Sonographic Signs of SARS-CoV-2 Placentitis. Association with Pregnancy Outcome

Being associated with a systemic infection, SARS-CoV-2 affects multiple organs, including the placenta. SARS-CoV-2 placentitis is a new condition that shows the destructive effects of fibrin deposition in the perivillous area, chronic histiocytic intervillositis and trophoblast necrosis after the placenta is infected with SARS-CoV-2. Until now, there have been no published reports regarding the ultrasound signs of massive perivillous fibrin deposition and the recommended monitoring for these cases.

Our aim was to analyze the sonographic appearance of the placenta in a series of SARS-CoV-2 infected pregnant women during their third trimester.

In all cases included in the present study, we performed serial obstetrical ultrasounds every seven days until delivery, followed by histopathological examination of the placenta postpartum.

In women with intrauterine growth restriction (IUGR), sonographic images of the placentas revealed that they matured faster within three weeks of receiving a COVID-19 diagnosis and reached a more rapid senescence. In all cases, there was a gradual increase in placental calcification from week to week, but only in pregnant women with a grade 3 placenta at the moment of inclusion in the study the deterioration was severe, leading to placental insufficiency and subsequently to IUGR.

The cases who had an increased placental degree at the time of infection were associated with abnormally rapid placental aging. These aspects can be evaluated sonographically.