. 2022 Apr 22;129(8):1361–1374. doi: 10.1111/1471-0528.17132

TABLE 2.

Characteristics of pregnant women with SARS‐CoV‐2 infection presenting with signs of fetal distress and characteristics of their live‐born infants including placental features

	Case 6	Case 7	Case 8	Case 9	Case 10	Case 11	Case 12,13 Diamniotic dichorionic twins		Case 14
Maternal characteristics
Maternal age (years)	28	38	30	27	31	30	31		33
Gestational age (in weeks) at
Onset of maternal symptoms	34⁺⁴	21⁺³	34⁺²	34⁺¹	32⁺⁴	23⁺⁰	33⁺⁰		28⁺⁴
Positive maternal RT‐qPCR	34⁺² (contact tracing)	21⁺⁶	34⁺⁵	34⁺⁴	32⁺⁵	23⁺⁴	33⁺⁴		28⁺⁴
Time of delivery	35⁺¹	31⁺⁶	36⁺⁰	34⁺⁴	33⁺⁵	24⁺¹	34⁺⁰		29⁺³
Parity	1	1	1	1	2	1	1		2
BMI (kg/m²)	31	23	27	27	23	35	40		22
Maternal comorbidities	Depression, Gastric by‐pass, gestational diabetes	None	None	None	None	Polycystic ovaries, Pregnant after ovulation stimulation	Depression, Asthma		Migraine
Mother born in Sweden	Yes	Yes	Yes	No	Yes	Yes	Yes		No
Presenting symptoms	Reduced fetal movement for 1 day	Planned ultrasound scan due to bad obstetric history (Previous pregnancy: oligo‐hydramnios, chorio‐amnionitis with premature delivery)	Reduced fetal movements for 1 day	Reduced fetal movement for 1 day Dry cough‐1 day Fever for 3 days Abdominal pain for 3 days	Reduced fetal movement for 3 days Maternal fever, 2–4 days ago	Reduced fetal movement for 2 days Fever for 8 days Blocked nose for 8 days	Reduced fetal movements‐1 day		Cough for 6 days Sore throat for 6 days Uterine contractions for 1 day
Cardiotocograph(CTG) classification ³⁸	Pathological Decreased baseline variability Recurrent prolonged, late decelerations	Normal	Pathological Repeated episodes of bradycardia	Pathological Reduced baseline variability Absence of accelerations Recurrent prolonged, late decelerations	Pathological Frequency 150/min Absence of accelerations Reduced baseline variability Recurrent late decelerations	Pathological Reduced baseline variability Recurrent, late decelerations	Normal 12 hours prior to delivery	Normal 12 hoursprior to delivery	Pathological Reduced baseline variability Recurrent variable decelerations and late decelerations
Mode of delivery	Emergency caesarean section	Semi‐acute caesarean section	Emergency caesarean section	Emergency caesarean section	Emergency caesarean section	Emergency caesarean section	Emergency caesarean section		Emergency caesarean section
Indication for delivery	Pathological CTG pattern	Fetal blood flow velocimetry deterioration	Pathological CTG pattern	Pathological CTG pattern	Pathological CTG pattern	Pathological CTG pattern and BFC 2	Preeclampsia (high blood pressure and thrombocytopenia)		Pathological CTG pattern
Infant characteristics
Apgar Score (1, 5, 10 minutes)	2, 4, 7	9, 10, 10	4, 8, 9	1, 4, 8	3, 5, 8	2, 5, 7	0, 0, 1	4, 7, 8	1, 5, 8
Umbilical cord blood gases (Units: lactate in mmol/litre, base excess [BE] in mEq/litre)	Arterial pH: 7.15 Arterial lactate: 11.5	NA	NA	Arterial pH: 7.20 Arterial lactate: 11.0 Vein pH: 7.22 Vein lactate: 10.1	Arterial pH: 7.21 Arterial BE: −7.6 Arterial lactate: 10 Vein pH: 7.26	Vein pH: 7.07 Vein BE: −15.5	Vein pH: 6.69 Vein BE: −22	Vein pH: 7.29 Vein BE: – 11	NA
Neonatal SARS‐CoV‐2 status (RT‐qPCR using naso‐pharyngeal swab within 24 hours of birth)	Negative	Negative	NA	Positive (Infant had no contact with parents prior to SARS‐CoV‐2 testing)	NA	Negative	Negative	Negative	Positive (Infant had no contact with parents prior to SARS‐CoV‐2 testing)
Birthweight (g)	2064	1200	2708	2310	1675	570	2182	1846	1370
Small‐for‐gestational age (SGA) ³⁷	Yes	Yes	No	No	Yes	Yes	No	Yes	No
Infant gender	Girl	Boy	Girl	Boy	Girl	Girl	Girl	Boy	Boy
Infant health at discharge	Thrombocytopenia before delivery, normalised 4 days postpartum	Healthy	Healthy	No spontaneous breathing directly after birth. Continuous positive airway pressure (CPAP) for 24 mins. No extra support was needed thereafter. Neonate discharged 14 days after birth.	Manual ventilation for 5 minutes directly after birth. There‐after CPAP for 9 hrs. Due to prematurity + SGA, neonate was kept at the Neonatal ward for 8 days. Dis‐charged after neo‐natal homecare for another 6 weeks.	Moved to the neonatal intensive care unit (NICU) due to a massive intra‐cerebral bleed. Life support turned off day 2. Post‐mortem showed intra‐ventricular haem‐orrhage (IVH) (grade 4) and fresh bleeding in the adrenal glands.	The neonate suffered from hypoxic ischaemic encephalopathy (HIE) grade III and intensive care was discontinued 6 days after birth. The neonate died 8 days after delivery.	Healthy	No spontaneous breathing after birth. Intubated with respirator day 1. Day 2: CPAP and developed IVH (grade 1). Recovering at the neonatal ward with high flow nasal cannula (HFNC) Day 18.
Placental features
Vertical transmission (Congenital infection) ³⁴	Probable	Probable	Probable	Confirmed	Probable	Probable	Probable	Probable	Probable
Placental weight (grams)	325	256	594	342	294	156	400	283	300
Placental weight according to gestational week ³³	Underweight	Underweight	Overweight	Normal weight	Underweight	Underweight	Normal weight	Underweight	Normal weight
Trophoblast staining for SARS‐CoV‐2	+	+	+	+	+	+	+	+	+
Fibrinoid deposits, percentage distribution within placental parenchyma	Borderline massive perivillous fibrinoid deposition, 40%	−	Borderline massive perivillous fibrinoid deposition, 40%	Massive intervillous fibrinoid deposition, 75%	Massive intervillous fibrinoid deposition, 75%	Massive perivillous fibrinoid deposition, 90%	Massive perivillous fibrinoid deposition and infarcts, >90%	Borderline massive perivillous fibrinoid deposition with infarcts, 40%	Perivillous fibrinoid deposition with infarcts, 10%
Intervillositis	Acute intervillositis	−	Focal acute intervillositis	Acute intervillositis	Widespread focal acute‐chronic inter‐villousitis with ‘Nuclear dust’	Widespread chronic histiocyte intervillositis	Widespread chronic histiocytic intervillositis	Widespread chronic histiocytic intervillositis	Chronic histiocytic intervillositis
Trophoblast necrosis	+	−	+	+	+	+	+	+	+
Maternal vascular malperfusion	+	−	+	−	−	−	+	−	−
Choriangiosis	−	−	−	+	+	−	+	+	−
Other placental findings	Agglutination of villi with inflammatory cells, increased villous maturation but no signs of maternal vasculopathy. Umbilical cord was hyperspiralised	Intraparenchymal infarctions covering 10% of the placenta tissue, plasma cell inflammation of the decidua capsularis and basalis. Immuno‐chemistry for SARS‐CoV‐2 was positive focally	Acute villitis, maternal vasculopathy of hypertrophy type. The umbilical cord was hyper‐spiralised with a marginal insertion.	Multiple regions of dense intervillous infiltrates of neutrophilic granulocytes and macrophages. SARS‐CoV‐2 nucleoprotein was strongly positive in the cytoplasm + nucleus of villous cytotropho‐blasts and syncytio‐trophoblasts in areas with intervillositis and fibrinoid depositions	Fibrinoid deposition focally transmural with accentuation on the maternal side of the placenta	Immunochemistry for SARS‐CoV‐2 was weakly positive in trophoblast cells but molecular analysis of (mRNA COVN and COVS) strongly positive in trophoblast cells and in placental parenchyma	Acute aterosis and thrombosis, villous necrosis and agglutination of villi with inflammatory cells. The umbilical cord was hyper‐spiralised. Calcified areas were found within the parenchyma	Few maternal vessels with necrosis of blood vessel walls, agglutination of villi with inflammatory cells and calcified areas with the parenchyma	Strong, diffuse positivity for SARS‐CoV‐2 nucleoprotein in villous trophoblasts. Areas with intervillositis are dominated with MPO⁺ granulocytes, CD68⁺ macrophages/histiocytes and to a lesser extent CD3⁺ T‐lymphocytes and minimally CD20⁺ B‐cells