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Researchers from CLÍNIC-IDIBAPS, Vall d'Hebron University Hospital and Parc Taulí in Sabadell have shown the damage caused by the infection of the SARS-CoV-2 in the placentas of about 200 pregnant women. A study led by Dr. Alfons Nadal, from the Pathological Anatomy Service of the Hospital Clínic and member of the group of Inflammatory Molecular Pathology and Solid Tumors of IDIBAPS, has demonstrated the fatal effect on fetuses that COVID-19 has had in a group of pregnant women between 24 and 39 years old.
At thestudy other Catalan pediatric pathologists have participated (Drs. Marta Garrido, Jessica Camacho i Alexandra Navarro, from Vall d'Hebron University Hospital i Dr. Joan Carles Ferreres, from Parc Taulí University Hospital) and professionals from the obstetrics and microbiology services of the three centers and has recently been published in the journal Modern Pathology. At Parc Taulí, the study was also led by Dra. Marina Alguacil, of Laboratory, and by Dra. Anna Moreno, from the Obstetrics Service.
The study analyzes about 200 cases of pregnant women who became infected with COVID-19 in pregnancy, provided between the three hospitals. In total, 9 cases of SARS-CoV-2-infected placenta were demonstrated, and in 5 of them there was intrauterine death of the fetus. All the cases analyzed had a pregnancy within normal and no other causes were identified that could end in the death of the fetus. Fortunately, placental involvement is very uncommon (4.5% of pregnant women who have suffered from COVID-19, according to this series), and fetal deaths attributable to this involvement are only about 2.5%. The participation of Vall d'Hebron University Hospital in its role as a reference center for gestational COVID-19 has been key in this work to provide power to this research.
The study shows that placental tissue infection is accompanied by a characteristic lesion that consists of necrosis of the trophoblast, a layer of cells that provides nutrients from the mother to the fetus inside the uterus, and collapse of the intervillous space, that is, each of the cavernous spaces of the placenta located between the chorionic villi and occupied by maternal blood. This damage to the trophoblast points to a new complication of COVID-19. This condition explains why the placenta is no longer spongy, much harder and is damaged to the point of causing, in some cases, the death of the fetus.
The placenta is the first organ to form in fetal development. It acts as the lungs, intestines, kidneys and liver of the fetus, obtaining oxygen and nutrients from the mother's bloodstream. It is also responsible for many of the hormonal changes within the mother’s body.
The pathologists of the study argue that “the study shows the damage caused by COVID-19 in the placenta. We had never seen these lesions in such damaged placentas and there were no references because it is a new disease.
Diffuse trophoblast damage is the hallmark of SARS-CoV-2 associated fetal demise. (Modern Pathology)
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