Merriel, Abi 
ORCID: 0000-0003-0352-2106, Fitzgerald, Brendan and ODonoghue, Keelin
(2023)
SARS-CoV-2 -- placental effects and association with stillbirth.
[Preprint]
Abstract
<jats:p id="p1">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.</jats:p>
| Item Type: | Preprint |
|---|---|
| Uncontrolled Keywords: | Infectious Diseases, Pediatric, Vaccine Related, Emerging Infectious Diseases, Conditions Affecting the Embryonic and Fetal Periods, Prevention, Biodefense, Reproductive health and childbirth, 3 Good Health and Well Being |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 20 Oct 2023 10:45 |
| Last Modified: | 17 Mar 2024 17:05 |
| DOI: | 10.22541/au.168720306.61380379/v1 |
| Open Access URL: | http://dx.doi.org/10.22541/au.168720306.61380379/v... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3174620 |
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