Lung Lesions in 4 Pregnant Women with Severe COVID-19 - Autopsy Case

Abstract

Currently, there are only scarce data on pulmonary COVID-19 lesions in pregnant women in the literature although the disease hasn't spared any country. This study aimed to provide insight into this issue. We carried out a retrospective analysis of the clinical data, autopsy, and microscopic findings in 4 pregnant women with severe COVID-19. Patients were admitted 4-5 days after COVID-19 onset with fever, dry cough, and reduced saturation. Positive SARSCoV2 nasopharyngeal swab PCRs were obtained. Chest CT revealed bilateral 'ground glass' pneumonia, CT 3-4. The women were diagnosed with severe COVID-19 requiring ALV and ECMO. They underwent emergent C-section with subsequent therapy. Patient 1, 37 y.o., 28-29 gestation weeks (GW), had comorbid conditions-obesity and arterial hypertension, died on the 11th bed-day (BD) due to pulmonary embolism. Patient 2, 31 y.o., 27 GW, developed bacterial pneumonia and acute pansinusitis with multiple organ failure resulting in death on 15th BD. Patient 3, 22 y.o., 35 GW, had ventilatorassociated pneumonia, lymphopenia, thrombocytopenia, anemia, and phlebothrombosis as COVID-19 complications. Later, she developed sepsis, which resulted in a lethal outcome (on 26th BD). Patient 4, 38 y.o., 32 GW, was diagnosed with pneumothorax on the 10th BD requiring pleural cavity drainage. The disease was complicated by bacterial pneumonia leading to respiratory failure and death (on the 30th BD). At autopsy, all four women had 'shock lungs' and diffuse alveolar damage at microscopy. Microscopic evaluation of the 1st patient's lung specimens revealed hyaline membranes corresponding to exudative DAD phase combined with proliferative DAD signs. In the 2nd case, we observed a pronounced cytopathic effect resulting in 'ugly' multinucleated cell formation, and multiple hemosiderophages in the alveolar lumens, as well as alveolar and bronchial metaplasia, confirmed by positive CK5-6 IHC staining. Third patient lung specimens demonstrated organizing viral pneumonia (with interalveolar granulation tissue, numerous interalveolar siderophages, indicating an alveolar-hemorrhagic syndrome) combined with massive bacterial pneumonia. Organizing viral pneumonia with mature interalveolar granulation tissue and sarcoid-like granulomas was diagnosed in 4 patient. Clinical and morphological analysis demonstrated that COVID-19 pneumonia features are similar for pregnant and non-pregnant patients of the same age group. The proliferative DAD phase was detected in three of 4 cases. However, of special interest is the first case, in which a combination of DAD phases was determined. At the same time, no severe obstetric complications were identified, which we associate with the timely diagnosis and prevention measures.