EA 73-28, Paris Cité University, Necker University Hospital, Paris, France.
Maternity Department, Necker University Hospital, Paris, France.
Ultrasound Obstet Gynecol. 2023 Dec;62(6):867-874. doi: 10.1002/uog.27439.
Placental infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to placental insufficiency and in-utero fetal death (IUFD). The objective of this study was to confirm and quantify the extent to which fetoplacental infection with SARS-CoV-2 is a cause of fetal death.
This was a multicenter retrospective cohort study of fetal deaths that underwent postmortem examination between January 2020 and January 2022 in three fetal pathology units in Paris, France. All cases of IUFD and termination of pregnancy (TOP) occurring in 31 maternity hospitals in the Paris region undergo detailed placental pathological examination in these units. Databases were searched for cases of IUFD and TOP. Cases with fetal malformation or cytogenetic abnormality were excluded to avoid bias. We included cases of IUFD with a placental or undetermined cause and cases of TOP in the context of severe intrauterine growth restriction (IUGR). Placentas were sent to a single virology unit for reverse-transcription polymerase chain reaction (RT-PCR) testing by a single laboratory technician blinded to the initial postmortem examination report. Our primary endpoint was the proportion of positive placental SARS-CoV-2 RT-PCR tests in the cohort.
Among 147 722 deliveries occurring over 2 years, 788 postmortem examinations for IUFD and TOP for severe IUGR were recorded, of which 462 (58.6%) were included. A total of 13/462 (2.8%) placentas tested positive for SARS-CoV-2 by RT-PCR. Wild-type virus and alpha and delta variants were identified. All positive cases had histological lesions consistent with placental dysfunction. There was a strong correlation between SARS-CoV-2 placentitis and the presence of chronic intervillositis and/or massive fibrin deposits in the placenta. When both lesion types were present, the specificity and negative predictive value for the diagnosis of placental SARS-CoV-2 infection were 0.99 (95% CI, 0.98-1.00) and 0.96 (95% CI, 0.94-0.98), respectively.
At the height of the SARS-CoV-2 pandemic, the cause of more than half of fetal deaths in the Paris area was determined by postmortem analysis to be of placental or undetermined origin. Of these cases, 2.8% were due to placental SARS-CoV-2 infection with a specific pattern of histological involvement. This study highlights the need for SARS-CoV-2 screening in stillbirth assessment. The impact of vaccination coverage remains to be established. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
胎盘感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）可导致胎盘功能不全和宫内胎儿死亡（IUFD）。本研究的目的是确认并量化 SARS-CoV-2 引起胎儿死亡的程度。
这是一项多中心回顾性队列研究，纳入了 2020 年 1 月至 2022 年 1 月在法国巴黎的三个胎儿病理学单位进行尸检的胎儿死亡病例。巴黎地区 31 家产科医院发生的所有 IUFD 和终止妊娠（TOP）病例均在这些单位进行详细的胎盘病理检查。检索数据库以寻找 IUFD 和 TOP 病例。排除有胎儿畸形或细胞遗传学异常的病例，以避免偏倚。我们纳入了 IUFD 病例，这些病例的胎盘或病因不明，以及在严重宫内生长受限（IUGR）背景下的 TOP 病例。胎盘被送到一个单一的病毒学单位进行逆转录聚合酶链反应（RT-PCR）检测，由一名对初始尸检报告不知情的单一实验室技术人员进行。我们的主要终点是队列中 SARS-CoV-2 阳性胎盘 RT-PCR 检测的比例。
在 2 年期间发生的 147722 例分娩中，记录了 788 例 IUFD 和严重 IUGR 的 TOP 尸检，其中 462 例（58.6%）被纳入。共有 13/462（2.8%）胎盘通过 RT-PCR 检测到 SARS-CoV-2 阳性。鉴定出野生型病毒和 alpha 和 delta 变体。所有阳性病例均有与胎盘功能障碍一致的组织学病变。SARS-CoV-2 胎盘炎与慢性绒毛膜炎和/或胎盘大量纤维蛋白沉积的存在之间存在很强的相关性。当两种病变类型都存在时，SARS-CoV-2 感染胎盘的诊断特异性和阴性预测值分别为 0.99（95%CI，0.98-1.00）和 0.96（95%CI，0.94-0.98）。
在 SARS-CoV-2 大流行期间，巴黎地区一半以上的胎儿死亡原因通过尸检分析确定为胎盘或病因不明。在这些病例中，2.8%是由于胎盘 SARS-CoV-2 感染引起的，具有特定的组织学受累模式。本研究强调了在死产评估中需要进行 SARS-CoV-2 筛查。疫苗接种覆盖率的影响仍有待确定。© 2023 作者。超声在妇产科由约翰威立父子公司出版代表国际妇产科超声学会。
