Severe COVID-19 in pregnant women: Analysis of placental features and perinatal outcomes.

Júnior, Gelson Farias Arcos; Francisco, Rossana Pulcineli Vieira; Kill, Beatriz; Peres, Stela Verzinhasse; Gibelli, Maria Augusta B. C.; Ibidi, Silvia Maria; Carvalho, Werther Brunow de; Simões, Angélica Braz; Brizot, Maria de Lourdes; Schultz, Regina; Carvalho, Mariana Azevedo; Group, HC-FMUSP-Obstetric COVID-19 Study

Objectives Changes in placental features, such as maternal and fetal vascular malperfusion, are associated with SARS-CoV-2 infection. The anatomopathologic study of the placenta is crucial for understanding pregnancy and fetal complications. To that end, this study aimed to describe placental features and analyze the association between placental findings and perinatal outcomes in a cohort of pregnant women with severe COVID-19. Methods This nested study within a prospective cohort study consisted of 121 singleton pregnant women with a diagnosis of severe COVID-19. Placental pathologic findings were described, and the associations between severe COVID-19 and clinical parameters and perinatal outcomes were assessed. Results The prevalence of maternal vascular malperfusion was 52.1%, followed by fetal vascular malperfusion at 21.5%, ascending intrauterine infections at 11.6%, and inflammatory lesions at 11.6%. Other lesions were observed in 39.7% of the placentas examined. Inflammatory lesions were an independent factor (P = .042) in 5-minute Apgar scores below 7. Ascending infection was associated with fetal death (P = .027). Conclusions Maternal vascular malperfusion was the most prevalent placental feature in patients with severe COVID-19. Chorangiosis is associated with poor perinatal outcomes.

COVID-19; PREGNANCY complications; FETAL death; PERINATAL death; PREGNANT women

American Journal of Clinical Pathology, 2024, Vol 162, Issue 6, p570

0002-9173

Academic Journal

10.1093/ajcp/aqae072