Infection by SARS-CoV-2 has been shown to involve a wide range of organs and tissues, leading to a kaleidoscope of clinical conditions. Within this spectrum, an involvement of the fetal-maternal unit could be expected, but, so far, the histopathological evaluation of placentas delivered by women with SARS-CoV-2 infection did not show distinct hallmarks. A consecutive series of 11 placentas, delivered by 10 women with COVID-19 admitted to our Obstetrics and Gynecology clinic have been investigated and compared to a control cohort of 58 pre-COVID-19 placentas and 28 placentas delivered by women who had a previous cesarean section. Four out of eleven placentas showed changes consistent with chronic villitis/villitis of unknown etiology (VUE), while in one case, chronic histiocytic intervillositis was diagnosed. Thrombo-hemorrhagic alterations were observed in a subset of cases. Compared to the control cohort, chronic villitis/VUE ( p < 0.001), chronic deciduitis ( p = 0.023), microvascular thrombosis ( p = 0.003), presence of infarction areas ( p = 0.047) and of accelerated villous maturation ( p = 0.005) showed higher frequencies in placentas delivered by women with COVID-19. Chronic villitis/VUE ( p = 0.003) and accelerated villous maturation ( p = 0.019) remained statistically significant by restricting the analysis to placentas delivered after a previous cesarean section. The observed differences in terms of pathological findings could be consistent with SARS-CoV-2 pathogenesis, but just a subset of alterations remained statistically significant after adjusting for a previous cesarean section. A careful consideration of potential confounders is warranted in future studies exploring the relationship between COVID-19 and pregnancy.
【저자키워드】 COVID-19, SARS-CoV-2, Inflammation, thrombosis, Histopathology, obstetrics, 【초록키워드】 Placenta, SARS-COV-2 infection, Cohort, Pregnancy, women, etiology, change, SARS-CoV-2 pathogenesis, Frequency, Analysis, Gynecology, Infarction, chronic, Microvascular thrombosis, tissues, maturation, alteration, clinical conditions, organ, Placentas, confounder, shown, investigated, remained, diagnosed, histopathological, expected, subset, pathological finding, statistically significant, accelerated, with COVID-19, 【제목키워드】 Cohort, Analysis,