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      Placental pathology from COVID-19 recovered (non-acute) patients

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          Abstract

          Placental pathology can identify characteristic features of specific infectious pathogens. The histopathology of acute SARS-CoV-2 placental infection and exposure without infection has been well described. However, whether the characteristic placental pathology persists after the acute phase of the infection is less clear. We retrospectively identified 67 COVID-19 recovered pregnant patients who had placental pathology available. After reviewing the gross and histopathology we categorized the findings and studied the placentas for evidence of chronic infection by immunohistochemistry for the Spike protein of the virus. We found these placentas showed significantly increased prevalence of maternal and fetal vascular malperfusion when compared to a control group of placentas examined for the sole indication of maternal GBS colonization. None of the COVID-19 recovered placentas showed expression of the viral protein, therefore we found no evidence of persistent infection of the placenta in women with a history of COVID-19 during their pregnancy... We conclude that recovery from a SARS-CoV-2 infection during pregnancy puts the pregnancy at risk for specific pathology.

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          Sampling and Definitions of Placental Lesions: Amsterdam Placental Workshop Group Consensus Statement.

          -The value of placental examination in investigations of adverse pregnancy outcomes may be compromised by sampling and definition differences between laboratories.
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            Placental Pathology in COVID-19

            Abstract Objectives To describe histopathologic findings in the placentas of women with coronavirus disease 2019 (COVID-19) during pregnancy. Methods Pregnant women with COVID-19 delivering between March 18, 2020, and May 5, 2020, were identified. Placentas were examined and compared to historical controls and women with placental evaluation for a history of melanoma. Results Sixteen placentas from patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were examined (15 with live birth in the third trimester, 1 delivered in the second trimester after intrauterine fetal demise). Compared to controls, third trimester placentas were significantly more likely to show at least one feature of maternal vascular malperfusion (MVM), particularly abnormal or injured maternal vessels, and intervillous thrombi. Rates of acute and chronic inflammation were not increased. The placenta from the patient with intrauterine fetal demise showed villous edema and a retroplacental hematoma. Conclusions Relative to controls, COVID-19 placentas show increased prevalence of decidual arteriopathy and other features of MVM, a pattern of placental injury reflecting abnormalities in oxygenation within the intervillous space associated with adverse perinatal outcomes. Only 1 COVID-19 patient was hypertensive despite the association of MVM with hypertensive disorders and preeclampsia. These changes may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology.
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              Is Open Access

              Placental Pathology in Covid-19 Positive Mothers: Preliminary Findings

              This study describes the pathology and clinical information on 20 placentas whose mother tested positive for the novel Coronovirus (2019-nCoV) cases. Ten of the 20 cases showed some evidence of fetal vascular malperfusion or fetal vascular thrombosis. The significance of these findings is unclear and needs further study.
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                Author and article information

                Journal
                Hum Pathol
                Hum Pathol
                Human Pathology
                Published by Elsevier Inc.
                0046-8177
                1532-8392
                9 April 2022
                9 April 2022
                Affiliations
                [a ]James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
                [b ]Deborah Kelly Center for Clinical Research, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
                [c ]Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
                Author notes
                []Corresponding author. Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 , 617-724-1415.
                Article
                S0046-8177(22)00084-3
                10.1016/j.humpath.2022.04.005
                8993452
                35405186
                474d6616-5240-4002-8b01-f54fc3fecf74
                © 2022 Published by Elsevier Inc.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 7 March 2022
                : 1 April 2022
                : 4 April 2022
                Categories
                Original Contribution

                Pathology
                covid-19,placenta,maternal vascular malperfusion,fetal vascular malperfusion
                Pathology
                covid-19, placenta, maternal vascular malperfusion, fetal vascular malperfusion

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