951. doi: 10.1016/ j.ebiom.2020.102951.

28. Patane L, Morotti D, Giunta MR et al. Vertical transmission of coronavirus disease 2019: severe acute respiratory syndrome coronavirus 2 RNA on the fetal side of the placenta in pregnancies with coronavirus disease 2019-positive mothers and neonates at birth. Am J Obstet Gynecol MFM 2020; 2 (3): 100145. doi: 10.1016/ j.ajogmf.2020.100145.

29. Kim CJ, Romero R, Chaemsaithong P et al. Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance. Am J Obstet Gynecol 2015; 213 (Suppl D): S53–S69. doi: 10.1016/j.ajog.2015.08.041.

30. Katzman PJ, Genest DR. Maternal floor infarction and massive perivillous fibrin deposition: histological definitions, association with intrauterine fetal growth restriction, and risk of recurrence. Pediatr Dev Pathol 2002; 5 (2): 159–164. doi: 10.1007/s10024001-0195-y.

31. Heerema-McKenney A. Defense and infection of the human placenta. APMIS 2018; 126 (7): 570–588. doi: 10.1111/apm.12847.