Merriel, Abi 
ORCID: 0000-0003-0352-2106, Fitzgerald, Brendan ORCID: 0000-0002-8509-088X and O'Donoghue, Keelin
(2024)
SARS-CoV-2-Placental effects and association with stillbirth.
BJOG : an international journal of obstetrics and gynaecology, 131 (4).
pp. 385-400.
Abstract
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 which 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 identify quickly such a phenomenon and provide clinicians with clear guidance for reducing fetal death and associated poor outcomes. While 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. As a placental condition with an infectious aetiology, SARS-CoV-placentitis is unlikely to recur in a subsequent pregnancy and thus a measured approach to subsequent pregnancy management is needed.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Placenta, Humans, Pregnancy Complications, Infectious, Chorioamnionitis, Pregnancy, Female, Stillbirth, Infectious Disease Transmission, Vertical, Pandemics, COVID-19, SARS-CoV-2, COVID-19 Testing |
| 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: | 18 Dec 2023 14:46 |
| Last Modified: | 09 Mar 2024 01:52 |
| DOI: | 10.1111/1471-0528.17698 |
| Open Access URL: | https://doi.org/10.1111/1471-0528.17698 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3177504 |
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