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SARS-CoV-2 -- placental effects and association with stillbirth
  • Abi Merriel,
  • Brendan Fitzgerald,
  • Keelin ODonoghue
Abi Merriel
University of Liverpool

Corresponding Author:[email protected]

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Brendan Fitzgerald
Cork University Hospital
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Keelin ODonoghue
University College Cork
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SARS-CoV-2 has had a significant impact on pregnancy outcomes due to the effects of the virus and the altered healthcare environment. Stillbirth has been relatively hidden during the COVID-19 pandemic, but a clear link between SARS-CoV-2 and poor fetal outcome emerged in the Alpha and Delta waves. A small minority of women/birthing people who contracted COVID-19 developed SARS-CoV-2 placentitis. In many reported cases this was linked to intrauterine fetal death, although there are cases of delivery just before imminent fetal demise and we shall discuss how some cases are sub-clinical. What is surprising, is that SARS-CoV-2 placentitis is often not associated with severe maternal COVID-19 infection, and this makes it difficult to predict. The worst outcomes seem to be with diffuse placental disease and occurs within 21 days of COVID-19 diagnosis. Poor outcomes are often pre-dated by reduced fetal movements, but are not associated with ultrasound changes. In some cases, there has also been maternal thrombocytopenia, or coagulation abnormalities, which may provide a clue as to which pregnancies are at risk of fetal demise if a further variant of concern is to emerge. In future, multidisciplinary collaboration and cross-boundary working must be prioritised, to quickly identify such a phenomenon and provide clinicians with clear guidance for reducing fetal death and associated poor outcomes. Whilst we wait to see if COVID-19 brings a future variant of concern, we must focus on appropriate future management of women who have had SARS-CoV-2 placentitis. The histopathology reports with pathologies of chronic histiocytic villositis and/or massive perivillous fibrin deposition fill clinicians with concern about future pregnancy outcomes. However, we must remember, that in the context of a cause (SARS-CoV-2) and no other history of concern, it is not likely that SARS-CoV-placentitis will recur, and thus a measured approach to subsequent pregnancy management is needed.
16 Jun 2023Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
19 Jun 2023Submission Checks Completed
19 Jun 2023Assigned to Editor
19 Jun 2023Review(s) Completed, Editorial Evaluation Pending
25 Jun 2023Reviewer(s) Assigned
11 Sep 2023Editorial Decision: Revise Minor
02 Oct 20231st Revision Received
03 Oct 2023Submission Checks Completed
03 Oct 2023Assigned to Editor
03 Oct 2023Review(s) Completed, Editorial Evaluation Pending
14 Oct 2023Editorial Decision: Accept