Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion
Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion
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DOI：
10.1159/000511324
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发表时间：
2021-01-01
期刊：
影响因子：
5
通讯作者：
Bruder, Elisabeth
中科院分区：
文献类型：
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作者：
Menter, Thomas;Mertz, Kirsten Diana;Bruder, Elisabeth
自2019年冠状病毒病（COVID-19）爆发以来，一直存在关于孕妇是否存在COVID-19特定风险以及它是否可能通过胎盘垂直传播的争论。我们展示了一系列5例SARS冠状病毒2（SARS-CoV-2）阳性女性的胎盘，这些女性被诊断患有COVID-19的轻度症状或在出生前无症状。我们提供了一个详细的组织病理学描述的形态学变化，伴随着分析存在的SARS-CoV-2的胎盘组织。所有胎盘均为足月分娩（第40和41孕周）。1例SARS-CoV-2阳性患者出现咳嗽和呼吸困难。胎盘显示明显的淋巴组织细胞性绒毛炎和绒毛间炎，以及母体和胎儿灌注不良的体征。病毒RNA存在于胎盘组织和脐带中，并可通过原位杂交在蜕膜中观察到。SARS-CoV-2检测在3/5的妇女分娩时呈阴性，她们的胎盘没有显示炎性浸润增加。分别有100%和40%的病例出现母体和/或胎儿灌注不良体征。婴儿没有经胎盘传播。在我们的队列中，我们可以记录SARS-CoV-2感染的不同时间点。在急性COVID-19中，可能发生显著的淋巴组织细胞性绒毛炎，可能归因于胎盘的SARS-CoV-2感染。此外，还有母体和胎儿灌注不良的组织病理学体征，这可能与SARS-CoV-2诱导的凝血或微血管病变状态改变有关，但考虑到大量混杂因素，这一点无法得到证实。
Since the outbreak of coronavirus disease 2019 (COVID-19), there has been a debate whether pregnant women are at a specific risk for COVID-19 and whether it might be vertically transmittable through the placenta. We present a series of five placentas of SARS coronavirus 2 (SARS-CoV-2)-positive women who had been diagnosed with mild symptoms of COVID-19 or had been asymptomatic before birth. We provide a detailed histopathologic description of morphological changes accompanied by an analysis of presence of SARS-CoV-2 in the placental tissue. All placentas were term deliveries (40th and 41st gestational weeks). One SARS-CoV-2-positive patient presented with cough and dyspnoea. This placenta showed prominent lymphohistiocytic villitis and intervillositis and signs of maternal and foetal malperfusion. Viral RNA was present in both placenta tissue and the umbilical cord and could be visualized by in situ hybridization in the decidua. SARS-CoV-2 tests were negative at the time of delivery of 3/5 women, and their placentas did not show increased inflammatory infiltrates. Signs of maternal and/or foetal malperfusion were present in 100% and 40% of cases, respectively. There was no transplacental transmission to the infants. In our cohort, we can document different time points regarding SARS-CoV-2 infection. In acute COVID-19, prominent lymphohistiocytic villitis may occur and might potentially be attributable to SARS-CoV-2 infection of the placenta. Furthermore, there are histopathological signs of maternal and foetal malperfusion, which might have a relationship to an altered coagulative or microangiopathic state induced by SARS-CoV-2, yet this cannot be proven considering a plethora of confounding factors.