doppler in pregnant women with severe covid- placental
TRANSCRIPT
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Placental histology and umbilical arterydoppler in pregnant women with severe COVID-
19
V Vannevel (1,2,3), C Wright (4,5), T Hlongwane (1,2,3), U Feucht (1,2,6), P Soma-Pillay(1,2,3), S Adam (3), D Fosu-Amoah (1,2), H Van Deventer (5), M Venter (7), A Mendes
(7), M Coetzee (6), J Cloete (6), C Chasela (8,9), R Pattinson (1,2,3)
(1) Research Centre for Maternal, Fetal, Newborn & Child Health, University of Pretoria (2) SAMRCMaternal and Infant Health Care Strategies Unit, Pretoria, South Africa (3) Dept of Obstetrics and
Gynaecology, University of Pretoria (4) Division of Anatomical Pathology, Faculty of Health Sciences,University of the Witwatersrand, Johannesburg, South Africa (5) Lancet Laboratories, Johannesburg, South
Africa (6) Dept of Paediatrics, University of Pretoria (7) Zoonotic Arbo and Respiratory virus researchgroup, Centre for Viral Zoonosis, Dept of Medical Virology, University of Pretoria (8) Right To Care,
Centurion, South Africa (9) Dept of Epidemiology and Biostatistics, School of Public Health, Faculty ofHealth Sciences, University of the Witwatersrand, Johannesburg, South Africa
PRESENTED AT:
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BACKGROUNDCOVID-19 is known to in-part be a vascular disease.
SARS-CoV-2 has been shown to affect the placenta, and varied histological pictures have been described.
Vascular placental disease leads to reduced placental blood flow, and increases the resistance of blood flow inthe placenta. This can be detected by increased resistance indices measured by doppler ultrasound.
Study aim: To investigate associations between severe COVID-19 disease in pregnancy, abnormalities in thedoppler ultrasound of the fetal umbilical artery (UA), and placental histology.
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STUDY DESIGN AND METHODSSingle centre, facility-based prospective cohort study.
Target sample size is 30 women.
Inclusion criteria:Singleton pregnancies
Gestational age (GA) ≥ 28 weeks
Severe COVID-19 (need for hospital admission)
Exclusion criteria:No informed consent available
Minors
Study procedures:Doppler UA ultrasound on COVID-19 admission and during further antenatal visits (if applicable)
SARS-CoV-2 polymerase chain reaction (PCR) on repeat nasopharyngeal (NP) swab at time ofdelivery (if initial positive swab ≥14 days prior)
SARS-CoV-2 PCR on fresh placental samples
SARS-CoV-2 serology on maternal blood
Placental histology
Neonatal blood gas (if possible)
Cardiotocography (CTG) (if available)
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RESULTSCurrent recruitment: 10 participants
Mean age: 33.4 years
Nulliparous: 1 woman
Mean GA (at COVID-19 disease): 32 weeks
Delivery: 2 at time of COVID-19 admission, 8 discharged and delivered later
UA doppler1 on admission: normal
6 during further antenatal follow-up: 50% (3/6) had an abnormal resistance index (≥ 75th centile for theirGA)
Delivery:Mean GA: 37 weeks
COVID-19 and delivery: mean interval of 36 days
All available CTGs (n=6) normal
All babies were born alive
Mean birthweight: 2780 grams
SARS-CoV-2:
Placental biopsies: all negative (n=8)
Maternal serology: positive in 78% (7/9)
Repeat NP swab: 1x positive (71 days after initial positive test); 1x indeterminate
Placental histology (n=10)
Fetal vascular malformation (FVM) x6
However: marginal umbilical cord insertion x3 (may also be associated with FVM)
Maternal vascular malperfusion (MVM) x4
However: maternal hypertensive disease x2 (may also cause MVM)
Retroplacental haemorrhage (RPH) x6
Abruptio x1 (in woman with hypertension)
Premature prelabour rupture of membranes (delivery at 34 w by caesarean section) x1
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TABLE AND IMAGESThe table shows the results case by case.
Figure 1: FVM
A: FVM - Intramural fibrin deposition. H and E X 200
B: FVM - Thrombosis in stem villous vessel. H and E x 200
Figure 2: MVM
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A: MVM - Decidual arteriopathy. H and E x 100
B: MVM - Perivillous fibrin and distal villous hypoplasia. H and E x 100
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CONCLUSION FVM found in 6 placentas
3 likely due to SARS-CoV-2 (no other risk factors)
Other 3 possibly related to SARS-CoV-2, but also umbilical cord abnormalities
One woman was admitted with COVID-19 at 31 weeks' gestation, developed an abnormal UA doppler duringfurther antenatal follow-up and delivered a healthy neonate at term. Her placenta showed both MVM (withouthypertension) and FVM (without cord abnormalities).
Study results may indicate need to screen pregnant women with COVID-19 with doppler ultrasound
Study still ongoing to increase sample size
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