Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 16 , ISSUE 3 ( May-June, 2024 ) > List of Articles

Original Article

Placental Pathology in Correlation with Inflammatory Markers and Perinatal Outcomes in Maternal COVID: A Prospective Study

G Umamaheswari, Lalitha Natarajan, Tadury M Subbarao, V Chaitra, S Lathamaheswari, T Ramya, Poornima

Keywords : Coronavirus disease-19 infection, Gestation at infection, Inflammatory markers, Perinatal outcome, Placental pathology

Citation Information : Umamaheswari G, Natarajan L, Subbarao TM, Chaitra V, Lathamaheswari S, Ramya T, Poornima. Placental Pathology in Correlation with Inflammatory Markers and Perinatal Outcomes in Maternal COVID: A Prospective Study. J South Asian Feder Obs Gynae 2024; 16 (3):243-251.

DOI: 10.5005/jp-journals-10006-2426

License: CC BY-NC 4.0

Published Online: 29-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim: The purpose of this study is to analyze the morphological findings in the placenta of coronavirus disease-2019 (COVID-19)-positive women in correlation with the severity of infection, elevated inflammatory markers, gestational age at diagnosis and perinatal outcomes. Materials and methods: This is a prospective observational study of 66 singleton placentas of COVID-positive pregnant women over a period of 18 months. Clinical details, inflammatory markers, and perinatal outcomes were collected and analyzed in correlation with placental morphology. Results: Out of 66 pregnancies, 57 (86.3%) culminated in live births, of which 23 (40%) were small for gestation (SGA). Out of 66 cases, 9 (13.7%) experienced complications involving fetal demise intrauterine fetal death (IUFD). Based on the increase in inflammatory markers and gestational age at infection, the pregnancies were analyzed with regard to fetal outcome. Out of 66 pregnancies, 26 (39.4%) had moderate to marked elevation of two or more inflammatory markers. Fetal outcomes in these pregnancies were IUFD (34.6%), SGA (34.6%), appropriate for gestation (AGA) (26.9%) and neonatal death (ND) (3.8%). In women with elevated markers, 20% fetal or neonatal mortality was noted when the infection occurred in the third trimester whereas it was 100% when the infection occurred in the second trimester. All pregnancies affected in the third trimester and without an increase in markers (n = 40) resulted in live birth. The most significant placental finding observed was chronic inflammatory pathology (80%), followed by maternal vascular malperfusion (MVM) with or without fetal vascular malperfusion (FVM) (75.7%), and massive perivillous fibrin deposition (MPVFD) (12%). Conclusion: This study reemphasizes that in maternal COVID, the gestational age at infection, elevated inflammatory markers and severity of placental lesions could explain the perinatal outcomes.

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  1. COVID19 India. Ministry of Health and Family Welfare Government of India. 2022. Available at
  2. Gavriatopoulou M, Korompoki E, Fotiou D, et al. Organ-specific manifestations of COVID-19 infection. Clin Exp Med 2020;20(4): 493–506. DOI: 10.1007/s10238-020-00648-x.
  3. Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) infection and pregnancy. 2021. Available from:
  4. Schwartz DA, Avvad-Portari E, Babál P, et al. Placental tissue destruction and insufficiency from COVID-19 causes stillbirth and neonatal death from hypoxic-ischemic injury: A study of 68 cases with SARS-CoV-2 placentitis from 12 countries. Arch Pathol Lab Med 2022;146(6):660–676. DOI: 10.5858/arpa.2022-0029-SA.
  5. Redline RW, Boyd TK, Roberts DJ. Placental and Gestational Pathology. Cambridge: Cambridge University Press; 2017. pp. 115–156.
  6. Kraus, Frederick T, (Eds). Placental Pathology. Atlas of Nontumor Pathology: Series 1 3. Washington, DC: Armed Forces Institute of Pathology, 2004. pp. 75–110.
  7. Roberts DJ, Edlow AG, Romero RJ, et al. A standardized definition of placental infection by SARS-CoV-2, a consensus statement from the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development SARS-CoV-2 placental infection workshop. Am J Obstet Gynecol 2021;225(6):593.e1–593.e9. DOI: 10.1016/j.ajog.2021.07.029.
  8. Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19). Available from:
  9. WHO Laboratory biosafety guidance related to coronavirus disease (COVID-19) Interim guidance. Available from:
  10. Guidance COVID-19: Safe handling and processing for samples in laboratories. Public health England. Available from:
  11. Farid E, Sridharan K, Alsegai OA, et al. Utility of inflammatory biomarkers in patients with COVID-19 infections: Bahrain experience. Biomark Med 2021;15(8):541–549. DOI: 10.2217/bmm-2020-0422.
  12. Gao YD, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy 2021;76(2):428–455. DOI: 10.1111/all.14657.
  13. More K, Chawla D, Murki S, et al. Outcomes of neonates born to mothers with coronavirus disease 2019 (COVID-19)-National neonatology forum (NNF) India COVID-19 Registry. Indian Pediatr 2021;58(6):525–531. DOI: 10.1007/s13312-021-2234-2.
  14. Menter T, Mertz KD, Jiang S, et al. Placental pathology findings during and after SARS-CoV-2 Infection: Features of villitis and malperfusion. Pathobiology 2021;88(1):69–77. DOI: 10.1159/000511324.
  15. Prabhu M, Cagino K, Matthews KC, et al. Pregnancy and postpartum outcomes in a universally tested population for SARS-CoV-2 in New York City: A prospective cohort study. BJOG 2020;127(12):1548–1556. DOI: 10.1111/1471-0528.16403.
  16. Patberg ET, Adams T, Rekawek P, et al. Coronavirus disease 2019 infection and placental histopathology in women delivering at term. Am J Obstet Gynecol 2021;224(4):382.e1–382.e18. DOI: 10.1016/j.ajog.2020.10.020.
  17. Rosenberg AZ, Yu W, Hill DA, et al. Placental pathology of zika virus: Viral infection of the placenta induces villous stromal macrophage (Hofbauer Cell) proliferation and hyperplasia. Arch Pathol Lab Med 2017;141(1):43–48. DOI: 10.5858/arpa.2016-0401-OA.
  18. Redline RW. Villitis of unknown etiology: Noninfectious chronic villitis in the placenta. Hum Pathol 2007;38(10):1439–1446. DOI: 10.1016/j.humpath.2007.05.025.
  19. Schwartz DA, Morotti D. Placental pathology of COVID-19 with and without fetal and neonatal infection: Trophoblast necrosis and chronic histiocytic intervillositis as risk factors for transplacental transmission of SARS-CoV-2. Viruses 2020;12(11):1308. DOI: 10.3390/v12111308.
  20. Bendon RW. Nosology: Infarction hematoma, a placental infarction encasing a hematoma. Hum Pathol 2012;43(5):761–763. DOI: 10.1016/j.humpath.2011.07.023.
  21. Heerema-McKenney A, Popek E, De Paepe M. Diagnostic pathology; Placenta, 2nd edition. Philadelphia: Elsevier, 2019. pp. 270–299.
  22. Shanes ED, Mithal LB, Otero S, et al. Placental pathology in COVID-19. Am J Clin Pathol 2020;154(1):23–32. DOI: 10.1093/ajcp/aqaa089.
  23. Smithgall MC, Liu-Jarin X, Hamele-Bena D, et al. Third-trimester placentas of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive women: Histomorphology, including viral immunohistochemistry and in-situ hybridization. Histopathology 2020;77(6):994–999. DOI: 10.1111/his.14215.
  24. Stanek J. Hypoxic patterns of placental injury: A review. Arch Pathol Lab Med 2013;137(5):706–720. DOI: 10.5858/arpa.2011-0645-RA.
  25. Garg R, Agarwal R, Yadav D, et al. Histopathological changes in placenta of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection and maternal and perinatal outcome in COVID-19. J Obstet Gynecol India 2023;73(1):44–50. DOI: 10.1007/s13224-022-01666-3.
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