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Covid Placentitis: what we know about the condition that may have caused four stillbirths in Ireland

NPHET reported the possible cases of the condition last night.

Image: Shutterstock/10 FACE

LAST NIGHT, NPHET revealed that it had been made aware of four preliminary reports of stillbirths potentially associated with a complication of Covid-19.

The condition, known as Covid Placentitis, is an infection which leads to stillbirth, when a baby is delivered after 24 weeks or more of pregnancy and is not alive.

The four cases reported last night involved pregnant women who had tested positive for the virus, and the development has raised concerns and prompted new questions about how Covid-19 could affect expecting mothers and their babies.

However, Deputy Chief Medical Officer, Dr Ronan Glynn, warned that the reports should be interpreted with caution, as coroners have not yet concluded their findings.

Both Glynn and Professor Keelin O’Donoghue of Cork University Hospital have urged pregnant women to speak to their doctors if they have any concerns, and to continue to take precautions against contracting Covid-19 as normal.

Here’s what we currently know about the condition.

What is Covid Placentitis?

Covid Placentitis is an infection of the placenta which occurs in some pregnant women who have tested positive for Covid-19.

It is a rare condition, but can lead to complications including reduced foetal movements and stillbirth.

One study carried out by researchers at Cork University Hospital and published in January looked at a third trimester pregnancy where Covid Placentitis occurred.

The researchers noted that the condition “appears to be an uncommon but distinctive complication of maternal Covid-19 infection” with the potential to cause “significant placental injury, potentially resulting in foetal compromise”.

They reported that the placenta showed a histiocytic intervillositis, a condition which can sometimes occur when a woman’s immune system reacts abnormally to a pregnancy and damages their placenta, increasing the risk of miscarriage.

This condition is not specifically linked to Covid-19, and can occur for other reasons.

The study also showed that Covid Placentitis does not always lead to stillbirth like the cases reported last night.

The CUH researchers discovered the condition in a woman who was 36 weeks pregnant and experienced reduced foetal movements after she had tested positive for Covid-19.

The woman’s child was delivered by an emergency Caesarean section ten days after she tested positive, despite her feeling well and her vital signs being recorded as normal when she presented to hospital.

The Caesarean was uncomplicated, and a baby girl was later delivered. Both mother and baby went home on day eight.

What did NPHET say?

Deputy Chief Medical Officer Dr Ronan Glynn said at last night’s briefing of the National Public Health Emergency Team (NPHET) that health officials had been made aware of four preliminary reports of stillbirths potentially associated with Covid Placentitis.

He confirmed at least two of them were from this year.

However, Glynn emphasised that information was limited at the moment and that full investigations still had to be carried out, with details still to come from coroners.

He warned that reports about the condition should be interpreted with “caution” because coroners had not yet concluded their findings, and added that the HSE’s National Women and Infants Programme is monitoring the situation.

“I say preliminary reports suggest these findings, but again, they’re preliminary,” he said.

“The condition has been reported internationally, but at this point I think further work needs to be done before we can confirm the findings.”

Dept of Health 013 Source: Leah Farrell/RollingNews.ie

Glynn also explained that the issue had not been discussed at NPHET’s briefing yesterday afternoon, because officials had only been made aware of the reports afterwards.

But although concerned by the reports, the deputy CMO said that international evidence showed that Covid Placentitis was a “very rare condition”.

“We have not seen high incidence of it internationally, we wouldn’t expect to see a high incidence summit here in this country,” he said.

What do we know about the four cases reported last night?

Professor Keelin O’Donoghue, a consultant obstetrician who is also one of the co-authors of the CUH study, told RTÉ Radio 1′s Morning Ireland that all four cases of stillbirth that are under investigation are from women whose pregnancy was from 24 weeks onwards.

She also said they involved women who were symptomatic in three of the four cases, but who were not critically unwell after being infected with Covid-19.

“They had all had recent Covid within two to three weeks, and in some cases presented feeling a change in foetal movements,” she said.

“These babies, as far from what we know, were normally grown and the pathologists have found evidence of very similar placental disease in all four that can be linked to the direct effects of Sars-CoV-2, the virus that causes Covid-19 infection.”

However, it is worth noting that these cases make up a tiny proportion of the overall number of women who have been pregnant with Covid-19 in Ireland.

Last year, 450 pregnancies were reported to the Health Protection Surveillance Centre where a woman had a positive Covid-19 diagnosis.

In the majority of these cases, women had a mild or moderate illness.

A small proportion (about 10%) had become critically unwell, but there were no reports of maternal deaths.

What is the medical advice for pregnant women? 

It is important to stress that the majority of pregnant patients infected with Covid-19 to date have had only mild cases of the illness and babies been largely unaffected.

The Deputy CMO said last night that pregnant women did not need to change their behaviour, beyond continued compliance with current public health advice.

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“What I would say again to women is that this doesn’t change what you have to do, if you’re pregnant and listening to this this evening,” he said.

“Ultimately, Covid does pose a potential risk to all of us. And so it’s not individual women who need to do anything different, over and above what they have been doing.

Professor Keelin O’Donoghue said the basic advice for pregnant women was to “try not to get Covid” and to get vaccinated when it becomes available.

She added that those who have tested positive for Covid-19 should let their health care provider know and attend their visits as normal.

“Women shouldn’t be afraid to attend hospital, and they should speak up if there’s any concerns about foetal wellbeing or if they experience reduced movements,” she told RTÉ radio.

“Women should certainly not ignore any signs of concerns that they might have and should be listened to when they presented to the maternity hospitals.”

The Chair of the Institute of Obstetricians and Gynaecologists has said that it is important that pregnant women who have Covid positive results still attend for appointments with their healthcare providers after they are infected.

“The vast majority of pregnant women who had Covid have had mild symptoms and have not had adverse outcomes,” the institute’s chair Dr Cliona Murphy said.

Glynn also added that if any woman has concerns about their pregnancy, they should speak with their doctor or get in touch with their local obstetrics department.

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