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. 2024 Feb 2;25(3):1836.
doi: 10.3390/ijms25031836.

Prompt Placental Histopathological and Immunohistochemical Assessment after SARS-CoV-2 Infection during Pregnancy-Our Perspective of a Small Group

Daniela Eugenia Popescu  1   2 , Ioana Roșca  3 , Ana Maria Cristina Jura  1 , Andreea Cioca  4 , Ovidiu Pop  5 , Nicoleta Lungu  1 , Zoran-Laurențiu Popa  6 , Adrian Rațiu  1 , Mărioara Boia  1
Affiliations

Prompt Placental Histopathological and Immunohistochemical Assessment after SARS-CoV-2 Infection during Pregnancy-Our Perspective of a Small Group

Daniela Eugenia Popescu et al. Int J Mol Sci. .

Abstract

Research indicates compelling evidence of SARS-CoV-2 vertical transmission as a result of placental pathology. This study offers an approach to histopathological and immunohistochemical placental observations from SARS-CoV-2-positive mothers compared to negative ones. Out of the 44 examined placentas, 24 were collected from patients with a SARS-CoV-2 infection during pregnancy and 20 were collected from patients without infection. The disease group showed strong SARS-CoV-2 positivity of the membranes, trophoblasts, and fetal villous macrophages. Most infections occurred during the third trimester of pregnancy (66.6%). Pathology revealed areas consistent with avascular villi (AV) and thrombi in the chorionic vessels and umbilical cord in the positive group, suggesting fetal vascular malperfusion (FVM). This study shows SARS-CoV-2 has an impact on coagulation, demonstrated by fetal thrombotic vasculopathy (p = 0.01) and fibrin deposition (p = 0.01). Other observed features included infarction (17%), perivillous fibrin deposition (29%), intervillous fibrin (25%), delayed placental maturation (8.3%), chorangiosis (13%), chorioamnionitis (8.3%), and meconium (21%). The negative control group revealed only one case of placental infarction (5%), intervillous fibrin (5%), delayed placental maturation (5%), and chorioamnionitis (5%) and two cases of meconium (19%). Our study sheds light on the changes and differences that occurred in placentas from SARS-CoV-2-infected mothers and the control group. Further research is necessary to definitively establish whether SARS-CoV-2 is the primary culprit behind these intricate complications.

Keywords: COVID-19; SARS-CoV-2 infection; fetal; immunohistochemistry; pathology; placenta; pregnancy; vascular complications; vertical transmission.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Macroscopic image of placentas, serially sectioned, showing pale areas consistent with avascular villi; (B) thrombi in the chorionic plate vessels and stem villous vessels; (C) umbilical vein containing a thrombus.
Figure 2
Figure 2
(A) Macroscopic image of an old intervillous thrombus and (B) a recent intervillous thrombus showing angular contours and lines of Zahn.
Figure 3
Figure 3
(A) Immunohistochemistry for the SARS-CoV-2 protein showing strong positivity of the placental membranes (×10) and (B) of the trophoblast and fetal villous macrophages (×20).
Figure 4
Figure 4
(A) Massive perivillous fibrin deposition; (B) A representative field of a placenta with chorangiosis; (C) recent infarct showing collapsed villi with loss of nuclear basophilia; (D) old infarct showing pale ghosts of necrotic villi (×20, hematoxylin and eosin).
Figure 5
Figure 5
(A) Microscopic image of a nonocclusive thrombus showing a fibrin thrombus cap; (B) A field of avascular in the center of the image showing villi with eosinophilic and paucicellular stroma without capillaries (×20, hematoxylin and eosin).
See this image and copyright information in PMC

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