Placental SARS-CoV-2 in a pregnant woman with mild COVID-19 disease.

The full impact of coronavirus disease 2019 (COVID-19) on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality. COVID-19 manifestations appear similar between pregnant and nonpregnant women. We present a case of placental severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in a woman with mild COVID-19 disease, then review the literature. Reverse transcriptase polymerase chain reaction was performed to detect SARS-CoV-2. Immunohistochemistry staining was performed with specific monoclonal antibodies to detect SARS-CoV-2 antigen or to identify trophoblasts. A 29-year-old multigravida presented at 40-4/7 weeks for labor induction. With myalgias 2 days prior, she tested positive for SARS-CoV-2. We demonstrate maternal vascular malperfusion, with no fetal vascular malperfusion, as well as SARS-CoV-2 virus in chorionic villi endothelial cells, and also rarely in trophoblasts. To our knowledge, this is the first report of placental SARS-CoV-2 despite mild COVID-19 disease (no symptoms of COVID-19 aside from myalgias); patient had no fever, cough, or shortness of breath, but only myalgias and sick contacts. Despite her mild COVID-19 disease in pregnancy, we demonstrate placental vasculopathy and presence of SARS-CoV-2 virus across the placenta. Evidence of placental COVID-19 raises concern for placental vasculopathy (potentially leading to fetal growth restriction and other pregnancy complications) and possible vertical transmission-especially for pregnant women who may be exposed to COVID-19 in early pregnancy. This raises important questions of whether future pregnancy guidance should include stricter pandemic precautions, such as screening for a wider array of COVID-19 symptoms, increased antenatal surveillance, and possibly routine COVID-19 testing throughout pregnancy.

Getting it right: educating professionals to work together in improving health and health care.

This paper is based on a lecture given by LAH as the 2nd John Horder lecture at Imperial College, London on 11 April 2006. Dr. Horder has been influential in improving patient outcomes in multiple ways, including his contributions to professional education. He was instrumental in the development of the Royal College of General Practitioners, serving as president from 1979-1982 and acting as a key leader in establishing post-graduate training for general practitioners in the United Kingdom. Dr Horder went on to found the Centre for the Advancement of Interprofessional Education, in part because of what he observed about the power of interprofessional collaboration in his own primary care practice. It was an honor to give a lecture in tribute to Dr John Horder. It was an opportunity to reflect on what we know about educating health professionals in training about the improvement of health care, including work I've helped to lead in the United States (where I now serve as the Senior Associate Dean for Education at the University of Missouri-Columbia School of Medicine). This paper also is dedicated to Dr. Horder.