{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:13:02Z","timestamp":1789729982013,"version":"4.0.1"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet & Gyne"],"published-print":{"date-parts":[[2022,6]]},"abstract":"Abstract<\/jats:title>Objectives<\/jats:title>To describe the placental pathology, fetal autopsy findings and clinical characteristics of pregnancies that resulted in stillbirth owing to severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102) placentitis, and to identify potential risk factors.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a prospective multicenter study of non\u2010vaccinated pregnant women affected by coronavirus disease 2019 (COVID\u201019) in Greece from April 2020 to August 2021. A total of 165 placentas were examined histologically and six cases of stillbirth associated with SARS\u2010CoV\u20102 placentitis were retrieved. Complete fetal autopsy was performed in three of these cases. Gross, histopathological, immunohistochemical, molecular and electron microscopy examinations were carried out in the stillbirth placentas and fetal organs. The histological findings of cases with SARS\u2010CoV\u20102 placentitis were compared with those in 159 cases with maternal COVID\u201019 which resulted in a live birth. Regression analysis was used to identify predisposing risk factors for SARS\u2010CoV\u20102 placentitis.<\/jats:p><\/jats:sec>Results<\/jats:title>The placentas of all six stillborn cases showed severe and extensive histological changes typical of SARS\u2010CoV\u20102 placentitis, characterized by a combination of marked intervillositis with a mixed inflammatory infiltrate and massive perivillous fibrinoid deposition with trophoblast damage, associated with intensely positive immunostaining for SARS\u2010CoV\u20102 spike protein, the presence of virions on electron microscopy and positive reverse\u2010transcription polymerase chain reaction test of placental tissues. The histological lesions obliterated over 75% of the maternal intervillous space, accounting for intrauterine fetal death. Similar histological lesions affecting less than 25% of the placenta were observed in seven liveborn neonates, while the remaining 152 placentas of COVID\u201019\u2010affected pregnancies with a live birth did not show these findings. Complete fetal autopsy showed evidence of an asphyctic mode of death without evidence of viral transmission to the fetus. The mothers had mild clinical symptoms or were asymptomatic, and the interval between maternal COVID\u201019 diagnosis and fetal death ranged from 3 to 15\u2009days. Statistically significant predisposing factors for SARS\u2010CoV\u20102 placentitis included thrombophilia and prenatally diagnosed fetal growth restriction (FGR). Multiple sclerosis was seen in one case.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>SARS\u2010CoV\u20102 placentitis occurred uncommonly in COVID\u201019\u2010affected pregnancies of non\u2010vaccinated mothers and, when extensive, caused fetal demise, with no evidence of transplacental fetal infection. Thrombophilia and prenatally detected FGR emerged as independent predisposing factors for the potentially lethal SARS\u2010CoV\u20102 placentitis. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.24906","type":"journal-article","created":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T17:03:58Z","timestamp":1648659838000},"page":"813-822","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Stillbirth due to SARS\u2010CoV<\/scp>\u20102 placentitis without evidence of intrauterine transmission to fetus: association with maternal risk factors"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2458-988X","authenticated-orcid":false,"given":"A. E.","family":"Konstantinidou","sequence":"first","affiliation":[{"name":"First Department of Pathology, Perinatal Pathology Unit, School of Medicine National and Kapodistrian University of Athens Athens Greece"},{"name":"Laboratory of Pathology, Aretaieion University Hospital, School of Medicine National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Angelidou","sequence":"additional","affiliation":[{"name":"Department of Pathology Hippokration Hospital Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0660-2179","authenticated-orcid":false,"given":"S.","family":"Havaki","sequence":"additional","affiliation":[{"name":"Molecular Carcinogenesis Group, Department of Histology and Embryology, School of Medicine National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Paparizou","sequence":"additional","affiliation":[{"name":"First Department of Pathology, Perinatal Pathology Unit, School of Medicine National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Spanakis","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Medicine National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5895-6887","authenticated-orcid":false,"given":"C.","family":"Chatzakis","sequence":"additional","affiliation":[{"name":"Second Department of Obstetrics and Gynecology, Medical School Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0876-5596","authenticated-orcid":false,"given":"A.","family":"Sotiriadis","sequence":"additional","affiliation":[{"name":"Second Department of Obstetrics and Gynecology, Medical School Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Theodora","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Donoudis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences University of Thessaly Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Daponte","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences University of Thessaly Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Skaltsounis","sequence":"additional","affiliation":[{"name":"First Department of Pathology, Perinatal Pathology Unit, School of Medicine National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9001-4112","authenticated-orcid":false,"given":"V. G.","family":"Gorgoulis","sequence":"additional","affiliation":[{"name":"Molecular Carcinogenesis Group, Department of Histology and Embryology, School of Medicine National and Kapodistrian University of Athens Athens Greece"},{"name":"Faculty of Biology, Medicine and Health, Manchester Cancer Research Centre, Manchester Academic Health Sciences Centre The University of Manchester Manchester UK"},{"name":"Center for New Biotechnologies and Precision Medicine, Medical School National and Kapodistrian University of Athens Athens Greece"},{"name":"Biomedical Research Foundation of the Academy of Athens Athens Greece"},{"name":"Ninewells Hospital and Medical School University of Dundee Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Papaevangelou","sequence":"additional","affiliation":[{"name":"Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine University General Hospital Attikon Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Kalantaridou","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, University General Hospital Attikon Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Tsakris","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Medicine National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.07.049"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004010"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2020.08.018"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2020-319791"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2021.01.012"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22134"},{"key":"e_1_2_8_8_1","unstructured":"National Institutes of Health. 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