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[新型冠状病毒感染合并妊娠:三例临床特征及胎盘病理分析]

[Pregnancy with new coronavirus infection: clinical characteristics and placental pathological analysis of three cases].

作者信息

Chen S, Huang B, Luo D J, Li X, Yang F, Zhao Y, Nie X, Huang B X

机构信息

Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.

出版信息

Zhonghua Bing Li Xue Za Zhi. 2020 May 8;49(5):418-423. doi: 10.3760/cma.j.cn112151-20200225-00138.

Abstract

To investigate the clinical characteristics and placental pathology of 2019-nCoV infection in pregnancy,and to evaluate intrauterine vertical transmission potential of 2019-nCoV infection. The placentas delivered from pregnant women with confirmed 2019-nCoV infection which were received in the Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology by February 4, 2020 were retrospectively studied. Their clinical material including placental tissue and lung CT, and laboratory results were collected, meanwhile, nucleic acid detection of 2019-nCoV of the placentas were performed by RT-PCR. Three placentas delivered from pregnant women with confirmed 2019-nCoV infection, who were all in their third trimester with emergency caesarean section. All of the three patients presented with fever (one before caesarean and two in postpartum), and had no significant leukopenia and lymphopenia. Neonatal throat swabs from three newborns were tested for 2019-nCoV, and all samples were negative for the nucleic acid of 2019-nCoV. One premature infant was transferred to Department of Neonatology due to low birth weight. By the end of February 25, 2020, none of the three patients developed severe 2019-nCoV pneumonia or died(two patients had been cured and discharged, while another one had been transferred to a square cabin hospital for isolation treatment). There were various degrees of fibrin deposition inside and around the villi with local syncytial nodule increases in all three placentas. One case of placenta showed the concomitant morphology of chorionic hemangioma and another one with massive placental infarction. No pathological change of villitis and chorioamnionitis was observed in our observation of three cases. All samples from three placentas were negative for the nucleic acid of 2019-nCoV. The clinical characteristics of pregnant women with 2019-nCoV infection in late pregnancy are similar to those of non-pregnant patients, and no severe adverse pregnancy outcome is found in the 3 cases of our observation. Pathological study suggests that there are no morphological changes related to infection in the three placentas. Currently no evidence for intrauterine vertical transmission of 2019-nCoV is found in the three women infected by 2019-nCoV in their late pregnancy.

摘要

探讨妊娠合并2019新型冠状病毒(2019-nCoV)感染的临床特征及胎盘病理学特点,评估2019-nCoV感染的宫内垂直传播可能性。回顾性研究截至2020年2月4日在华中科技大学同济医学院附属协和医院病理科接收的确诊为2019-nCoV感染孕妇所娩出的胎盘。收集其临床资料包括胎盘组织及肺部CT,以及实验室检查结果,同时采用逆转录-聚合酶链反应(RT-PCR)对胎盘进行2019-nCoV核酸检测。3例确诊为2019-nCoV感染孕妇所娩出的胎盘,均为孕晚期行急诊剖宫产。3例患者均有发热(1例剖宫产术前发热,2例产后发热),且无明显白细胞减少及淋巴细胞减少。对3例新生儿的咽拭子进行2019-nCoV检测,所有样本2019-nCoV核酸均为阴性。1例早产儿因低体重转入新生儿科。截至2020年2月25日,3例患者均未发生重症2019-nCoV肺炎或死亡(2例治愈出院,另1例转至方舱医院隔离治疗)。3例胎盘绒毛内及绒毛周围均有不同程度的纤维素沉积,局部合体结节增多。1例胎盘表现为绒毛膜血管瘤合并形态改变,另1例有大面积胎盘梗死。3例观察病例均未观察到绒毛炎及绒毛膜羊膜炎的病理改变。3例胎盘所有样本2019-nCoV核酸均为阴性。妊娠晚期2019-nCoV感染孕妇的临床特征与非妊娠患者相似,本观察的3例病例未发现严重不良妊娠结局。病理研究提示,3例胎盘均未发现与感染相关的形态学改变。目前未发现3例妊娠晚期感染2019-nCoV的孕妇存在2019-nCoV宫内垂直传播的证据。

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