SARS-CoV-2 Placentitis, Stillbirth and Maternal COVID-19 Vaccination: Clinical-Pathological Correlations

Authors

David A. Schwartz, Perinatal Pathology Consulting, Atlanta, GA. Electronic address: davidalanschwartz@gmail.com.
Sarah B. Mulkey, Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Drucilla J. Roberts, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Document Type

Journal Article

Publication Date

10-10-2022

Journal

American journal of obstetrics and gynecology

DOI

10.1016/j.ajog.2022.10.001

Keywords

COVID-19 in pregnancy; COVID-19 vaccine; SARS-CoV-2 placentitis; massive perivillous fibrin deposition; maternal vaccination; maternal viremia; maternal-fetal tolerance; perinatal death; placental insufficiency; placental malperfusion; placental pathology; stillbirth; stillbirth prevention

Abstract

Stillbirth is a recognized complication of COVID-19 in pregnant women that has recently been demonstrated to be caused by SARS-CoV-2 infection of the placenta. Multiple global studies have found that the placental pathology findings present in cases of stillbirth consists of a combination of concurrent destructive findings that include increased fibrin deposition which typically reaches the level of massive perivillous fibrin deposition, chronic histiocytic intervillositis and trophoblast necrosis. These three pathological lesions, collectively termed SARS-CoV-2 placentitis, can cause severe and diffuse placental parenchymal destruction that can affect greater than 75% of the placenta, effectively rendering the placenta incapable of performing its function of oxygenating the fetus and leading to stillbirth and neonatal death via malperfusion and placental insufficiency. Placental infection and destruction can occur in the absence of demonstrable fetal infection. Development of SARS-CoV-2 placentitis is a complex process that may have both an infectious and immunological basis. An important observation is that in all reported cases of SARS-CoV-2 placentitis causing stillbirth and neonatal death the mothers were unvaccinated. SARS-CoV-2 placentitis is likely the result of an episode of SARS-CoV-2 viremia at some time during the pregnancy. This article discusses clinical and pathological aspects of the relationship between maternal COVID-19 vaccination, SARS-CoV-2 placentitis and perinatal death.

APA Citation

Schwartz, David A.; Mulkey, Sarah B.; and Roberts, Drucilla J., "SARS-CoV-2 Placentitis, Stillbirth and Maternal COVID-19 Vaccination: Clinical-Pathological Correlations" (2022). GW Authored Works. Paper 1792.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1792

Department

Neurology