Maternal First Trimester Gestational COVID-19 Infection is Associated with Increased Placental Maternal Vascular Malperfusion, But Not Clinical Morbidity or Mortality
Paul H Hartel1-3* and Weronika Wudarczyk4
1Sligo University Hospital, The Mall, Sligo, Ireland
2National University of Ireland, Galway School of Medicine, Galway, Ireland
3West Virginia University School of Medicine, Morgantown, WV, USA
4Sligo Institute of Technology, Ireland
*Corresponding Author: Paul H Hartel, Sligo University Hospital, The Mall, Sligo, Ireland.
January 27, 2022; Published: February 16, 2022
Maternal COVID-19 infection during pregnancy has been associated with a myriad of pathologic placental changes. Clinically, rare studies have highlighted intrauterine growth restriction (IUGR), pre-term birth, intrauterine fatal demise and stillbirth in association with maternal gestational COVID-19 infection. Third trimester infants should be protected from acquiring COVID-19 infection since there is a paucity of the required angiotensin-converting enzyme (ACE) receptors present in the placenta, and earlier maternal gestational infections theoretically pose higher risk. We reviewed the total of 20 placentas from first trimester maternal COVID-positive pregnancies and clinical outcomes in the Sligo University Hospital catchment area from 2020-2021 to add to the literature of COVID-19 clinical and pathologic findings. Clinical audit was performed on placentas from maternal COVID-positive pregnancies from 2020-2021. Anonymised data from patient pathology reports including maternal and gestational age, clinically provided morbidity and maternal and neonatal outcome data and placental pathologic findings and were reviewed. Haematoxylin and eosin-stained slides were available in all cases and reviewed by a consultant pathologist. All variables were compared with known background incidence and a cohort of 20 randomly selected non-COVID cases from the same time period. Maternal age ranged from 20-41 years (m = 31), and gestational age from 25 to 41 weeks (m = 36). All maternal COVID-19 positive results were from first trimester. Placental weights ranged from 312 to 897 grams (m = 594). All cases showed increased peri-villous fibrin deposition with 3 showing extensive fibrin. Ten cases had infarctions and 2 with extensive infarctions (>15% of placenta). Five cases had increased syncytial knotting. Our results support that placental pathology from early maternal gestational COVID-19 infection is associated with maternal pro-coagulopathic state, not fetal or ‘placental’ infection.
Keywords:COVID-19; Gestational Infection; Pregnancy; Coagulopathy
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