Abstract
To date, mother-to-fetus transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) pandemic, remains controversial. Although placental COVID-19 infection has been documented in some cases during the second- and third-trimesters, no reports are available for the first trimester of pregnancy, and no SARS-CoV-2 protein has been found in fetal tissues. We studied the placenta and fetal organs from an early pregnancy miscarriage in a COVID-19 maternal infection by immunohistochemical, reverse transcription quantitative real-time polymerase chain reaction, immunofluorescence, and electron microscopy methods. SARS-CoV-2 nucleocapsid protein, viral RNA, and particles consistent with coronavirus were found in the placenta and fetal tissues, accompanied by RNA replication revealed by double-stranded RNA (dsRNA) positive immunostain. Prominent damage of the placenta and fetal organs were associated with a hyperinflammatory process identified by histological examination and immunohistochemistry. The findings provided in this study document that congenital SARS-CoV-2 infection is possible during the first trimester of pregnancy and that fetal organs, such as lung and kidney, are targets for coronavirus. The infection and multi-organic fetal inflammation produced by SARS-CoV-2 during early pregnancy should alert clinicians in the assessment and management of pregnant women for possible fetal consequences and adverse perinatal outcomes.
Keywords: COVID-19; fetus; first trimester; miscarriage; placenta; pregnancy.
【저자키워드】 COVID-19, Placenta, Pregnancy, fetus, first trimester, miscarriage, 【초록키워드】 coronavirus disease, SARS-CoV-2, Inflammation, immunohistochemistry, Coronavirus disease 2019, coronavirus, pandemic, Placenta, SARS-COV-2 infection, Infection, lung, Transmission, severe acute respiratory syndrome Coronavirus, nucleocapsid protein, Particle, RNA, kidney, Replication, pregnant women, outcomes, Protein, polymerase chain reaction, Pregnancy, COVID-19 infection, management, Microscopy, fetus, placental, target, reverse transcription, Viral RNA, targets, immunofluorescence, Quantitative, first trimester, miscarriage, dsRNA, double-stranded RNA, in some, Chain Reaction, early pregnancy, acute respiratory syndrome, Particles, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, tissues, clinician, organs, SARS-CoV-2 protein, positive, SARS-CoV-2 nucleocapsid, organ, histological examination, Hyperinflammatory, consequence, polymerase chain, produced, responsible, provided, fetal, histological, accompanied, Prominent, 【제목키워드】 SARS-CoV-2, Placental infection,