Association of placental histopathological findings with COVID-19 and its predictive factors

Helmi, Zeena; Al-badri, Hadeel

doi:10.61622/rbgo/2024AO03

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev. bras. ginecol. obstet. 46 • 2024 • https://doi.org/10.61622/rbgo/2024AO03 copy

Association of placental histopathological findings with COVID-19 and its predictive factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The aims of the study are to describe the association of coronavirus disease (COVID-19) with the abnormal histopathological findings in human placenta and to highlight the potential predictors of these histopathological findings.

Methods:

A retrospective cohort study, held in two obstetric units from January 2021- 2022, 34 patients who were confirmed cases of COVID- 19 were followed up till the time of delivery as their placenta were sent for histopathology. Patients diagnosed with other viral infections, chorioamnionitis, or were known case of as pre-term or term pre labour rupture of membrans (PROM) were excluded as well as pre exisiting diabetes mellitus or pre-eclampsia. Data analysis were performed using STATA software version 16.

Result:

Specific histopatological findings (fetal vascular malperfusion, maternal vascular malperfusion, inflammatory pathology and thrombotic finding) were significantly high among 13 (38.2%) of the study group who got infected earlier in pregnancy (P<0.001). The period between the diagnosis of COVID-19 and the delivery significantly increases the odds of the presence of pathological findings by 2.75 times for each week the patients getting infected earlier.

Conclusion:

Association of abnormal placental histopathological findings with COVID-19 infection in pregnancy and the potential predictor for the occurrence of placental findings is the longer duration between the diagnosis of the infection and the delivery.

Keywords
COVID-19; Coronavirus infections; Histopathology; Placenta

Parameters	Placental pathological findings				p-value^* * Student's T-test;
	Yes (n=13)		No (n=21)
	Mean	SD	Mean	SD
Maternal age (years)	28.74	5.46	28.03	6.54	0.735
Body mass index (Kilograms/meter²)	27.69	4.43	27.92	5.03	0.886
Timing of infection during pregnancy (Weeks)	28.15	3.76	35.95	1.40	<0.001*
Gestational age at delivery (mean in Weeks)	37.26	1.62	37.01	1.91	0.686
COVID-19 diagnosis to delivery (Weeks)	9.2	4.4	1.1	1.1	<0.001*
Random blood glucose (mg/dl)	133.1	40	96.9	24.8	0.002*
Hemoglobin (grams/deciliter)	11.15	1.02	11.12	1.67	0.954
White blood cells (*)	8.18	3.43	11.86	3.63	0.006*
Lymphocytes (%)	29.7%	12.2%	19.3%	8.1%	0.013*
Platelets (*)	220.6	97.5	230.1	92.3	0.78
			n(%)	n(%)	p-value^ Pearson's chi-square test;
Gravida	Nulli/Primi		6(46.2)	0(0.0)	-
Gravida	Multi		7(53.8)	21(100.0)	-
Parity	Nulli/Primi		13(100)	8(38.1)	-
Parity	Multi		0(0.0)	13(61.9)	-
History of abortion	Yes		2(15.4)	5(23.8)	0.555
History of abortion	No		11(84.6)	16(76.2)	0.555
Blood groups & rh	A-		1(7.7)	2(9.5)	0.975
	A+		1(7.7)	3(14.3)
	AB+		2(15.4)	3(14.3)
	B+		4(30.8)	5(23.8)
	O+		5(38.5)	8(38.1)
Severity of corona	Mild		8(61.5)	13(61.9)	0.983
Severity of corona	Moderate/severe		5(38.5)	8(38.1)	0.983
Mode of delievery^* ***** Significant at 0.05	vaginal		5(38.5)	1(4.7)	0.012
Mode of delievery^* ***** Significant at 0.05	Cesearean		8(61.5)	20(95.3)	0.012
Admission to the critical care unit	Yes		0(0.0)	2(9.5)	-
Admission to the critical care unit	No		13(100)	19(90.5)	-

Parameters		Placental pathological findings				p-value ^a a Student's T-test;
		Yes (n=13)		No (n=21)
		Mean	SD	Mean	SD
Birth weight (Kg)		2.86	0.55	2.94	0.41	0.667
		n(%)		n(%)		p-value^b b Pearson's chi-square test;
Apgar score (1^st min.)	<7	3(23.1)		8(38.1)		0.363
Apgar score (1^st min.)	7+	10(76.9)		13(61.9)		0.363
Apgar score (5^th min)	<7	1(7.7)		2(9.5)		0.855
Apgar score (5^th min)	7+	12(92.3)		19(90.5)		0.855
Mode of delivery	Normal vaginal	5(38.5)		1(4.8)		0.012^* * Significant at 0.05;
Mode of delivery	Cesarean section	8(61.5)		20(95.2)		0.012^* * Significant at 0.05;
Preterm	Yes	1(7.7)		8(38.1)		0.051
Preterm	No	12(92.3)		13(61.9)		0.051
Stillbirth	Yes	1^c c this case presented at 36 weeks as severe oligohydramnios; Amniotic fluid index = 1cm, with a history of covid infection at 29 weeks; (7.7)		2^d d one of the cases had a previous scar, and her uterus ruptured during labor; the other case gave a history of midwife interference and had obstructed labor (9.5)		0.855
Stillbirth	No	12(92.3)		19(90.5)		0.855
Neonatal admission	Yes	3(23.1)		3(14.3)		0.513
Neonatal admission	No	10(76.9)		18(85.7)		0.513
Admission to the neonatal care unit	Yes	0(0)		3(14.3)		-
Admission to the neonatal care unit	No	13(100)		18(85.7)		-

Parameters	Correlation coefficient	p-value	Odds ratio	95% Confidence interval for odds ratio
Parameters	Correlation coefficient	p-value	Odds ratio	Lower	Upper
COVID-19 Diagnosis to delivery (Weeks)	1.01	0.018^* * Significant at 0.05	2.75	1.19	6.36
White blood cells ^* * Significant at 0.05 10³	-0.04	0.884	0.96	0.54	1.70
Constant	-3.74	0.318	0.02

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[1] Corresponding author Zeena Helmi. Email: Zeena.helmi@uomustansiriyah.edu.iq