Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms

被引:38
作者
Husen, Marjolein F. [1 ]
van der Meeren, Lotte E. [2 ,3 ]
Verdijk, Robert M. [3 ,4 ]
Fraaij, Pieter L. A. [5 ,6 ]
van der Eijk, Annemiek A. [5 ]
Koopmans, Marion P. G. [6 ]
Freeman, Liv [7 ]
Bogers, Hein [8 ]
Trietsch, Marjolijn D. [9 ]
Reiss, Irwin K. M. [10 ]
DeKoninck, Philip L. J. [1 ]
Schoenmakers, Sam [1 ]
机构
[1] Univ Med Ctr, Dept Obstet & Gynaecol, Erasmus MC, NL-3015 GD Rotterdam, Netherlands
[2] Leiden Univ Med Ctr, Dept Pathol, NL-2333 ZA Leiden, Netherlands
[3] Univ Med Ctr Utrecht, Dept Pathol, NL-3584 CX Utrecht, Netherlands
[4] Univ Med Ctr, Dept Pathol, Erasmus MC, NL-3015 GD Rotterdam, Netherlands
[5] Univ Med Ctr, Dept Virosci, Erasmus MC, NL-3015 GD Rotterdam, Netherlands
[6] Erasmus MC, Dept Pediat Infectiol Immunol & Rheumatol, NL-3015 GD Rotterdam, Netherlands
[7] Ikazia Hosp, Dept Obstet & Gynaecol, NL-3083 AN Rotterdam, Netherlands
[8] Franciscus Vlietland Hosp, Dept Obstet & Gynaecol, NL-3045 PM Rotterdam, Netherlands
[9] Leiden Univ Med Ctr, Dept Obstet & Gynaecol, NL-2333 ZA Leiden, Netherlands
[10] Univ Med Ctr, Dept Neonatol, Erasmus MC, NL-3015 GD Rotterdam, Netherlands
来源
VIRUSES-BASEL | 2021年 / 13卷 / 08期
关键词
placenta; SARS-CoV-2; pregnancy; foetal outcome; UNKNOWN ETIOLOGY; CHRONIC INTERVILLOSITIS; REPRODUCIBILITY; INFLAMMATION; INFECTION; PATHOLOGY; NOSOLOGY; VILLITIS; LESIONS; WOMEN;
D O I
10.3390/v13081670
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
Background: Although the risk for transplacental transmission of SARS-CoV-2 is rare, placental infections with adverse functional consequences have been reported. This study aims to analyse histological placental findings in pregnancies complicated by SARS-CoV-2 infection and investigate its correlation with clinical symptoms and perinatal outcomes. We want to determine which pregnancies are at-risk to prevent adverse pregnancy outcomes related to COVID-19 in the future. Methods: A prospective, longitudinal, multicentre, cohort study. All pregnant women presenting between April 2020 and March 2021 with a nasopharyngeal RT-PCR-confirmed SARS-CoV-2 infection were included. Around delivery, maternal, foetal and placental PCR samples were collected. Placental pathology was correlated with clinical maternal characteristics of COVID-19. Results: Thirty-six patients were included, 33 singleton pregnancies (n = 33, 92%) and three twin pregnancies (n = 3, 8%). Twenty-four (62%) placentas showed at least one abnormality. Four placentas (4/39, 10%) showed placental staining positive for the presence of SARS-CoV-2 accompanied by a unique combination of diffuse, severe inflammatory placental changes with massive perivillous fibrin depositions, necrosis of syncytiotrophoblast, diffuse chronic intervillositis, and a specific, unprecedented CD20+ B-cell infiltration. This SARS-CoV-2 placental signature seems to correlate with foetal distress (75% vs. 15.6%, p = 0.007) but not with the severity of maternal COVID-19 disease. Conclusion: We describe a unique placental signature in pregnant patients with COVID-19, which has not been reported in a historical cohort. We show that the foetal environment can be seriously compromised by disruption of placental function due to local, devastating SARS-CoV-2 infection. Maternal clinical symptoms did not predict the severity of the SARS-CoV-2-related placental signature, resulting in a lack of adequate identification of maternal criteria for pregnancies at risk. Close foetal monitoring and pregnancy termination in case of foetal distress can prevent adverse pregnancy outcomes due to COVID-19 related placental disease.
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页数:13
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