SARS-CoV-2 Placentitis Associated With B.1.617.2 (Delta) Variant and Fetal Distress or Demise

Abstract

There is limited information on the specific impact of maternal infection with the SARS-CoV-2 B.1.617.2 (delta) variant on pregnancy outcomes. We present 2 cases of intrauterine fetal demise and 1 case of severe fetal distress in the setting of maternal infection with delta-variant SARS-CoV-2. In all cases, fetal demise or distress occurred within 14 days of COVID-19 diagnosis. Evaluation revealed maternal viremia, high nasopharyngeal viral load, evidence of placental infection with delta-variant SARS-CoV-2, and hallmark features of SARS-CoV-2 placentitis. We suggest that delta-variant SARS-CoV-2 infection during pregnancy warrants vigilance for placental dysfunction and fetal compromise regardless of disease severity.

Keywords: COVID-19; SARS-CoV-2 placentitis; delta variant; placental infection; pregnancy; stillbirth.

Figure 1.

Hematoxylin and eosin (A, C, and E) and SARS-CoV-2 RNA-ISH (B, D, and F) photomicrographs at 20 × original from case 1 (A and B), case 2 (C and D), and case 3 (E and F). A, C, and E, SARS-CoV-2 placentitis: histiocytic intervillositis, increased perivillous fibrin deposition, and villous trophoblast necrosis. B, D, and F, SARS-CoV-2 RNA-ISH showing positive brown particulate signal in a patchy distribution in the villous trophoblast. G, Gross slab section of the parenchyma from case 1 with pale and mottled parenchyma. Abbreviations: SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; RNA-ISH, RNA in situ hybridization.