PDF(Pubmed)
Abstract：
Coronavirus disease 2019 (COVID-19) has had significant impacts on mothers and neonates. In this report, we present four unique cases of COVID-19 infections in pregnancy and its effects on the mother, fetus, and placenta. Four mothers presented to the hospital during their pregnancy. Each had tested COVID-19-positive 1-29 days prior to admission. Gestational age ranged from 16 weeks six days to 36 weeks six days. Three of the four cases resulted in fetal demise or infant expiration. The common finding among all four cases was pathologic changes in the placenta. Most of the placentas were small for gestational age and had extensive villous infarction. There was also histiocytic intervillositis with villous necrosis and perivillous fibrin deposition. The placentas demonstrated positive staining of syncytiotrophoblasts for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike S1 subunit protein. SARS-CoV-2 RNA was detected in tissue samples of two of the fetuses demonstrating vertical transmission. A higher incidence of severe COVID-19 disease course has been observed in pregnant women. Prior to the SARS-CoV-2 pandemic, chorionic histiocytic intervillositis of the placenta was rarely seen, and mostly of unknown etiology. The increase in placental fibrin levels results in decreased maternal placenta blood flow ensuing hypoxic stress in the fetus. Intrauterine hypoxia has been associated with alterations in brain structure and function resulting in defects in motor skills, cerebral palsy, decreased brain weight, schizophrenia, and other forms of cognitive impairment.
摘要：
2019年冠状病毒病（COVID-19）对母亲和新生儿产生了重大影响。在这份报告中,我们介绍了4例妊娠期间COVID-19感染的独特病例及其对母亲的影响，胎儿,和胎盘。四名母亲在怀孕期间被送到医院。每个人在入院前1-29天检测到COVID-19阳性。妊娠年龄为16周6天至36周6天。四例中的三例导致胎儿死亡或婴儿过期。在所有四例中，常见的发现是胎盘的病理变化。大多数胎盘小于胎龄，并有广泛的绒毛梗塞。也有组织细胞间粘膜炎伴绒毛状坏死和绒毛状纤维蛋白沉积。胎盘显示合胞体滋养层对严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）尖峰S1亚基蛋白的阳性染色。在两个胎儿的组织样品中检测到SARS-CoV-2RNA，显示出垂直传播。在孕妇中观察到严重COVID-19病程的发病率较高。在SARS-CoV-2大流行之前，很少见到胎盘的绒毛膜组织细胞间粘膜炎，大多病因不明。胎盘纤维蛋白水平的增加导致母体胎盘血流量减少，从而导致胎儿缺氧应激。宫内缺氧与大脑结构和功能的改变有关，导致运动技能的缺陷。脑瘫,减少大脑重量,精神分裂症,和其他形式的认知障碍。
