背景:妊娠期间SARS-Cov-2感染可导致严重的胎盘病变,其特征是大量绒毛周围纤维蛋白沉积,组织细胞性颌间炎和滋养细胞坏死。这种弥漫性胎盘损伤很少见,但有时会导致产科并发症,如宫内胎儿死亡(IUFD)。这项研究的目的是确定严重胎盘病变的可能预测因素。
方法:我们回顾性研究了在2020年3月至2022年3月期间分娩的SARS-Cov-2阳性孕妇的96个胎盘。在临床和实验室发现方面,比较了有和没有严重胎盘病变的病例。
结果:96例患者中有12例出现严重的胎盘病变。与糖尿病没有显著关联,肥胖或严重的临床孕产妇疾病。相比之下,严重胎盘病变的存在与新生儿重症监护显著相关,剖宫产,早产,IUFD,宫内生长受限(IUGR),胎龄,母亲低纤维蛋白原血症和血小板减少症。在接种疫苗的患者或具有Omicron变体的患者中未观察到严重胎盘病变的病例。
结论:在这些患者中,SARS-Cov-2引起的严重胎盘病变与凝血异常(低纤维蛋白原血症和血小板减少症)的存在显着相关,IUGR和胎龄。这些结果支持SARS-Cov-2感染孕妇的实验室和超声监测这些参数,尤其是在妊娠中期,预测潜在的负面胎儿结局。
SARS-Cov-2 infection during pregnancy can lead to severe placental lesions characterized by massive perivillous fibrin deposition, histiocytic intervillositis and trophoblast necrosis. Diffuse placental damage of this kind is rare, but can sometimes lead to obstetric complications, such as intrauterine fetal death (IUFD). The objectives of this study were to identify possible predictors of severe placental lesions.
We retrospectively studied 96 placentas from SARS-Cov-2 positive pregnant women who gave birth between March 2020 and March 2022. Cases with and without severe placental lesions were compared in terms of clinical and laboratory findings.
Twelve of the 96 patients had severe placental lesions. There was no significant association with diabetes, obesity or severe clinical maternal disease. In contrast, presence of severe placental lesions was significantly associated with neonatal intensive care, cesarean section, prematurity, IUFD, intrauterine growth restriction (IUGR), gestational age, maternal hypofibrinogenemia and thrombocytopenia. No cases of severe placental lesions were observed in vaccinated patients or in those with the Omicron variant.
In these patients, severe placental lesions due to SARS-Cov-2 were significantly associated with the presence of coagulation abnormalities (hypofibrinogenemia and thrombocytopenia), IUGR and gestational age. These results support laboratory and ultrasound monitoring of these parameters in pregnant women with SARS-Cov-2 infection, especially during the second trimester, to predict potential negative fetal outcomes.