Ramphal S, Govender N, Singh S, Khaliq O P, Naicker T
Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Department of Basic Medical Sciences, Durban University of Technology, Durban, KwaZulu-Natal, South Africa.
Eur J Obstet Gynecol Reprod Biol X. 2022 May 14;15:100153. doi: 10.1016/j.eurox.2022.100153. eCollection 2022 Aug.
This study aims to provide a semi-qualitative histopathological report of the dual SARS-CoV-2 and HIV infected placentae in the third trimester of Advanced Abdominal Pregnancy (AAP).
Four AAP placentae in the third trimester of pregnancy (two positive for HIV-1 and two positives for SARS-CoV-2) were histologically examined.
The SARS-CoV-2 HIV placentae were dysmorphic in shape compared to the flattened disc-like shape noted in the SARS-CoV-2HIV, SARS-CoV-2HIVand SARS-CoV-2HIV placentae. Diffused syncytial knots and syncytial degeneration were observed in all placentae. Intermittent cytotrophoblast increase, perivillous and intravillous fibrin deposition, mononuclear inflammatory cells with widespread degeneration/necrosis of the syncytiotrophoblast and microcalcification were pronounced in the SARS-CoV-2HIV compared to the SARS-CoV-2HIV placentae. Vascular pathological changes included thrombi, ectasis, mural hypertrophy and atherotic vessels.
Elevated syncytial trophoblast injury, villitis, microcalcifications and mineralisation of the syncytial basement membrane in the AAP placentae may be due to SARS-CoV-2 viral transgression instead of HIV infection alone. Vascular malperfusion is suggestive of a hypoxic insult arising from a compensatory response to meet the fetal oxygen and nutrient demands of an AAP. Placentae from HIV infected women on antiretroviral treatment were characterised by vascular malperfusion.
本研究旨在提供晚期腹腔妊娠（AAP）晚期妊娠第三个月时，同时感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）和人类免疫缺陷病毒（HIV）的胎盘的半定性组织病理学报告。
对妊娠晚期的四个AAP胎盘（两个HIV-1阳性，两个SARS-CoV-2阳性）进行组织学检查。
与SARS-CoV-2HIV、SARS-CoV-2HIV和SARS-CoV-2HIV胎盘呈现的扁平盘状形状相比，SARS-CoV-2 HIV胎盘形状异常。在所有胎盘中均观察到弥漫性合体细胞结节和合体细胞变性。与SARS-CoV-2HIV胎盘相比，SARS-CoV-2HIV中滋养层细胞间歇性增加、绒毛周围和绒毛内纤维蛋白沉积、单核炎性细胞以及合体滋养层细胞广泛变性/坏死和微钙化更为明显。血管病理变化包括血栓形成、扩张、壁肥厚和动脉粥样硬化血管。
AAP胎盘中合体滋养层细胞损伤增加、绒毛炎、微钙化以及合体基底膜矿化可能是由于SARS-CoV-2病毒侵袭，而非仅由HIV感染所致。血管灌注不良提示因对AAP胎儿氧气和营养需求的代偿反应而产生的缺氧损伤。接受抗逆转录病毒治疗的HIV感染女性的胎盘特征为血管灌注不良。
