Placental Pathology in COVID-19: Case Series in a Community Hospital Setting.
Placental Pathology in COVID-19: Case Series in a Community Hospital Setting.
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Covid-19的胎盘病理学：社区医院环境中的病例系列。
DOI：
10.7759/cureus.12522
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发表时间：
2021-01-06
期刊：
影响因子：
--
通讯作者：
Shertz W
中科院分区：
文献类型：
--
作者：
Singh N;Buckley T;Shertz W
目的报告妊娠合并冠状病毒病（COVID-19）患者胎盘的病理组织学表现。方法确定2020年4月至2020年6月期间分娩的COVID-19孕妇。对来自Robert Wood约翰逊巴纳巴斯健康公司附属的蒙茅斯医学中心病理科的COVID阳性妇女的胎盘进行了回顾性研究，并与来自COVID阴性妇女的胎盘对照队列进行了比较。产妇在临产和分娩时通过鼻咽拭子进行冠状病毒检测。根据产科医生的临床判断，病毒检测呈阴性的母亲的胎盘被送往病理科进行检查。结果对来自COVID-19阳性患者的50份手术标本（49份胎盘和1份妊娠产物）进行了检查，并与同期分娩的COVID-19检测结果阴性的50份胎盘进行了比较。大多数新生儿在1分钟和5分钟时的外观、脉搏、鬼脸、活动和呼吸（APGAR）评分分别为9分和9分。在Rh阳性A型血和犹太血统的个体中，COVID-19阳性的发生率增加。与对照组相比，COVID-19阳性胎盘表现出灌注不良特征（微钙化、纤维蛋白血栓、合胞体打结和绒毛凝集）增加。然而，在其他变量中没有显著的失调，如炎症或凝血。没有一例母亲或胎儿死亡（超过8周）或由于母亲的阳性COVID-19状态而导致胎儿结局恶化的证据。结论COVID-19阳性胎盘显示微钙化和纤维蛋白血栓的患病率增加，这可能反映了COVID-19感染引起的潜在高凝状态，也可能是由于过度的合胞体滋养层损伤。
Objective To report the histopathologic findings in the placentas of pregnant women with coronavirus disease-19 (COVID-19). Methods Pregnant women with COVID-19 delivering between April 2020 to June 2020 were identified. A retrospective study of placentas from COVID positive women received in the Department of Pathology, Monmouth Medical Center affiliate of Robert Wood Johnson Barnabas Health were examined and compared to control cohort of placentas from COVID negative women. The mothers were tested for coronavirus through nasopharyngeal swab upon admission to labor and delivery. The placentas from mothers who tested negative for the virus were sent to Pathology for examination based on the obstetrician’s clinical judgment. Results Fifty surgical specimens (49 placentas and one product of conception) from patients positive for COVID-19 were examined and compared with fifty placentas from women with negative COVID-19 test results, who delivered during the same period. Most of the neonates had Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores of 9 and 9 at 1 and 5 minutes, respectively. Increased incidence of the COVID-19 positivity was noted in individuals with Rh-positive blood group A and Jewish heritage. Compared to the control group, the COVID-19 positive placentas showed increased features of malperfusion (microcalcifications, fibrin thrombi, syncytial knotting, and villous agglutination). However, there was no significant dysregulation in other variables, such as inflammation or coagulation. There was no case of maternal or fetal death (greater than eight weeks) or evidence of worse fetal outcomes noted due to a mother's positive COVID-19 status. Conclusions The COVID-19 positive placentas showed an increased prevalence of microcalcifications and fibrin thrombi, which may reflect an underlying hypercoagulable state induced by COVID-19 infection or could be due to excessive syncytiotrophoblast injury.
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