Placental pathologies and fetal outcome in pregnant women with COVID-19: A retrospective study

Objective:To describe histopathologic findings in the placentas in women with coronavirus disease 2019(COVID-19)during pregnancy.Methods:In a cross-sectional study,38 pregnant women with COVID-19 and undergoing delivery between March 2020 and January 2022,were included.The patients had positive polymerase chain reaction(PCR)test for SARS-CoV-2 infection and the placentas after delivery were sent for histopathologic evaluation based on the Amsterdam Placental Workshop Group Consensus Statement and assessed by two pathologists.Results:Our results showed that maternal vascular malperfusion was the most common and was present in 17 cases(44.7%).These features included accelerated villous maturation(36.8%)distal villous hypoplasia(5.3%),placental infarction(5.3%)and intervillous fibrin deposition(10.5%).Other pathologic findings included focal calcification(10.5%),intravillous congestion and hemorrhage(10.5%),sub-chorionic hemorrhage(5.3%),acute villitis,chronic histiocytic intervillositis and delayed villous maturation each in one case(2.6%).Twelve out of 38 cases showed no significant pathologic changes.Fetal outcomes included neonatal intensive care unit admission rate of 13.2%,dyspnea 31.6%,newborn’s anosmia 7.9%,intrauterine fetal demise 2.6%,asphyxia 2.6%and neonate COVID infection 5.3%.Conclusions:Microvasculopathy,as a sign of maternal vascular malperfusion,is a common finding in placentas from SARS-CoV-2 positive pregnant women in the present study.Further studies with larger sample sizes and comparative studies between COVID-19 positive and negative,as well as information from patient follow-up are suggested.