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(searched for: doi:10.17352/jgro.000110)
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Hartmann Beda, Rindler Lisa, Hoenigschnabl Selma
Journal of Gynecological Research and Obstetrics, Volume 8, pp 022-024; https://doi.org/10.17352/jgro.000110

Abstract:
Background: The effects of Coronavirus disease 2019 in women during the second trimester of pregnancy and the health of the fetus, remain very poorly explored. This report describes a case in which the normal development of pregnancy was complicated immediately after the patient had experienced COVID-19 at the 21st week of gestation. Specific conditions included critical blood flow in the fetal umbilical artery, fetal growth restriction and hydramnios in the 25th week of gestation. After informed consent, we decided just to wait and interrupted all examinations (CTG, Ultrasound) because of the high risk of severe adverse events at such an early premature birth. The patient finally delivered a healthy boy in the 39th week of gestation. Methods: We performed a histological examination of the placenta and analyzed the placenta for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through molecular and immunohistochemical assays and measured the fetal antibody response in the blood to this infection. Results: In the immunohistochemical examination with antibodies against SARS-CoV-2 a partial positivity in the villious throphoblastic epithel cells could be demonstrated. The PCR swab of the placenta which was obtained was positive for SARS-CoV-2 with a crossing threshold value of 22,8. The histological examination of the placenta showed a Massive Perivillous Fibrinoid Deposition (MPFD) with multiple focal placental infarctions in the intervillious space, intervillious thrombus, and a localized chorangiomatosis. Conclusion: According to many clinical and laboratory findings in this patient, the histopathological features and viral infection of the placenta suggest a prominent role for COVID-19 in this patient’s presentation. This is highlighted by the presence of levels of SARS-CoV-2 RNA. In this patient, an infection with Sars-CoV-2 might have caused the development of the MPFD. These findings suggest that COVID-19 may have contributed to placental dysfunction and fetal growth retardation. Also with a SARS-CoV-2 PCR test with a crossing threshold value of 22,8, it must be assumed that the placenta has been potentially infectious.
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