VP31.20: Fetal deaths in COVID‐19 infected pregnancies

Abstract

Fetal death as an ultimate consequence of COVID-19 infection in pregnancy, is a complication that must not be underestimated. Maternal infection can trigger a hyper-inflammatory response, causing endothelial vascular dysfunction and coagulation abnormalities. These lesions compromise placental perfusion which consequently affects fetal perfusion and leads, in some situations, to fetal anoxia and death. Our case series report clinical, analytical and histopathological findings of four cases of in utero fetal demise in COVID-19 infected pregnant women, without any other obvious cause, managed at a tertiary hospital, in Portugal. All pregnancies were uncomplicated until the third trimester and either had obstetric history or developed obstetric conditions related to placental vascular compromise such as hypertensive disorders of pregnancy and fetal growth restriction. Three cases were asymptomatic for COVID-19 on admission, whereas the fourth presented mild symptoms and developed disseminated intravascular coagulation. All fetus were morphologically normal and two of them tested positive for COVID-19. Placental histopathological examinations revealed multiple signs of maternal and fetal vascular malperfusion, chorioangioma and increased perivillous fibrin deposition, findings that are consistent with those observed in hypertensive disorders of pregnancy and fetal growth restriction. This observation suggests that COVID-19 can place at greater risk of in utero fetal demise pregnancies that are already complicated by obstetric conditions related with impaired placental perfusion.