Hessami Kamran, Aagaard Kjersti M, Castro Eumenia C, Arian Sara E, Nassr Ahmed A, Barrozo Enrico R, Seferovic Maxim D, Shamshirsaz Alireza A
Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Am J Perinatol. 2022 Nov;39(15):1643-1653. doi: 10.1055/a-1787-7933. Epub 2022 Mar 3.
We aimed to perform a meta-analysis of the literature concerning histopathologic findings in the placentas of women with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection during pregnancy. Searches for articles in English included PubMed, Web of Science, Google Scholar, and reference lists (up to April 2021). Studies presenting data on placental histopathology according to the Amsterdam Consensus Group criteria in SARS-CoV-2 positive and negative pregnancies were identified. Lesions were categorized into: maternal and fetal vascular malperfusion (MVM and FVM, respectively), acute placental inflammation with maternal and fetal inflammatory response (MIR and FIR, respectively), chronic inflammatory lesions (CILs), and increased perivillous fibrin deposition (PVFD). A total of 15 studies reporting on 19,025 placentas, = 699 of which were derived from women who were identified as being infected with SARS-CoV-2 and 18,326 as SARS-CoV-2-negative controls, were eligible for analysis. No significant difference in incidence of MVM (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 0.73-1.90), FVM (OR: 1.23, 95% CI: 0.63-2.42), MIR (OR: 0.66, 95% CI: 0.29-1.52) or FIR (OR: 0.85, 95% CI: 0.44-1.63), and CILs (OR: 0.97, 95% CI: 0.55-1.72) was found between placentae from gravida identified as being SARS-CoV-2 infected. However, placenta from gravida identified as being infected with SARS-CoV-2 were associated with significantly increased occurrence of PVFD (OR: 2.77, 95% CI: 1.06-7.27). After subgroup analyses based on clinical severity of COVID-19 infection, no significant difference was observed in terms of reported placental pathology between symptomatic or asymptomatic SARS-CoV-2 gravidae placenta. Current evidence based on the available literature suggests that the only pathologic finding in the placentae of women who are pregnant identified as having been infected with SARS-CoV-2 was an increased prevalence of PVFD. KEY POINTS: · No association between SARS-CoV-2 and maternal or fetal placental malperfusion.. · No association between SARS-CoV-2 and maternal or fetal inflammatory response.. · SARS-CoV-2 is associated with increased perivillous fibrin deposition in placenta..
我们旨在对有关妊娠期间感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的女性胎盘组织病理学发现的文献进行荟萃分析。检索英文文章的数据库包括PubMed、科学网、谷歌学术以及参考文献列表（截至2021年4月）。确定了根据阿姆斯特丹共识小组标准呈现SARS-CoV-2阳性和阴性妊娠胎盘组织病理学数据的研究。病变分为：母体和胎儿血管灌注不良（分别为MVM和FVM）、伴有母体和胎儿炎症反应的急性胎盘炎症（分别为MIR和FIR）、慢性炎症病变（CILs）以及绒毛周围纤维蛋白沉积增加（PVFD）。共有15项研究报告了19,025例胎盘，其中699例来自被确定感染SARS-CoV-2的女性，18,326例作为SARS-CoV-2阴性对照，符合分析条件。在被确定感染SARS-CoV-2的孕妇胎盘中，MVM（优势比[OR]：1.18，95%置信区间[CI]：0.73 - 1.90）、FVM（OR：1.23，95% CI：0.63 - 2.42）、MIR（OR：0.66，95% CI：0.29 - 1.52）或FIR（OR：0.85，95% CI：0.44 - 1.63）以及CILs（OR：0.97，95% CI：0.55 - 1.72）的发生率均无显著差异。然而，被确定感染SARS-CoV-2的孕妇胎盘与PVFD的发生率显著增加相关（OR：2.77，95% CI：1.06 - 7.27）。在根据COVID-19感染的临床严重程度进行亚组分析后，有症状或无症状的SARS-CoV-2感染孕妇胎盘在报告的胎盘病理学方面未观察到显著差异。基于现有文献的当前证据表明，被确定感染SARS-CoV-2的孕妇胎盘中唯一的病理发现是PVFD的患病率增加。要点：· SARS-CoV-2与母体或胎儿胎盘灌注不良之间无关联。· SARS-CoV-2与母体或胎儿炎症反应之间无关联。· SARS-CoV-2与胎盘绒毛周围纤维蛋白沉积增加有关。
