Chronic histiocytic intervillositis with trophoblast necrosis is a risk factor associated with placental infection from coronavirus disease 2019 (COVID-19) and intrauterine …
DA Schwartz, M Baldewijns… - … of pathology & …, 2021 - meridian.allenpress.com
Archives of pathology & laboratory medicine, 2021•meridian.allenpress.com
Context.—The number of neonates with severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection is increasing, and in a few there are reports of intrauterine infection.
Objective.—To characterize the placental pathology findings in a preselected cohort of
neonates infected by transplacental transmission arising from maternal infection with SARS-
CoV-2, and to identify pathology risk factors for placental and fetal infection. Design.—Case-
based retrospective analysis by a multinational group of 19 perinatal specialists of the …
(SARS-CoV-2) infection is increasing, and in a few there are reports of intrauterine infection.
Objective.—To characterize the placental pathology findings in a preselected cohort of
neonates infected by transplacental transmission arising from maternal infection with SARS-
CoV-2, and to identify pathology risk factors for placental and fetal infection. Design.—Case-
based retrospective analysis by a multinational group of 19 perinatal specialists of the …
Context
The number of neonates with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is increasing, and in a few there are reports of intrauterine infection.
Objective
To characterize the placental pathology findings in a preselected cohort of neonates infected by transplacental transmission arising from maternal infection with SARS-CoV-2, and to identify pathology risk factors for placental and fetal infection.
Design
Case-based retrospective analysis by a multinational group of 19 perinatal specialists of the placental pathology findings from 2 cohorts of infants delivered to mothers testing positive for SARS-CoV-2: live-born neonates infected via transplacental transmission who tested positive for SARS-CoV-2 after delivery and had SARS-CoV-2 identified in cells of the placental fetal compartment by molecular pathology, and stillborn infants with syncytiotrophoblast positive for SARS-CoV-2.
Results
In placentas from all 6 live-born neonates acquiring SARS-CoV-2 via transplacental transmission, the syncytiotrophoblast was positive for coronavirus using immunohistochemistry, RNA in situ hybridization, or both. All 6 placentas had chronic histiocytic intervillositis and necrosis of the syncytiotrophoblast. The 5 stillborn/terminated infants had placental pathology findings that were similar, including SARS-CoV-2 infection of the syncytiotrophoblast, chronic histiocytic intervillositis, and syncytiotrophoblast necrosis.
Conclusions
Chronic histiocytic intervillositis together with syncytiotrophoblast necrosis accompanies SARS-CoV-2 infection of syncytiotrophoblast in live-born and stillborn infants. The coexistence of these 2 findings in all placentas from live-born infants acquiring their infection prior to delivery indicates that they constitute a pathology risk factor for transplacental fetal infection. Potential mechanisms of infection of the placenta and fetus with SARS-CoV-2, and potential future studies, are discussed.
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