PDF(Pubmed)
Abstract：
Although studies evaluated placental involvement in Covid-19 patients, few have assessed its association with clinical repercussions. The study aimed to determine the association between the clinical status and maternal and perinatal outcomes of patients with Covid-19 at delivery and changes in placental histology. It is so far the largest cohort evaluating placentas of patients infected by the SARS-CoV-2. A secondary analysis was conducted of a database from which a cohort of 226 patients, who tested real-time polymerase chain reaction-positive for Covid-19 at delivery and whose placentas were collected and submitted to pathology, was selected for inclusion. One or more types of histological changes were detected in 44.7% of the 226 placentas evaluated. The most common abnormalities were maternal vascular malperfusion (38%), evidence of inflammation/infection (9.3%), fetal vascular malperfusion (0.8%), fibrinoid changes and intervillous thrombi (0.4%). Oxygen use (P = .01) and need for admission to an intensive care unit (ICU) (P = .04) were less common in patients with placental findings, and hospital stay was shorter in these patients (P = .04). There were more fetal deaths among patients with evidence of inflammation/infection (P = .02). Fetal death, albeit uncommon, is associated with findings of inflammation/infection. Oxygen use and need for admission to an ICU were less common among patients with placental findings, probably due to the pregnancy being interrupted early. None of the other findings was associated with maternal clinical status or with adverse perinatal outcome.
摘要：
尽管研究评估了Covid-19患者的胎盘受累，很少有人评估其与临床影响的关联.该研究旨在确定新冠肺炎患者分娩时的临床状况、孕产妇和围产期结局与胎盘组织学变化之间的关系。这是迄今为止评估SARS-CoV-2感染患者胎盘的最大队列。对一个数据库进行了二次分析，该数据库中有226名患者，谁在分娩时检测到Covid-19的实时聚合酶链反应阳性，谁的胎盘被收集并接受病理检查，被选中列入。在评估的226个胎盘中，有44.7％检测到一种或多种类型的组织学变化。最常见的异常是母体血管灌注不良（38%），炎症/感染的证据（9.3％），胎儿血管灌注不良（0.8%），纤维蛋白样变化和绒毛间血栓（0.4％）。在有胎盘发现的患者中，氧气使用（P=0.01）和重症监护病房（ICU）的需要（P=0.04）较不常见。这些患者的住院时间较短（P=0.04）。有炎症/感染证据的患者中有更多的胎儿死亡（P=0.02）。胎儿死亡,虽然不常见,与炎症/感染的发现有关。在胎盘发现的患者中，氧气的使用和ICU的需要不太常见。可能是由于怀孕早期中断。其他发现均与孕产妇临床状况或不良围产期结局无关。
