Abstract

Stillbirth has been relatively hidden during the COVID-19 pandemic, but a clear link between the SARS-CoV-2 virus and poor fetal outcome was seen in the Alpha and Delta waves of the pandemic. A small minority of women who contracted COVID-19 developed SARS-CoV-2 placentitis. In many reported cases this was linked to intrauterine fetal death, although there are cases where an emergency delivery took place just before likely fetal demise. What is surprising is that SARS-CoV-2 placentitis is often not associated with severe COVID-19 infection in the mother and this makes it difficult to predict. The worst outcomes for the baby seem to be with widespread placental disease which happens within 21 days of diagnosis of COVID-19 infection. Poor outcomes are often pre-dated by reduced fetal movements but are not associated with changes on ultrasound scans. In future, multidisciplinary collaboration and cross-boundary working between clinicians and scientists internationally must be prioritised, to identify quickly situations where a viral infection causes poor outcomes for women and babies. Clinicians also need to be given clear guidance for reducing fetal death and associated poor outcomes. While we wait to see if COVID-19 brings a future variant of concern, we must also focus on appropriate future management of women who have had SARS-CoV-2 placentitis. As a placental condition with an infectious cause, SARS-CoV-placentitis is not likely to happen again in the next pregnancy and thus a measured approach to subsequent pregnancy management is needed.