Medipath Montpellier, 80 rue de Pythagore, 34170, Castelnau-Le-Lez, France.
Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France.
Placenta. 2023 May;136:1-7. doi: 10.1016/j.placenta.2023.03.004. Epub 2023 Mar 17.
SARS-Cov-2 infection during pregnancy can lead to severe placental lesions characterized by massive perivillous fibrin deposition, histiocytic intervillositis and trophoblast necrosis. Diffuse placental damage of this kind is rare, but can sometimes lead to obstetric complications, such as intrauterine fetal death (IUFD). The objectives of this study were to identify possible predictors of severe placental lesions.
We retrospectively studied 96 placentas from SARS-Cov-2 positive pregnant women who gave birth between March 2020 and March 2022. Cases with and without severe placental lesions were compared in terms of clinical and laboratory findings.
Twelve of the 96 patients had severe placental lesions. There was no significant association with diabetes, obesity or severe clinical maternal disease. In contrast, presence of severe placental lesions was significantly associated with neonatal intensive care, cesarean section, prematurity, IUFD, intrauterine growth restriction (IUGR), gestational age, maternal hypofibrinogenemia and thrombocytopenia. No cases of severe placental lesions were observed in vaccinated patients or in those with the Omicron variant.
In these patients, severe placental lesions due to SARS-Cov-2 were significantly associated with the presence of coagulation abnormalities (hypofibrinogenemia and thrombocytopenia), IUGR and gestational age. These results support laboratory and ultrasound monitoring of these parameters in pregnant women with SARS-Cov-2 infection, especially during the second trimester, to predict potential negative fetal outcomes.
SARS-CoV-2 感染孕妇可导致严重的胎盘病变，其特征为绒毛外大量纤维蛋白沉积、组织细胞绒毛炎和滋养细胞坏死。这种弥漫性胎盘损伤较为罕见，但有时可导致产科并发症，如胎儿宫内死亡（IUFD）。本研究的目的是确定严重胎盘病变的可能预测因素。
我们回顾性研究了 2020 年 3 月至 2022 年 3 月期间 SARS-CoV-2 阳性孕妇分娩的 96 例胎盘。比较了有和无严重胎盘病变的病例在临床和实验室发现方面的差异。
96 例患者中有 12 例存在严重胎盘病变。与糖尿病、肥胖或严重的母体临床疾病无关。相比之下，严重胎盘病变与新生儿重症监护、剖宫产、早产、IUFD、宫内生长受限（IUGR）、胎龄、母体低纤维蛋白原血症和血小板减少症显著相关。未观察到接种疫苗的患者或感染奥密克戎变异株的患者有严重胎盘病变。
在这些患者中，SARS-CoV-2 引起的严重胎盘病变与凝血异常（低纤维蛋白原血症和血小板减少症）、IUGR 和胎龄显著相关。这些结果支持对 SARS-CoV-2 感染孕妇进行这些参数的实验室和超声监测，特别是在孕中期，以预测潜在的不良胎儿结局。
