Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland,
Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland.
Pathobiology. 2021;88(1):69-77. doi: 10.1159/000511324. Epub 2020 Sep 18.
Since the outbreak of coronavirus disease 2019 (COVID-19), there has been a debate whether pregnant women are at a specific risk for COVID-19 and whether it might be vertically transmittable through the placenta. We present a series of five placentas of SARS coronavirus 2 (SARS-CoV-2)-positive women who had been diagnosed with mild symptoms of COVID-19 or had been asymptomatic before birth. We provide a detailed histopathologic description of morphological changes accompanied by an analysis of presence of SARS-CoV-2 in the placental tissue. All placentas were term deliveries (40th and 41st gestational weeks). One SARS-CoV-2-positive patient presented with cough and dyspnoea. This placenta showed prominent lymphohistiocytic villitis and intervillositis and signs of maternal and foetal malperfusion. Viral RNA was present in both placenta tissue and the umbilical cord and could be visualized by in situ hybridization in the decidua. SARS-CoV-2 tests were negative at the time of delivery of 3/5 women, and their placentas did not show increased inflammatory infiltrates. Signs of maternal and/or foetal malperfusion were present in 100% and 40% of cases, respectively. There was no transplacental transmission to the infants. In our cohort, we can document different time points regarding SARS-CoV-2 infection. In acute COVID-19, prominent lymphohistiocytic villitis may occur and might potentially be attributable to SARS-CoV-2 infection of the placenta. Furthermore, there are histopathological signs of maternal and foetal malperfusion, which might have a relationship to an altered coagulative or microangiopathic state induced by SARS-CoV-2, yet this cannot be proven considering a plethora of confounding factors.
自 2019 年冠状病毒病(COVID-19)爆发以来,一直存在争议,即孕妇是否存在 COVID-19 的特定风险,以及 COVID-19 是否可以通过胎盘垂直传播。我们呈现了一系列五例 SARS-CoV-2(SARS-CoV-2)阳性孕妇的胎盘,这些孕妇在产前被诊断为 COVID-19 轻度症状或无症状。我们详细描述了形态变化,并分析了胎盘组织中 SARS-CoV-2 的存在。所有胎盘均为足月分娩(第 40 周和第 41 周)。一名 SARS-CoV-2 阳性患者表现为咳嗽和呼吸困难。该胎盘显示出明显的淋巴组织细胞绒毛炎和绒毛膜炎以及母体和胎儿灌注不良的迹象。胎盘组织和脐带中均存在病毒 RNA,并可在蜕膜中通过原位杂交观察到。在 5 名妇女中,有 3 名在分娩时 SARS-CoV-2 检测呈阴性,且其胎盘未显示出炎症浸润增加。母体和/或胎儿灌注不良的迹象分别出现在 100%和 40%的病例中。没有向婴儿的胎盘传播。在我们的队列中,我们可以记录到 SARS-CoV-2 感染的不同时间点。在急性 COVID-19 中,可能会发生明显的淋巴组织细胞绒毛炎,并且可能归因于胎盘的 SARS-CoV-2 感染。此外,还有母体和胎儿灌注不良的组织病理学迹象,这可能与 SARS-CoV-2 引起的凝血或微血管病状态改变有关,但考虑到大量混杂因素,这无法得到证明。