COVID-19 Associated Pathological Changes In Placentae of Third-trimester Pregnant Females التغييرات المرضية المصاحبة لكوفيد -19 في مشيمة الإناث الحوامل في الثلث الثالث من الحمل

Faculty Medicine Year: 2022
Type of Publication: ZU Hosted Pages:
Authors:
Journal: Egyptian Journal of Pathology Egyptian Journal of Pathology Volume:
Keywords : COVID-19 Associated Pathological Changes , Placentae , Third-trimester    
Abstract:
Abstract Background and aim: Recently, many instances of SARS-CoV-2 (COVID-19) placental invasion in late pregnancy have been reported, and this is still not completely clear. Controversy data are sequentially published, so more studies are needed to investigate placental pathology as it gives vital information on placental changes, mechanisms of maternal-fetal infection transmission, and viral effects on the placenta as inflammatory or vascular changes. We aimed to find out the placental pathological changes in term placentae and to detect SARS-CoV-2 RNA in formalin fixed, paraffin embeddedspecimens. Methods: Thirty placentae were obtained from COVID-19-infected pregnant women. They were examined for pathological changes by histopathology, immunohistochemistry for (CD3, CD20, CD15, CD68, ACE2, Cytokeratin, PDL-1), and reverse RT PCR to recognize viral RNA. Results: According to the COVID-19 status at the delivery time, four groups were identified. Group 1: (Twelve patients with COVID-19 at the delivery time) showed chronic villitis and placental maternal and fetal malperfusion. Group 2: (Seven cases who turned negative by PCR of the nasopharyngeal swab prior to delivery by 5-8 days) showed maternal malperfusion but no villitis. Both groups were SARS CoV-2 RNA positive by PCR of the nasopharyngeal swab. Group 3: (Five cases who turned negative one day before delivery) showed maternal-fetal malperfusion and mild chronic subchorionitis and deciduitis. Only three had SARS –Co-V RNA. Group 4: (Six cases with a persistent negative swab for 20 days before delivery) showed focal villitis (much less than other groups) and maternal malperfusion. Only two had SARSCoV-2 RNA. Immunophenotyping of cases in the four groups, detected mixed inflammatory infiltrate with variable diffuse ACE2 immunostaining of villus and extravillous trophoblasts. Cytokeratin staining detected thinning and discontinuity of syncytiotrophoblast and strong PD-L1 expression was seen in villitis areas. Conclusion: SARS-CoV-2-positive females exhibited a diverse range of results; thus, pregnant women should not be considered a homogeneous group since outcomes are dependent on a multitude of interdependent circumstances. Keywords: Immunohistochemistry; RT-PCR, SARS CoV-2 RNA; ACE2; PDL-1; villitis.
   
     
 
       

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