Legal medicine (Tokyo, Japan) · 2026
Third-trimester placental alterations in SARS-CoV-2 infection: insights from a controlled case series from the University Hospital of Palermo.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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D'Anna Tommaso, Bilotta Clio, Montana Angelo, Maresi Gabriele, Morello Gaia, Merighi Simona, Orlando Elisabetta, Formisano Eleonora, Perrone Giulio, Malta Ginevra, Albano Giuseppe Davide, Argo Antonina, Zerbo Stefania, Florena Ada Maria, Belmonte Beatrice, Maresi Emiliano
Аннотация
BACKGROUND: SARS-CoV-2 contracted during pregnancy has raised doubts about its infectious potential on the placenta and on the health of the newborn. Uncertainty remains about whether the virus alters placental structure, facilitates vertical transmission, or contributes to adverse perinatal outcomes. Although previous reports have described maternal and fetal vascular malperfusion (MVM/FVM) and inflammatory changes, a direct causal link with viral infection remains a topic of debate.
METHODS: We conducted a controlled case series of 42 placentas from third-trimester pregnancies: 21 from SARS-CoV-2-positive women and 21 gestational age-matched controls. We followed the guidelines of the Amsterdam Placental Workshop Group to analyze formalin-fixed, paraffin-embedded samples. We assessed MVM, FVM, and maternal/fetal inflammatory responses, and investigated viral RNA localization with RNAscope in situ hybridization.
RESULTS: MVM and FVM lesions were significantly more frequent in SARS-CoV-2-positive placentas compared to controls (MVM 90.4% vs. 33.3%, p = 0.0089; FVM 95.2% vs. 23.8%, p = 0.0089). We observed inflammatory responses in 14.2% of positive cases but none in controls (p = 0.48). We did not detect specific viral mRNA signals in syncytiotrophoblasts, endothelial cells, or fibroblasts. Neonatal outcomes were uniformly favorable, with negative molecular testing for SARS-CoV-2 and no significant perinatal complications.
CONCLUSIONS: Our findings indicate that placental changes are more likely due to indirect maternal or systemic effects rather than direct viral infection. These data may inform medicolegal causal assessment in pregnancy or perinatal outcomes temporally associated with maternal SARS-CoV-2 infection. To better clarify clinical and forensic implications, larger prospective molecular studies are needed.
METHODS: We conducted a controlled case series of 42 placentas from third-trimester pregnancies: 21 from SARS-CoV-2-positive women and 21 gestational age-matched controls. We followed the guidelines of the Amsterdam Placental Workshop Group to analyze formalin-fixed, paraffin-embedded samples. We assessed MVM, FVM, and maternal/fetal inflammatory responses, and investigated viral RNA localization with RNAscope in situ hybridization.
RESULTS: MVM and FVM lesions were significantly more frequent in SARS-CoV-2-positive placentas compared to controls (MVM 90.4% vs. 33.3%, p = 0.0089; FVM 95.2% vs. 23.8%, p = 0.0089). We observed inflammatory responses in 14.2% of positive cases but none in controls (p = 0.48). We did not detect specific viral mRNA signals in syncytiotrophoblasts, endothelial cells, or fibroblasts. Neonatal outcomes were uniformly favorable, with negative molecular testing for SARS-CoV-2 and no significant perinatal complications.
CONCLUSIONS: Our findings indicate that placental changes are more likely due to indirect maternal or systemic effects rather than direct viral infection. These data may inform medicolegal causal assessment in pregnancy or perinatal outcomes temporally associated with maternal SARS-CoV-2 infection. To better clarify clinical and forensic implications, larger prospective molecular studies are needed.