The severity of symptoms in a mother and fetus is not linear.

Fetal compromise can also occur in women with a mild COVID-19 disease.

A high viral load of SARS-CoV-2 can cause trophoblast necrosis.

The SARS-CoV-2 virus can be detected in fresh and fixed tissue samples.

We demonstrate the nonlinear severity of symptoms of SARS-CoV-2 infection in the mother leading to fetal death after acute placental failure.

Careful clinical evaluation, real-time RT-PCR molecular microbiologic testing, isolation of a viable virus, and autopsy with histologic results were used to investigate the possible vertical transmission of SARS-CoV-2 infection from mother to fetus.

Histologic changes in the placenta correlate with SARS-CoV-2 infection. Total nucleic acid isolated from vaginal swabs, fresh placental tissue, and deparaffinized tissue showed a high viral load of SARS-CoV-2. Complete genome sequencing confirmed the presence of the SARS-CoV-2 Delta variant.

Several methods have been used to confirm SARS-CoV-2-mediated acute placental failure, all of which were conclusive. It should be noted that careful periodic fetal well-being checks are required in women infected with SARS-CoV-2, regardless of the severity of symptoms. Most of the cases described with fetal death occurred in the third trimester.

Covid-19

SARS-CoV-2

Fetal death

Placenta

Delta variant

© 2023 The Authors. Published by Elsevier B.V.