Analysis of Placenta with SARS-CoV-2 and Fetal Death: Case Report

Abstract

Introduction: The pandemic of the new coronavirus (SARS-CoV-2) has unfolded at a remarkable speed, presenting unprecedented challenges for society and for health systems. The experience with coronavirus infections during pregnancy is still limited, requiring analysis regarding the impact of SARSCoV-2 on the health of pregnant women and newborns. We aimed to report a case of fetal death of a pregnant woman with COVID-19 and SARS-CoV-2 identified in the placenta with morphological repercussions.

Case Report: Primigravida, 39 years old, gestation initially twinned, evolved non-evolution of the second embryo, verified in ultrasound evaluation in
the first trimester of pregnancy. In the course of 35 weeks, she reported watery diarrhea, without blood or mucus, with progressive worsening, about 10 to 12 episodes in 24 hours, associated with diffuse colicky abdominal pain. She denies having other symptoms. 48 hours after the onset of diarrhea, the pain worsened, radiating bilaterally into the lumbar region, in addition to prostration and asthenia, seeking emergency care at a maternity hospital. Physical examination revealed active labor (9 cm dilation), rupture of ovular membranes and lack of fetal vitality by cardiac auscultation and evaluation of fetal movement. A cesarean section was performed, in which fetal death was confirmed. Soon after the procedure, still in the delivery room, a naso-oropharyngeal swab was collected from the patient, and SARS-CoV-2 was detected through RT-PCR technique.

Conclusion: The maternal surface of the placenta had an area of previous infarction and an area of recent infarction, peripheral, making up about 20% of the organ and the placental cuts showed white bundles. The fetal membranes had thickened and yellowish areas. Histopathological examination of the placenta showed diffuse villitis, characterized by lymphoplasmacytic infiltrate, in addition to intervillositis with areas of intense intervillous fibrin deposition. Swab collection was performed from the placental cut surface for detection of SARS-CoV-2 by RT-PCR, which was positive. The naso-oropharyngeal swab of the fetus was negative.