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

Abstract

Background Pregnant 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.Case Herein 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.Conclusion This 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.