COVID-19 and Intrauterine Fetal Death (IUFD): Possible Immunological Causes and Pathologies

Abstract

COVID-19; The first recognized outbreak in Wuhan, China, December 2019 is considered a global threat (1,2) and its mortality rate according to WHO, ranges from 2-3% (3,4). The pregnant woman and her fetus are more susceptible to the poor outcomes of COVID-19, in which fatality rate may reach more than 35%(5,6). More than 90% of infected pregnant women suffering from pneumonia are susceptible to a miscarriage and other several adverse outcomes (4). A case report of intrauterine fetal death (IUFD) that occurred due to multiple organ dysfunction syndrome (MODS) accompanied by acute respiratory distress syndrome (ARDS) (7). A systemic review of seventeen published studies (8) reported several adverse fetal and neonatal outcomes, including stillbirth (1.2%) and fetal distress ( 10.7%). Moreover, one pregnant woman with Covid-19 had a stillbirth, delivered by the cesarean section (CS) according to Liu et al.(7). That occurred after she had a fever and a sore throat at the 34th week of gestation. Her condition worsened and needed to be transferred to the intensive care unit (ICU). The only available information about fetal and neonatal results is for women who were infected in their third trimester. It is still unknown whether the infection in the first or second trimester might increase the incidence of fetal and neonatal death(8). We will try to discuss the relation between COVID-19 and IUFD as possible complications via mentioning possible immunological mechanisms and pathologies for that via available data.