COVID-19 & differential effects in twins: Insights from Placenta Pathology

Placenta. 2022 Jun 24;124:62-66. doi: 10.1016/j.placenta.2022.05.014. Epub 2022 May 20.


Introduction: COVID-19 has been associated with several adverse pregnancy outcomes, including perinatal loss. Differential effects of COVID-19 in a twin pregnancy may provide unique insights into virus-placental interactions. We present a case of perinatal loss of a female fetus with survival of the male co-twin in a pregnancy complicated by COVID-19 and premature delivery.

Methods: Viral detection methods recommended by the NICHD task force were used to identify SARS-CoV-2 and its viral receptors in the placentas and fetal tissue (Antoun et al., 2020) [1] RESULTS: Compared with the surviving twin, we found a more severe intervillous necrosis and a relatively low detection of ACE2 membranous expression in the syncytiotrophoblasts of the female twin that succumbed.

Discussion: The interactions of SARS-CoV-2 and ACE2 at the maternal fetal interface within the placenta may play a significant role in perinatal loss, and the effects of fetal sex and gestational age at time of infection need to be explored further.

Publication types

  • Case Reports

MeSH terms

  • Angiotensin-Converting Enzyme 2
  • COVID-19*
  • Female
  • Humans
  • Infectious Disease Transmission, Vertical
  • Male
  • Placenta / metabolism
  • Pregnancy
  • Pregnancy Complications, Infectious* / pathology
  • SARS-CoV-2


  • Angiotensin-Converting Enzyme 2