ABSTRACT
L’infection par le SRAS-CoV-2 peut provoquer des lésions placentaires sévères conduisant rapidement à une mort fœtale intra-utérine (MFIU). Entre août 2020 et septembre 2021, nous avons reçu et analysé 50 placentas de mères non vaccinées positives au COVID-19, dans le service de pathologie de Toulouse. Le but de notre étude est de décrire les caractéristiques clinicopathologiques de ces atteintes placentaires et d’en comprendre la physiopathologie. Dix d’entre eux (20 %) présentaient des lésions placentaires avec une immunohistochimie positive au SARS-CoV-2 au niveau du trophoblaste villositaire. Dans cinq cas (10 %), nous avons observé des lésions placentaires massives associant nécrose trophoblastique, dépôts fibrinoides, intervillite ainsi que des modifications hémorragiques étendues dues à l’infection par le SARS-CoV-2 probablement responsable de la MFIU par insuffisance placentaire fonctionnelle. Dans cinq autres cas, nous avons trouvé des lésions placentaires similaires mais avec une distribution focale ayant conduit à une naissance vivante. Ces lésions sont indépendantes de la sévérité clinique maternelle de l’infection à COVID-19 car elles surviennent malgré des symptômes maternels bénins les rendant difficiles à prévoir. Dans nos cas, elles sont apparues 1 à 3 semaines après un test RT-PCR maternel positif au SRAS-CoV-2 et ont été observées au cours des 2e et 3e trimestres de la grossesse. Lorsque ces lésions sont focales, elles n’entraînent pas de MFIU mais peuvent être associées à un retard de croissance intra-utérin.
ABSTRACT
OBJECTIVES: The coronavirus SARS-CoV-2 identified late 2019 in China had spread across all continents. In the majority of cases, patients have mild symptoms (fever, cough, myalgia, headache, some digestive disorders) or are asymptomatic, however it can cause serious lung diseases and lead to death. On September 2020, over 28 million people have been infected with over 920,000 deaths. METHODS: In view of the evolution of the epidemic the French National College of Obstetricians and Gynecologists has decided to update the recommendations previously issued. To do this, the same group of experts was called upon to carry out a review of the literature and take into account the opinions of the General Directorate of Health (DGS), the "Haute Autorité de Santé" (HAS) and the "Haut Conseil de santé Publique" (HCSP). RESULTS: The data on consequences during pregnancy have accumulated. The symptoms in pregnant women appear to be similar to those of the general population, but an increased risk of respiratory distress exists in pregnant women especially in the third trimester. A case of intrauterine maternal-fetal transmission has been clearly identified. Induced prematurity and cases of respiratory distress in newborns of infected mothers have been described. CONCLUSION: In light of the new data, we propose updated recommendations. These proposals may continue to evolve in view of the pandemic and of advances in studies in pregnant women.
Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious/epidemiology , Symptom Assessment , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/mortality , Female , France/epidemiology , Humans , Male , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/mortality , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Trimester, Third , SARS-CoV-2ABSTRACT
A new coronavirus (SARS-CoV-2) highlighted at the end of 2019 in China is spreading across all continents. Most often at the origin of a mild infectious syndrome, associating mild symptoms (fever, cough, myalgia, headache and possible digestive disorders) to different degrees, SARS-Covid-2 can cause serious pulmonary pathologies and sometimes death. Data on the consequences during pregnancy are limited. The first Chinese data published seem to show that the symptoms in pregnant women are the same as those of the general population. There are no cases of intrauterine maternal-fetal transmission, but cases of newborns infected early suggest that there could be vertical perpartum or neonatal transmission. Induced prematurity and cases of respiratory distress in newborns of infected mothers have been described. Pregnancy is known as a period at higher risk for the consequences of respiratory infections, as for influenza, so it seems important to screen for Covid-19 in the presence of symptoms and to monitor closely pregnant women. In this context of the SARS-Covid-2 epidemic, the societies of gynecology-obstetrics, infectious diseases and neonatalogy have proposed a French protocol for the management of possible and proven cases of SARS-Covid-2 in pregnant women. These proposals may evolve on a daily basis with the advancement of the epidemic and knowledge in pregnant women. Subsequently, an in-depth analysis of cases in pregnant women will be necessary in order to improve knowledge on the subject.