Discordant Zika Virus Findings in Twin Pregnancies Complicated by Antenatal Zika Virus Exposure: A Prospective Cohort.

BACKGROUND: There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes. METHODS: This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment. RESULTS: Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virus infection occurred at 16-33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities. CONCLUSIONS: Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission

The role of amniocentesis in the diagnosis of congenital zika syndrome

Submitted by Janaína Nascimento ([email protected]) on 2019-03-25T13:52:10Z No. of bitstreams: 1 va_Pereira_José_etal_INI_2019.pdf: 769967 bytes, checksum: 8874ba6d4af263d1fb6edab16f4c9fc0 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-03-26T13:37:25Z (GMT) No. of bitstreams: 1 va_Pereira_José_etal_INI_2019.pdf: 769967 bytes, checksum: 8874ba6d4af263d1fb6edab16f4c9fc0 (MD5)Made available in DSpace on 2019-03-26T13:37:25Z (GMT). No. of bitstreams: 1 va_Pereira_José_etal_INI_2019.pdf: 769967 bytes, checksum: 8874ba6d4af263d1fb6edab16f4c9fc0 (MD5) Previous issue date: 2019Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente. Rio de Janeiro, RJ, Brasil.University of California, San Francisco. Department of Obstetrics, Gynecology, and Reproductive Sciences. Division of Maternal-Fetal Medicine. San Francisco, CA, USA.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente. Rio de Janeiro, RJ, Brasil.University of California, Los Angeles. Jules Stein Eye Institute. Retina Division. Los Angeles, CA, USA.Fundação Oswaldo Cruz. Instituto de Infectologia Evandro Chagas. Laboratório de Doenças Febris Agudas Rio de Janeiro, BrazilUniversity of California, Los Angeles. Department of Pediatrics. Division of Pediatric Infectious Diseases. Los Angeles, CA, USAFundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente. Rio de Janeiro, RJ, Brasil.University of California, San Francisco. Department of Obstetrics, Gynecology, and Reproductive Sciences. Division of Maternal-Fetal Medicine. San Francisco, CA, USA.There is limited data on amniocentesis as a diagnostic tool for congenital Zika syndrome. Here we report on a prospective cohort of 16 women with suspected Zika virus infection in a highly endemic area, and discusss the role of amniocentesis in the prenatal diagnosis of fetal Zika infection

Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury : A Study of 68 Cases With SARS-CoV-2 Placentitis From 12 Countries

Context: Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. Objective: To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Design: Case-based retrospective clinicopathologic analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. Results: Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis (32%; 22 of 68). The majority (19; 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. Conclusions: The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths