Severe Acute Respiratory Syndrome Coronavirus 2 Placental Infection and Inflammation Leading to Fetal Distress and Neonatal Multi-Organ Failure in an Asymptomatic Woman.

Autor: Schoenmakers S; Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands., Snijder P; Department of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Verdijk RM; Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands., Kuiken T; Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands., Kamphuis SSM; Department of Pediatric Infectiology, Immunology and Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Koopman LP; Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands., Krasemann TB; Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands., Rousian M; Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands., Broekhuizen M; Department of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands.; Department of Pharmacology and Vascular Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands., Steegers EAP; Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands., Koopmans MPG; Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands., Fraaij PLA; Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands.; Department of Pediatric Infectiology, Immunology and Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Reiss IKM; Department of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of the Pediatric Infectious Diseases Society [J Pediatric Infect Dis Soc] 2021 May 28; Vol. 10 (5), pp. 556-561.
DOI: 10.1093/jpids/piaa153
Abstrakt: Background: In general, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is not considered to be an increased risk for severe maternal outcomes but has been associated with an increased risk for fetal distress. Maternal-fetal transmission of SARS-CoV-2 was initially deemed uncertain; however, recently a few cases of vertical transmission have been reported. The intrauterine mechanisms, besides direct vertical transmission, leading to the perinatal adverse outcomes are not well understood.
Methods: Multiple maternal, placental, and neonatal swabs were collected for the detection of SARS-CoV-2 using real-time quantitative polymerase chain reaction (RT-qPCR). Serology of immunoglobulins against SARS-CoV-2 was tested in maternal, umbilical cord, and neonatal blood. Placental examination included immunohistochemical investigation against SARS-CoV-2 antigen expression, with SARS-CoV-2 ribonucleic acid (RNA) in situ hybridization and transmission electron microscopy.
Results: RT-qPCRs of the oropharynx, maternal blood, vagina, placenta, and urine were all positive over a period of 6 days, while breast milk, feces, and all neonatal samples tested negative. Placental findings showed the presence of SARS-CoV-2 particles with generalized inflammation characterized by histiocytic intervillositis with diffuse perivillous fibrin depositions with damage to the syncytiotrophoblasts.
Conclusions: Placental infection by SARS-CoV-2 leads to fibrin depositions hampering fetal-maternal gas exchange with resulting fetal distress necessitating a premature emergency cesarean section. Postpartum, the neonate showed a fetal or pediatric inflammatory multisystem-like syndrome with coronary artery ectasia temporarily associated with SARS-CoV-2 for which admittance and care on the neonatal intensive care unit (NICU) were required, despite being negative for SARS-CoV-2. This highlights the need for awareness of adverse fetal and neonatal outcomes during the current coronavirus disease 2019 pandemic, especially considering that the majority of pregnant women appear asymptomatic.
(© The Author(s) 2020. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society.)
Databáze: MEDLINE
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