Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Department of Pathology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Placenta. 2023 Aug;139:190-199. doi: 10.1016/j.placenta.2023.06.015. Epub 2023 Jul 8.
Placental morphology findings in SARS-CoV-2 infection are considered nonspecific, although the role of trimester and severity of infection are underreported. Therefore, we aimed to investigate abnormal placental morphology, according to these two criteria.
This is an ancillary analysis of a prospective cohort study of pregnant women with suspected SARS-CoV-2 infection, managed in one maternity, from March 2020 to October 2021. Charting of clinical/obstetric history, trimester and severity of COVID-19 infection, and maternal/perinatal outcomes were done. Placental morphological findings were classified into maternal and fetal circulatory injury and acute/chronic inflammation. We further compared findings with women with suspected disease which tested negative for COVID-19. Diseases' trimester of infection and clinical severity guided the analysis of confirmed COVID-19 cases.
Ninety-one placental discs from 85 women were eligible as a COVID-19 group, and 42 discs from 41 women in negative COVID-19 group. SARS-CoV-2 infection occurred in 68.2% during third trimester, and 6.6% during first; 16.5% were asymptomatic, 61.5% non-severe and 22.0% severe symptomatic (two maternal deaths). Preterm birth occurred in 33.0% (one fetal death). Global maternal vascular malperfusion (MVM) were significant in COVID-19 group whether compared with negative COVID-19 tests group; however, fetal vascular malperfusion lesions and low-grade chronic villitis were not. Three placentas had COVID-19 placentitis. Decidual arteriopathy was associated with infection in first/mid trimester, and chorangiosis in asymptomatic infections.
Placental abnormalities after an infection by COVID-19 were more frequent after first/mid-trimester infections. Extensive placental lesions are rare, although they may be more common upon underlying medical conditions.
在 SARS-CoV-2 感染中，胎盘形态学发现被认为是非特异性的，尽管感染的 trimester 和严重程度的作用报道较少。因此，我们旨在根据这两个标准研究异常胎盘形态。
这是对 2020 年 3 月至 2021 年 10 月期间在一家产科中心管理的疑似 SARS-CoV-2 感染的孕妇进行的前瞻性队列研究的辅助分析。记录临床/产科病史、COVID-19 感染 trimester 和严重程度以及母婴围生期结局。将胎盘形态学发现分为母体和胎儿循环损伤以及急性/慢性炎症。我们进一步将这些发现与 COVID-19 检测阴性的疑似疾病妇女进行了比较。感染的 trimester 和疾病的临床严重程度指导了对确诊 COVID-19 病例的分析。
85 名妇女的 91 个胎盘盘符合 COVID-19 组，41 名妇女的 42 个胎盘盘符合 COVID-19 阴性组。SARS-CoV-2 感染发生在第三个 trimester 的 68.2%，第一个 trimester 的 6.6%；16.5%无症状，61.5%非严重，22.0%严重症状（两例母亲死亡）。早产发生率为 33.0%（一例胎儿死亡）。与 COVID-19 阴性检测组相比，COVID-19 组的全球母体血管功能不全（MVM）显著，但胎儿血管功能不全病变和低级别慢性绒毛膜炎则不然。有 3 例胎盘有 COVID-19 胎盘炎。蜕膜动脉病变与第一/中期感染有关，绒毛膜炎与无症状感染有关。
COVID-19 感染后胎盘异常更常见于第一/中期感染后。尽管在潜在的疾病情况下可能更常见，但广泛的胎盘病变很少见。
