Institut de Pathologie Multisite des Hospices Civils de Lyon, 69677, Bron Cedex, Lyon, France; SOFFOET-Société Française de Fœtopathologie, 75014, Paris, France.
SOFFOET-Société Française de Fœtopathologie, 75014, Paris, France; Institut de Pathologie, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Bénite, Lyon, France.
Placenta. 2021 Sep 1;112:97-104. doi: 10.1016/j.placenta.2021.07.288. Epub 2021 Jul 15.
Pregnant women with covid-19 are more likely to experience preterm birth. The virus seems to be associated with a wide range of placental lesions, none of them specific.
We collected cases of Covid-19 maternal infection during pregnancy associated with poor pregnancy outcomes, for which we received the placenta. We studied clinical data and described pathological findings of placenta and post-mortem examination of fetuses. We performed an immunohistochemical study and RT-PCR of SARS-Cov-2 on placenta samples.
We report 5 cases of poor fetal outcome, 3 fetal deaths and 2 extreme premature neonates, one with growth restriction, without clinical and biological sign of SARS-Cov-2 infection. All placenta presented massive perivillous fibrin deposition and large intervillous thrombi associated with strong SARS-Cov-2 expression in trophoblast and SARS-CoV-2 PCR positivity in amniotic fluid or on placenta samples. Chronic histiocytic intervillositis was present in 4/5 cases. Placental ultrasound was abnormal and the sFLT1-PIGF ratio was increased in one case. Timing between mothers' infection and the poor fetal outcome was ≤10 days in 4 cases. The massive placental damage are directly induced by the virus whose receptors are expressed on trophoblast, leading to trophoblast necrosis and massive inflammation in villous chamber, in a similar way it occurs in diffuse alveolar damage in adults infected by SARS-Cov-2.
SARS-Cov-2 can be associated to a rare set of placental lesions which can lead to fetal demise, preterm birth, or growth restriction. Stronger surveillance of mothers infected by SARS-Cov-2 is required.
感染新冠病毒的孕妇更有可能早产。该病毒似乎与广泛的胎盘病变有关，但没有一种是特异性的。
我们收集了与妊娠不良结局相关的新冠病毒感染的母体病例，为此我们收到了胎盘。我们研究了临床数据和胎盘的病理发现以及胎儿的尸检。我们对胎盘样本进行了 SARS-CoV-2 的免疫组化研究和 RT-PCR。
我们报告了 5 例不良胎儿结局，3 例胎儿死亡和 2 例早产极低体重儿，其中 1 例有生长受限，但无 SARS-CoV-2 感染的临床和生物学迹象。所有胎盘均表现为大量绒毛膜下纤维蛋白沉积和大的绒毛间血栓，伴有滋养细胞中强烈的 SARS-CoV-2 表达和羊水或胎盘样本中 SARS-CoV-2 PCR 阳性。4/5 例存在慢性组织细胞性绒毛膜炎。4 例胎盘超声异常，1 例 sFLT1-PIGF 比值升高。母亲感染与不良胎儿结局之间的时间间隔在 4 例中均≤10 天。这种严重的胎盘损伤是由病毒直接引起的，病毒的受体在滋养细胞上表达，导致滋养细胞坏死和绒毛腔大量炎症，这与感染 SARS-CoV-2 的成年人发生弥漫性肺泡损伤的方式类似。
SARS-CoV-2 可能与一组罕见的胎盘病变有关，这些病变可导致胎儿死亡、早产或生长受限。需要对感染 SARS-CoV-2 的母亲进行更严格的监测。
