Four stillbirths among women with Covid-19 prompt HSE alert

Postmortems identified coronavirus infection of the placenta as factor in a number of recent stillbirths

A number of stillbirths among women with Covid-19 has prompted separate alerts from the Health Service Executive (HSE) and the Institute of Obstetricians. Video: RTÉ

 

A number of stillbirths among women with Covid-19 has prompted separate alerts from the Health Service Executive (HSE) and the Institute of Obstetricians.

The alerts have been sent to maternity staff across the country after postmortems identified Covid-19 infection of the placenta as a factor in four recent stillbirths.

On foot of the postmortem findings, two separate coroners took the unusual step of contacting the HSE directly with their concerns. The women had mild or moderate symptoms of Covid-19, but were not very unwell.

The stillbirths, which occurred in the first two months of this year, have yet to be examined at inquests, which are not bound to follow the findings of the postmortems.

Dr Ronan Glynn, Deputy Chief Medical Officer said on Thursday evening: “We have been made aware of four preliminary reports of stillbirths potentially associated with a condition called Covid Placentitis.

“These reports should be interpreted with caution as the coroners have not yet concluded their findings. The HSE’s National Women and Infants Programme is aware of and is monitoring the situation and has issued a related notice to obstetric departments.

“I would ask that the privacy of all of those affected by this disease continue to be respected at all times.”

Two of the stillbirths were included in Nphet’s daily mortality figures on Thursday evening.

Meanwhile, while international experience showed it was “not unusual” for Covid-19 to cause placental infection, stillbirth was an “unusual complication”, Prof Peter McKenna, head of the HSE women and infants health programme, told The Irish Times.

The fact four stillbirths had occurred in a short time and among the small population of women with Covid-19 had raised concerns, prompting the HSE to issue the alert, he said.

Despite the absence of international evidence for Covid-related stillbirth, it was decided to issue the alert on a precautionary basis.

In each of the cases, pathologists found the placenta from the women who had Covid was inflamed, thereby impairing blood flow to the fetus.

There has been no overall increase in stillbirths during the pandemic, research from the US and UK indicates.

A study from Cork, in relation to one woman with the virus who gave birth successfully by emergency caesarean, found placental inflammation was an uncommon complication of infection but appeared to have the potential to cause “significant placental injury, potentially resulting in fetal compromise”.

Prof McKenna urged pregnant women to do all they can to protect themselves from getting Covid-19. As a result of the postmortem findings, expecting mothers who have had Covid-19 are likely to be monitored more intensively and for longer than normal as a precaution, he said, and may be induced or delivered earlier.

“I’d be cautious about drawing too much from this. It could be an unfortunate coincidence,” said Dr Cliona Murphy, chairwoman of the Institute of Obstetricians.

She urged pregnant women who test positive for Covid-19 to get a check-up as soon as their isolation period was finished, and not to hesitate about seeking medical attention if they have concerns.

In January, the HSE said 548 pregnant women had tested positive for the virus during the pandemic, but this is regarded as an underestimate. Some 41 were hospitalised and under five required admission to ICU.