doppler in pregnant women with severe COVID- Placental ...

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Placental histology and umbilical arterydoppler in pregnant women with severe COVID-

19

V Vannevel (1,2,3), C Wright (4,5), T Hlongwane (1,2,3), U Feucht (1,2,6), P Soma-Pillay(1,2,3), S Adam (3), D Fosu-Amoah (1,2), H Van Deventer (5), M Venter (7), A Mendes

(7), M Coetzee (6), J Cloete (6), C Chasela (8,9), R Pattinson (1,2,3)

(1) Research Centre for Maternal, Fetal, Newborn & Child Health, University of Pretoria (2) SAMRCMaternal and Infant Health Care Strategies Unit, Pretoria, South Africa (3) Dept of Obstetrics and

Gynaecology, University of Pretoria (4) Division of Anatomical Pathology, Faculty of Health Sciences,University of the Witwatersrand, Johannesburg, South Africa (5) Lancet Laboratories, Johannesburg, South

Africa (6) Dept of Paediatrics, University of Pretoria (7) Zoonotic Arbo and Respiratory virus researchgroup, Centre for Viral Zoonosis, Dept of Medical Virology, University of Pretoria (8) Right To Care,

Centurion, South Africa (9) Dept of Epidemiology and Biostatistics, School of Public Health, Faculty ofHealth Sciences, University of the Witwatersrand, Johannesburg, South Africa

PRESENTED AT:



BACKGROUNDCOVID-19 is known to in-part be a vascular disease.

SARS-CoV-2 has been shown to affect the placenta, and varied histological pictures have been described.

Vascular placental disease leads to reduced placental blood flow, and increases the resistance of blood flow inthe placenta. This can be detected by increased resistance indices measured by doppler ultrasound.

Study aim: To investigate associations between severe COVID-19 disease in pregnancy, abnormalities in thedoppler ultrasound of the fetal umbilical artery (UA), and placental histology.



STUDY DESIGN AND METHODSSingle centre, facility-based prospective cohort study.

Target sample size is 30 women.

Inclusion criteria:Singleton pregnancies

Gestational age (GA) ≥ 28 weeks

Severe COVID-19 (need for hospital admission)

Exclusion criteria:No informed consent available

Minors

Study procedures:Doppler UA ultrasound on COVID-19 admission and during further antenatal visits (if applicable)

SARS-CoV-2 polymerase chain reaction (PCR) on repeat nasopharyngeal (NP) swab at time ofdelivery (if initial positive swab ≥14 days prior)

SARS-CoV-2 PCR on fresh placental samples

SARS-CoV-2 serology on maternal blood

Placental histology

Neonatal blood gas (if possible)

Cardiotocography (CTG) (if available)



RESULTSCurrent recruitment: 10 participants

Mean age: 33.4 years

Nulliparous: 1 woman

Mean GA (at COVID-19 disease): 32 weeks

Delivery: 2 at time of COVID-19 admission, 8 discharged and delivered later

UA doppler1 on admission: normal

6 during further antenatal follow-up: 50% (3/6) had an abnormal resistance index (≥ 75th centile for theirGA)

Delivery:Mean GA: 37 weeks

COVID-19 and delivery: mean interval of 36 days

All available CTGs (n=6) normal

All babies were born alive

Mean birthweight: 2780 grams

SARS-CoV-2:

Placental biopsies: all negative (n=8)

Maternal serology: positive in 78% (7/9)

Repeat NP swab: 1x positive (71 days after initial positive test); 1x indeterminate

Placental histology (n=10)

Fetal vascular malformation (FVM) x6

However: marginal umbilical cord insertion x3 (may also be associated with FVM)

Maternal vascular malperfusion (MVM) x4

However: maternal hypertensive disease x2 (may also cause MVM)

Retroplacental haemorrhage (RPH) x6

Abruptio x1 (in woman with hypertension)

Premature prelabour rupture of membranes (delivery at 34 w by caesarean section) x1



TABLE AND IMAGESThe table shows the results case by case.

Figure 1: FVM

A: FVM - Intramural fibrin deposition. H and E X 200

B: FVM - Thrombosis in stem villous vessel. H and E x 200

Figure 2: MVM



A: MVM - Decidual arteriopathy. H and E x 100

B: MVM - Perivillous fibrin and distal villous hypoplasia. H and E x 100



CONCLUSION FVM found in 6 placentas

3 likely due to SARS-CoV-2 (no other risk factors)

Other 3 possibly related to SARS-CoV-2, but also umbilical cord abnormalities

One woman was admitted with COVID-19 at 31 weeks' gestation, developed an abnormal UA doppler duringfurther antenatal follow-up and delivered a healthy neonate at term. Her placenta showed both MVM (withouthypertension) and FVM (without cord abnormalities).

Study results may indicate need to screen pregnant women with COVID-19 with doppler ultrasound

Study still ongoing to increase sample size



REFERENCESVarga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. The Lancet. 2020; 395(10234):1417-8.

Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J

Am Coll Cardiol. 2020; 75(23):2950-73.

Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mother with 2019-nCoV pneumonia. Transl Pediatr. 2020; 9(1):51-60.

Wang X, Zhou Z, Zhang J, et al. A case of 2019 novel coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis. 2020; 71(15):844-6.

Shanes ED, Mithal LB, Otero S, et al., 2020. Placental Pathology in COVID-19. Am J Clin Pathol. 2020;154(1):23-32.

Baud D, Greub G, Favre G, et al. Second-Trimester Miscarriage in a Pregnant Woman With SARS-CoV-2 Infection. JAMA. 2020;323(21):2198-200.

Hosier H, Farhadian SF, Morotti RA, et al. SARS-CoV-2 infection of the placenta. J Clin Invest. 2020;130(9):4947-53.

Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynaecol. 2004;191(1):292–

7.

Mendoza M, Garcia-Ruiz I, Maiz N, et al. Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study. BJOG. 2020;127(11):1374-80.

Schwartz DA, Morotti D. Placental pathology of COVID-19 with and without feral and neonatal infection: trophoblast necrosis and chronic histiocytic intervillositis as

risk factors for transplacental transmission of SARS-CoV-2. Viruses. 2020;12(11):1308.

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