The Department of Pathology, Medical College of Georgia, Augusta (Schwartz).
The Department of Pathology, University Hospitals Leuven, Leuven, Belgium (Baldewijns).
Arch Pathol Lab Med. 2021 May 1;145(5):517-528. doi: 10.5858/arpa.2020-0771-SA.
CONTEXT.—: The number of neonates with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is increasing, and in a few there are reports of intrauterine infection.
OBJECTIVE.—: To characterize the placental pathology findings in a preselected cohort of neonates infected by transplacental transmission arising from maternal infection with SARS-CoV-2, and to identify pathology risk factors for placental and fetal infection.
DESIGN.—: Case-based retrospective analysis by a multinational group of 19 perinatal specialists of the placental pathology findings from 2 cohorts of infants delivered to mothers testing positive for SARS-CoV-2: live-born neonates infected via transplacental transmission who tested positive for SARS-CoV-2 after delivery and had SARS-CoV-2 identified in cells of the placental fetal compartment by molecular pathology, and stillborn infants with syncytiotrophoblast positive for SARS-CoV-2.
RESULTS.—: In placentas from all 6 live-born neonates acquiring SARS-CoV-2 via transplacental transmission, the syncytiotrophoblast was positive for coronavirus using immunohistochemistry, RNA in situ hybridization, or both. All 6 placentas had chronic histiocytic intervillositis and necrosis of the syncytiotrophoblast. The 5 stillborn/terminated infants had placental pathology findings that were similar, including SARS-CoV-2 infection of the syncytiotrophoblast, chronic histiocytic intervillositis, and syncytiotrophoblast necrosis.
CONCLUSIONS.—: Chronic histiocytic intervillositis together with syncytiotrophoblast necrosis accompanies SARS-CoV-2 infection of syncytiotrophoblast in live-born and stillborn infants. The coexistence of these 2 findings in all placentas from live-born infants acquiring their infection prior to delivery indicates that they constitute a pathology risk factor for transplacental fetal infection. Potential mechanisms of infection of the placenta and fetus with SARS-CoV-2, and potential future studies, are discussed.
感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的新生儿数量正在增加，并且有少数报告称存在宫内感染。
描述通过胎盘传播从感染 SARS-CoV-2 的母亲感染而感染的新生儿中选择的队列的胎盘病理学发现，并确定胎盘和胎儿感染的病理学危险因素。
由 19 名围产期专家组成的跨国小组对 2 个队列的胎盘病理学发现进行了基于病例的回顾性分析，这些队列是由 SARS-CoV-2 检测呈阳性的母亲分娩的感染通过胎盘传播的活产新生儿，这些新生儿在分娩后检测出 SARS-CoV-2 阳性，并通过分子病理学在胎盘胎儿隔室的细胞中鉴定出 SARS-CoV-2，以及感染 SARS-CoV-2 的合胞体阳性的死胎婴儿。
在所有 6 例通过胎盘传播感染 SARS-CoV-2 的活产新生儿的胎盘组织中，使用免疫组织化学、RNA 原位杂交或两者均检测到合体滋养层中冠状病毒阳性。所有 6 例胎盘均有慢性组织细胞性绒毛膜炎和合体滋养层坏死。5 例死产/终止妊娠的婴儿具有相似的胎盘病理学发现，包括合胞体滋养层感染 SARS-CoV-2、慢性组织细胞性绒毛膜炎和合体滋养层坏死。
慢性组织细胞性绒毛膜炎伴合体滋养层坏死伴随活产和死产婴儿的合胞体滋养层感染 SARS-CoV-2。在所有活产婴儿的胎盘组织中均存在这 2 种发现，表明它们构成了胎盘和胎儿感染的病理学危险因素。讨论了感染胎盘和胎儿的 SARS-CoV-2 的潜在机制以及未来的潜在研究。
