Histopathological Study of Placenta in COVID-19 Positive Mothers in a Tertiary Care Hospital, South Kerala

Abstract

BACKGROUND The coronavirus disease 2019 (Covid-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is a global public health emergency. Data on the effect of coronavirus disease 2019 in pregnancy is limited to few case series. The purpose of this study was to describe the histopathological findings in the placentas of women with Covid-19 during pregnancy. METHODS Pregnant women with Covid-19 who delivered between August 1, 2020 and May 10, 2021, at Government Medical College, Trivandrum were considered for the study. Handling of specimens were carried out using Indian council of medical research (ICMR) guidelines for Covid-19 specimens. Placentas underwent routine clinical examination and processing. Clinical information was retrieved from the medical records. Histological examination was performed and features classified into maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM). RESULTS 50 placentas from patients with severe acute respiratory syndrome coronavirus 2 were examined [33 patients delivered at term, 12 patients were preterm, 4 cases were intrauterine fetal demise and 1 case was medical termination of pregnancy (MTP)]. Patients with risk factors for maternal and fetal vascular malperfusion were excluded. 8 cases showed features of maternal vascular malperfusion and 11 cases showed features of fetal vascular malperfusion. Among intra uterine fetal death (IUFD) cases, 2 cases showed features of vascular malperfusion, 7 cases showed low grade acute inflammatory pathology which needs further studies with a greater number of cases to establish relationship with Covid-19 virus. CONCLUSIONS Covid-19 placentas showed increased rates of maternal and fetal vascular malperfusion. These changes may reflect a hypercoagulable state influencing placental pathology and hence an increased antenatal surveillance for women diagnosed with SARS–CoV-2 infection may be warranted. Further studies with control groups are necessary to determine the reproducibility and significance of these initial findings. KEYWORDS Covid-19, Pregnancy, Maternal Vascular Malperfusion, Fetal Vascular Malperfusion.