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COVID-19 Infection and Placental Histopathology in Women Delivering at Term

  • PATBERG, Elizabeth T.1
  • ADAMS, Tracy1
  • REKAWEK, Patricia1
  • VAHANIAN, Sevan A.1
  • AKERMAN, Meredith2
  • HERNANDEZ, Andrea3
  • RAGOLIA, Louis2
  • SICURANZA, Genevieve1
  • CHAVEZ, Martin R.1
  • VINTZILEOS, Anthony M.1
  • KHULLAR, Poonam3
  • 1 Department of Obstetrics and Gynecology, NYU Langone Health, NYU Winthrop Hospital, NYU Long Island School of Medicine. 259 First Street, Mineola, NY 11501
  • 2 Department of Foundations of Medicine, NYU Langone Health, NYU Winthrop Hospital, NYU Long Island School of Medicine. 101 Mineola Boulevard, Suite 3-041, Mineola, NY 11501
  • 3 Department of Pathology, NYU Langone Health, NYU Winthrop Hospital, NYU Long Island School of Medicine. 222 Station Plaza North, Suite 618, Mineola, NY 11501
Published Article
American Journal of Obstetrics and Gynecology
Elsevier Inc.
Publication Date
Oct 19, 2020
DOI: 10.1016/j.ajog.2020.10.020
PMID: 33091406
PMCID: PMC7571377
PubMed Central


Background – There is a paucity of data describing the effects of COVID-19, especially in asymptomatic patients, on placental pathology. Although the pathophysiology of COVID-19 is not completely understood, there is emerging evidence that it causes a severe systemic inflammatory response and results in a hypercoagulable state with widespread microthrombi. We hypothesized that it is plausible that a similar disease process may occur in the fetal-maternal unit. Objective – The aim of this study was to determine whether COVID-19 in term patients admitted to Labor and Delivery, including women without COVID-19 symptomatology, is associated with increased placental injury compared to a cohort of COVID-19 negative controls. Study Design – This was a retrospective cohort study performed at NYU Winthrop Hospital between 3/31/2020 and 6/17/2020. During the study period all women admitted to Labor and Delivery were routinely tested for SARS-CoV-2 regardless of symptomatology. The placental histopathological findings of COVID-19 patients (n=77) who delivered a singleton gestation at term were compared to a control group of term patients without COVID-19 (n=56). Controls were excluded if they had obstetric or medical complications including fetal growth restriction, oligohydramnios, hypertension, diabetes, coagulopathy or thrombophilia. Multivariable logistic regression models were performed for variables that were significant in univariable analyses. A subgroup analysis was also performed comparing asymptomatic COVID-19 cases to negative controls. Results – In univariable analyses, COVID-19 cases were more likely to have evidence of fetal vascular malperfusion, i.e. presence of avascular villi and/or mural fibrin deposition (32.5% (25/77) vs. 3.6% (2/56), p<0.0001) and villitis of unknown etiology (20.8% (16/77) vs. 7.1% (4/56), p=0.030). These findings persisted in a subgroup analysis of asymptomatic COVID-19 cases compared to COVID-19 negative controls. In a multivariable model adjusting for maternal age, race/ethnicity, mode of delivery, preeclampsia, fetal growth restriction and oligohydramnios, the frequency of fetal vascular malperfusion abnormalities remained significantly higher in the COVID-19 group (OR= 12.63, 95% CI [2.40, 66.40]). While the frequency of villitis of unknown etiology was more than double in COVID-19 cases compared to controls, this did not reach statistical significance in a similar multivariable model (OR=2.11, 95% CI [0.50, 8.97]). All neonates of mothers with COVID-19 tested negative for SARS-CoV-2 by PCR. Conclusions – Despite the fact that all neonates born to mothers with COVID-19 were negative for SARS-CoV-2 by PCR, we found that COVID-19 in term patients admitted to Labor and Delivery is associated with increased rates of placental histopathologic abnormalities, particularly fetal vascular malperfusion and villitis of unknown etiology. These findings appear to occur even among asymptomatic term patients.

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