Acta Scientific Women's Health (ASWH)(ISSN: 2582-3205)

Research Article Volume 4 Issue 3

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.

Received: 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


  1. Wong YP., et al. “The Effects of COVID-19 on Placenta and Pregnancy: What Do We Know So Far?” Diagnostics (Basel)1 (2021): 94.
  2. Brandt JS., et al. “Epidemiology of coronavirus disease 2019 in pregnancy: Risk factors and associations with adverse maternal and neonatal outcomes”. American Journal of Obstetrics and Gynecology 4 (2020): 389.
  3. Khalil A., et al. “SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes”. E Clinical Medicine 25 (2020): 100446.
  4. Fitzgerald B., et al. “Fetal deaths in Ireland due to SARS-CoV-2 placentitis caused by SARS-CoV-2 Alpha”. Archives of Pathology and Laboratory Medicine 12 (2022).
  5. Shook LL., et al. “SARS-CoV-2 placentitis associated with B.1.617.2 (Delta) variant and foetal distress or demise”. The Journal of Infectious Diseases 13 (2022).
  6. Bloise E., et al. “Expression of Severe Acute Respiratory Syndrome Coronavirus 2 cell entry genes, angiotensin-converting enzyme 2 and transmembrane protease serine 2, in the placenta across gestation and at the maternal-foetal interface in pregnancies complicated by preterm birth or preeclampsia”. American Journal of Obstetrics and Gynecology 3 (2020): 298.
  7. Wu C., et al. “Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China”. JAMA Internal Medicine7 (2020): 934-843.
  8. Wong RS., et al. “Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis”. BMJ7403 (2003): 1358-1362.
  9. Lee N., et al. “A major outbreak of severe acute respiratory syndrome in Hong Kong”. The New England Journal of Medicine20 (2003): 1986-1994.
  10. Tang N., et al. “Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia”. Journal of Thrombosis and Haemostasis 4 (2020): 844-847.
  11. Huang C., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet 10223 (2020): 497-506.
  12. Zhou F., et al. “Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study”. Lancet10229 (2020): 1054-1062.
  13. Guan WJ., et al. “China Medical Treatment Expert Group for COVID-19. Clinical Characteristics of Coronavirus Disease 2019 in China”. The New England Journal of Medicine18 (2020): 1708-1720.
  14. Cui S., et al. “Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia”. Journal of Thrombosis and Haemostasis 6 (2020): 1421-1424.
  15. Klok FA., et al. “Incidence of thrombotic complications in critically ill ICU patients with COVID-19”. Thrombosis Research 191 (2020): 145-147.
  16. Poissy J., et al. “ICU Haemostasis COVID-19 group. Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence”. Circulation2 (2020): 184-186.
  17. Toshiaki Iba., et al. “The coagulopathy, endotheliopathy, and vasculitis of COVID‑19”. Inflammation Research12 (2020): 1181-1189.
  18. Baud D., et al. “Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection”. JAMA21 (2020): 2198-2200.
  19. Baergen RN., et al. “Placental Pathology in COVID-19 Positive Mothers: Preliminary Findings”. Pediatric and Developmental Pathology3 (2020): 177-180.
  20. Shuo C., et al. “Clinical characteristics and pathological analysis of placenta in three cases of pregnant women with novel coronavirus infection”. Chinese Journal of Pathology 5 (2020): 418-423.
  21. Shanes ED., et al. “Placental Pathology in COVID-19”. American Journal of Clinical Pathology1 (2020): 23-32.
  22. Facchetti F., et al. “SARS-CoV-2 vertical transmission with adverse effects on the new born revealed through integrated immunohistochemical, electron microscopy and molecular analyses of placenta”. E Bio Medicine 59 (2020): 102951.
  23. Menter T., et al. “Placental pathology findings during and after SARS-CoV-2 infection: Features of villitis and malperfusion”. Pathobiology1 (2020): 69-77.
  24. Lokken EM., et al. “Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington state”. American Journal of Obstetrics and Gynecology 6 (2020): 911.
  25. Hecht JL., 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”. Modern Pathology11 (2020): 2092-2103.
  26. Robbins JR. et al. “Pathogens and the placental fortress”. Current Opinion on Microbiology1 (2012): 36-43.


Citation: Paul H Hartel and Weronika Wudarczyk. “Maternal First Trimester Gestational COVID-19 Infection is Associated with Increased Placental Maternal Vascular Malperfusion, But Not Clinical Morbidity or Mortality". Acta Scientific Women's Health 4.3 (2022): 02-07.


Copyright: © 2022 Paul H Hartel and Weronika Wudarczyk. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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