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    We presented the case of stillbirth in a paucisymptomatic mother affected by SARS-CoV-2. At gross examination, the placenta showed a diffuse marble appearance and a focal hemorrhagic area. Multiple areas of hemorrhagic or ischemic necrosis with central and peripheral villous infarctions and thrombosis of several maternal and fetal vessels with luminal fibrin and platelet deposition were observed. All lesions seemed to be synchronous. Virus particles were identified within the cytoplasm of endothelial cells using electron microscopy, whereas SARS-CoV-2 RNA was detected in the placental tissue using real-time reverse transcription-polymerase chain reaction. Here, fetal vascular malperfusion was associated with infection; in fact, electron microscopy images showed that marked SARS-CoV-2 endotheliotropism involved the intravillous fetal capillaries. Furthermore, we confirmed that syncytiotrophoblast is the major target cell type for SARS-CoV-2 infection of the placenta. In conclusion, the possible consequences of the action of the placentotropic SARS-CoV-2 included the occurrence of vertical transmission, as reported in the literature, and/or stillbirth: the latter possibility may be triggered by a hampered maternal and/or fetal perfusion of the placenta. The diffuse thrombosis and subsequent ischemia of fetal capillaries induced by COVID-19 cannot be predicted by standard clinical surveillance. Copyright © 2021 Elsevier Inc. All rights reserved.


    Cira di Gioia, Fabrizio Zullo, Roberta Costanza Bruno Vecchio, Cristina Pajno, Giuseppina Perrone, Paola Galoppi, Francesco Pecorini, Daniele Di Mascio, Raffaella Carletti, Carla Prezioso, Valeria Pietropaolo, Laura Masuelli, Roberto Bei, Costantino Ciallella, Carlo Della Rocca, Antonella Giancotti, Roberto Brunelli. Stillbirth and fetal capillary infection by SARS-CoV-2. American journal of obstetrics & gynecology MFM. 2022 Jan;4(1):100523

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    PMID: 34700024

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