Maternal COVID-19 causing intrauterine foetal demise with microthrombotic placental insufficiency: a case report

BackgroundPregnant women have an increased risk of getting infected with SARS-CoV-2 and are more prone to severe illness. Data on foetal demise in affected pregnancies and its underlying aetiology is scarce and pathomechanisms remain largely unclear.CaseHerein we present the case of a pregnant woman with COVID-19 and intrauterine foetal demise. She had no previous obstetric or gynaecological history, and presented with mild symptoms at 34 + 3 weeks and no signs of foetal distress. At 35 + 6 weeks intrauterine foetal death was diagnosed. In the placental histopathology evaluation, we found inter- and perivillous fibrin depositions including viral particles in areas of degraded placental anatomy without presence of viral entry receptors and SARS-CoV-2 infection of the placenta.ConclusionThis case demonstrates that maternal SARS-CoV-2 infection in the third trimester may lead to an unfavourable outcome for the foetus due to placental fibrin deposition in maternal COVID-19 disease possibly via a thrombogenic microenvironment, even when the foetus itself is not infected. Symptomatic COVID-19 of the mother may cause microthrombotic events in the placenta.These microthrombotic events may lead to placental insufficiency and reduced growth velocity.Further systematic clinical studies investigating the thrombogenic effect of a SARS-CoV-2 infection in pregnancy are warranted.Although a single case report, the findings support previous concerns about placental insufficiency after SARS-CoV-2 infection.This report adds to existing literature and could help support recommendations for additional antenatal testing in similar settings.

Automated summary

Pregnant women infected with SARS-CoV-2 may experience adverse outcomes for their fetus, as exemplified by this case of intrauterine fetal demise. Maternal COVID-19 in the third trimester can lead to placental fibrin deposition and microthrombotic events, causing placental insufficiency and reduced growth velocity. Further research is needed to investigate the thrombogenic effects of SARS-CoV-2 infection in pregnancy.