Scientific Online Resource System

Scripta Scientifica Medica

Stillbirth in the third trimester in a mother with type 1 diabetes mellitus and COVID-19: an autopsy and histopathology case report of the fetus and placenta

George St. Stoyanov, Deyan Dzhenkov, Lilyana Petkova

Abstract

Ever since the emergence of the novel coronavirus disease in 2019 (COVID-19), there have been multiple reports on its effect on maternal health. Recently there have also been reports on fetal risk and placental changes. Herein we report the placental and fetal finding in a 19-year-old Caucasian female with type 1 diabetes and COVID-19, who suffered a spontaneous miscarriage in the 35th gestational week. No specific virus-induced changes in the fetus were observed, with the only pathological changes being the aspiration of amniotic fluid and asymmetry in height and weight. Placental and umbilical histopathology showed chorangiosis, chorionic villi edema, increased fibrinoid deposition, increased syncytial knots, thrombi with organization, and recanalization in subamniotic blood vessels as well as umbilical thrombosis. All these changes point towards increased placental aging, which is likely to be a result of the infection aggravating the mother's condition and not directly damaging the placenta and fetus itself.


Keywords

COVID-19, placenta, fetus, histopathology, chorangiosis, syncytial knots

Full Text


References

Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. Reprod Health. 2021; 18:10. doi: 10.1186/s12978-021-01070-6.

Soheili MM, Moradi G, Baradaran HR, Soheili MM, Mokhtari MM, Moradi Y. Clinical manifestation and maternal complications and neonatal outcomes in pregnant women with COVID-19: a comprehensive evidence synthesis and meta-analysis. J Matern Neonatal Med. 2021; online ahead of print. doi: 10.1080/14767058.2021.1888923.

Zwart JJ, Richters JM, Öry F, De Vries JIP, Bloemenkamp KWM, Van Roosmalen J. Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: A nationwide population-based study of 371 000 pregnancies. BJOG An Int J Obstet Gynaecol. 2008; 115(7):842–50. doi: 10.1111/j.1471-0528.2008.01713.x.

Takemoto MLS, Menezes MO, Andreucci CB, Knobel R, Sousa LAR, Katz L, et al. Maternal mortality and COVID-19. J Matern Neonatal Med. 2020; 1-7. online ahead of print. doi: 10.1080/14767058.2020.1786056.

Sriwijitalai W, Wiwanitkit V. Comparative nanostructure consideration on novel coronavirus and possibility of transplacental transmission. Am J Obstet Gynecol. 2020; 223(6):955. doi: 10.1016/j.ajog.2020.08.061.

Wiwanitkit V. Covid-19, villitis and placenta in pregnancy. Turkish J Pathol. 2021; Online ahead of print. doi: 10.5146/tjpath.2020.01520.

Bar-On YM, Flamholz A, Phillips R, Milo R. Sars-Cov-2 (Covid-19) by the numbers. Elife. 2020; 9:e57309. doi: 10.7554/eLife.57309.

Laue M, Kauter A, Hoffmann T, Möller L, Michel J, Nitsche A. Morphometry of SARS-CoV and SARS-CoV-2 particles in ultrathin plastic sections of infected Vero cell cultures. Sci Rep. 2021; 11(1):3515. doi: 10.1038/s41598-021-82852-7.

Ozer E, Cagliyan E, Yuzuguldu RI, Cevizci MC, Duman N. Villitis of unknown etiology in the placenta of a pregnancy complicated by COVID-19. Turkish J Pathol. 2021; 37(2):167-71. doi: 10.5146/tjpath.2020.01506.

Shanes ED, Mithal LB, Otero S, Azad HA, Miller ES, Goldstein JA. Placental Pathology in COVID-19. Am J Clin Pathol. 2020; 154(1):23–32. doi: 10.1093/ajcp/aqaa089.

Gao L, Ren J, Xu L, Ke X, Xiong L, Tian X, et al. Placental pathology of the third trimester pregnant women from COVID-19. Diagn Pathol. 2021; 16(8):1–11. doi: 10.1186/s13000-021-01067-6.

Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013; 13(59):1–13. doi: 10.1186/1471-2431-13-59.

Cui J, Schlub TE, Holmes EC. An allometric relationship between the genome length and virion volume of viruses. J Virol. 2014; 88(11):6403–10. doi: 10.1128/JVI.00362-14.

Vivanti AJ, Vauloup-Fellous C, Prevot S, Zupan V, Suffee C, Do Cao J, et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020; 11(1):1–7. doi: 10.1038/s41467-020-17436-6.

Vafaei H, Karimi Z, Akbarzadeh-Jahromi M, Asadian F. Association of placental chorangiosis with pregnancy complication and prenatal outcome: a case-control study. BMC Pregnancy Childbirth. 2021; 21(1):1184–7. doi: 10.1186/s12884-021-03576-0.

Kelehan P, Downey P. Villous oedema. In: Pathology of the Placenta. Springer International Publishing; 2019. pp. 153–5. doi: 10.1007/978-3-319-97214-5_21.

Kaufmann P, Huppertz B, Frank HG. The fibrinoids of the human placenta: Origin, composition and functional relevance. Ann Anat. 1996; 178(6):485–501. doi: 10.1016/S0940-9602(96)80102-6.

Loukeris K, Sela R, Baergen RN. Syncytial knots as a reflection of placental maturity: Reference values for 20 to 40 weeks' gestational age. Pediatr Dev Pathol. 2010; 13(4):305–9. doi: 10.2350/09-08-0692-OA.1.

Nelson SM, Coan PM, Burton GJ, Lindsay RS. Placental structure in type 1 diabetes: Relation to fetal insulin, leptin, and IGF-I. Diabetes. 2009; 58(11):2634–41. doi: 10.2337/db09-0739.

Huynh J, Dawson D, Roberts D, Bentley-Lewis R. A systematic review of placental pathology in maternal diabetes mellitus. Placenta. 2015; 36(2):101–14. doi: 10.1016/j.placenta.2014.11.021.

Buckley T, Singh N, Shertz W. Placental pathology in COVID-19: Case series in a community hospital setting. Cureus. 2021; 13(1):e12522. doi: 10.7759/cureus.12522.




DOI: http://dx.doi.org/10.14748/ssm.v54i2.8152
About The Authors

George St. Stoyanov
Medical University of Varna
Bulgaria

Department of General and Clinical Pathology, Forensic Medicine and Deontology

Deyan Dzhenkov
Medical University of Varna

Department of General and Clinical Pathology, Forensic Medicine and Deontology

Lilyana Petkova
Medical University of Varna

Department of General and Clinical Pathology, Forensic Medicine and Deontology

Font Size


|