Placental lesions in pregnant women with SARS-CoV-2 infection


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Abstract

The paper analyzes the data available in the literature on placental lesions in pregnant women with SARS-CoV-2 infection. The placenta is noted to be a potential target organ for SARS-CoV-2 due to that it has coronavirus receptors: angiotensin-converting enzyme-2, transmembrane serine protease 2 (TMPRSS2), and CD147. An immunohistochemical study and in situ hybridization showed the presence of SARS-CoV-2 proteins in the syncytiotrophoblast, vascular endothelium, and villous stromal macrophages. The data available in the literature on main placental lesions are summarized. The placenta most often exhibited vascular disorders, such as decidual vasculopathy, accelerated villous maturation and distal villous hypoplasia, as well as perivascular fibrin deposits, intervillous thrombi, and villous infarcts. The development of fetal thrombotic vasculopathy and avascular villi is also described. There are quite frequently occurring inflammatory placental changes as chorioamnionitis and villitis of unknown etiology. Differences in the degree of placental lesion were noted in pregnant women with clinical manifestations of COVID and in those with an asymptomatic course. Villous infarcts and villous chorangiosis, perivascular fibrinoid deposits, and blood clots in the intervillous space were more common in the symptomatic course of the disease; distal villous hypoplasia, fetal vascular disorders, chorioamnionitis, and villitis were in the asymptomatic course. It is emphasized that placental lesions in SARS- CoV-2 infection can cause pregnancy, fetal, and maternal complications. At the same time, an indication is given to the ambiguity of the literature data on transplacental (vertical) transmission of infection from mother to fetus.

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About the authors

Aleksandr I. Shchegolev

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: ashegolev@oparina4.ru
Dr. Med. Sci., professor, Head of 2-nd Morbid Anatomy

Ulyana N. Tumanova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: patan777@gmail.com
Ph.D., senior researcher of Department of 2-nd Morbid Anatomy

Vladimir N. Serov

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: v_serov@oparina4.ru
MD, professor, academician of the Russian Academy of Sciences, chief researcher

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