Placental Histopathology Findings during SARS-CoV-2 Infection in Haji Adam Malik General Hospital Medan Indonesia: Series of 28 Cases in 2021

Abstract

: Background: During pregnancy, SARS Coronavirus 2 infection may cause an abnormal development of the placenta, thus influencing maternal and fetal outcomes. Placental pathology in the setting of maternal SARS-CoV-2 infection remains a topic of great interest because the raising concern for vertical transmission and earlier studies have shown mixed results Objective: We present series of 28 placentas of SARS-CoV-2 positive women who had been diagnosed by RT PCR in Haji Adam Malik General Hospital as one major goverment hospital for COVID-19 management in Medan, North Sumatera, Indonesia from February-August 2021. Methods: All placentas were microscopically examined with H&E-stained sections, which usually included full-thickness sections that included fetal and maternal surfaces and one section with two umbilical cord sections and membrane rolls. Results: Pathologic findings were divided into maternal vascular malperfusion, fetal vascular malperfusion, chronic inflammatory lesions, amniotic fluid infection sequence, increased perivillous fibrin, intervillous thrombi, increased subchorionic fibrin, meconium-laden macrophages within fetal membranes, and chorangiosis. Mostly, the placentas showed prominent signs of increased fibrin deposition in perivillous and intervillous thrombus (92,9 % and 82,1%), but not many showed lymphohistiocytic villitis (10,7%) respectively, as reported in other studies. Conclusions: Limited conclusions can be drawn about the effect of maternal SARS-CoV-2 infection on placental pathology. Based on the data in this study, we report general histopathological features, which include maternal vascular malperfusion, fetal vascular malperfusion, inflammation and thrombus in placentas with COVID-19 infection. A prospective cohort study with a larger sample population with thorough placental examination is needed to understand the impact of SARS-CoV-2 on the placenta, pregnancy and possible fetal sequelae.