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    1 Comment for this article
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    Less Than Meets the Eye ?
    Yves Ville, MD | Obstetrics and Fetal Medicine and Bettina Bessière. Fetal pathology . Hôpital Necker Enfants Malades. University of Paris.
    This report is adequately provocative and finds its credibility in the care taken to perform the placental swab and biopsies. The viral RNA could only be amplified from the nasopharyngeal sample and the placenta.

    How would the virus reach the placenta before delivery while it could not be retrieved from the vagina, maternal blood, nor from any fetal sampling site ?

    One possibility is that the placenta could have been contaminated at delivery by maternal infected feces. Those were not tested, although symptomatic patients especially those with digestive symptoms as in this case excrete the virus
    in their stools.

    The authors did not mention if antibiotics had been administered prior to delivery. If so, this could have contributed to the negativity of the microbiological examination on the fetus and placenta.

    Placental histological changes are compatible with severe inflammatory changes and so is funisitis. This might illustrate the process for SARS-CoV-2 to cause perinatal morbidity. Large series of standardized placental histological examinations are needed.

    In addition, if the placenta can be damaged through a deregulated inflammatory process. Rupture of membranes might therefore have occurred primarily and be the cause for non-specific chorioamnionitis or alternatively chorioamnionitis could be the result of the inflammatory process caused by SARS-CoV-2 infection.
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    April 30, 2020

    Second-Trimester Miscarriage in a Pregnant Woman With SARS-CoV-2 Infection

    Author Affiliations
    • 1Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
    • 2Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland
    • 3Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
    JAMA. 2020;323(21):2198-2200. doi:10.1001/jama.2020.7233

    No data exist regarding the effect on fetuses of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the first or second trimester of pregnancy, and data are limited regarding infections that occur during the third trimester. However, reports of newborns with fetal distress or requiring admission to the intensive care unit1,2 and a stillbirth after maternal coronavirus disease 2019 (COVID-19)3 in the third trimester suggest the possibility of COVID-19–induced placental pathology.

    We present a case of miscarriage during the second trimester in a pregnant woman with COVID-19.

    A pregnant woman in her second trimester who had a miscarriage was evaluated at Lausanne University Hospital on March 20, 2020. Institutional review board approval and written informed consent were obtained. Information was obtained from medical records. Reverse transcriptase–polymerase chain reaction (RT-PCR) to detect SARS-CoV-2 and cultures to detect bacterial pathogens and PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum were performed on samples from the mother, fetus, and placenta (Table). Placental histological examination and fetal autopsy were performed by 2 experienced perinatal pathologists (C.G. and E.D.). Hematoxylin-eosin, myeloperoxidase immunohistochemistry, Gram, and periodic acid–Schiff colorations were performed on the placenta.

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