Abstract

Fetal and neonatal death is an important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. A multinational group of 44 perinatal specialists from 12 countries collected placental and post mortem pathology findings from 64 stillborns and 4 neonatal deaths where placentas tested positively for the SARS-CoV-2 virus following delivery to mothers with a history of COVID-19. Severe destructive placental disease from SARS-CoV-2 placentitis (placental infection) involved 78% of the placental tissue, on average. The majority (19; 63%) of the 30 post mortems revealed no significant fetal anomalies except for intrauterine hypoxia (lack of oxygen in utero). The study shows that the pathological anomalies composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental compromise. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and lack of oxygen supply to the fetus. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.