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    妊娠晚期新型冠状病毒感染孕产妇妊娠结局及母婴垂直传播风险的研究

    Research on the pregnancy outcome of pregnant women infected with SARS-CoV-2 in late pregnancy infection and mother-to-infant vertical transmission risks

    • 摘要: 目的 评估妊娠晚期感染新型冠状病毒(SARS-CoV-2)对孕产妇妊娠结局的影响,并进一步探究SARS-CoV-2是否存在母婴垂直传播的可能。方法 选取2022年12月20日—2023年3月1日于徐州医科大学附属医院产科住院的感染SARS-CoV-2且已治愈的晚期妊娠(28~41周)孕妇30例作为研究组。选取同期收治且未感染过SARS-CoV-2的正常晚期妊娠孕妇30例作为对照组。入院后检测孕妇核酸抗原,并记录结果。收集患者一般资料,采集妊娠晚期感染SARS-CoV-2产妇的样本,采用实时逆转录聚合酶链式反应(RT-PCR)检测新生儿咽拭子及羊水样本中新型冠状病毒RNA。对胎盘进行组织病理学检查,评估胎盘有无炎症反应、梗死灶及血栓形成等。结果 所有妊娠晚期感染SARS-CoV-2产妇均为选择性剖宫产终止妊娠。产妇羊水及新生儿咽拭子行SARS-CoV-2核酸检测,结果均为阴性。绝大多数胎盘表现出常见的病理变化,如绒毛梗死、纤维蛋白沉积、慢性绒毛炎、壁内纤维蛋白沉积等,获得了类似胎盘血流灌注不良结果。随访产妇和新生儿均预后良好。结论 本研究尚未发现晚期感染SARS-CoV-2治愈后会产生不良的妊娠结局及宫内垂直传播的证据。但短期内母体炎症反应的增加可能影响胎儿组织及胎盘血流灌注不足,导致不良产科结局。

       

      Abstract: Objective To evaluate the impact of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) on pregnant woman in the late pregnancy, and further explores the possibility of mother-to-infant vertical transmission risks.Methods Patients with missed abortion who were admitted to Department of Obstetrics, the Affiliated Hospital of Xuzhou Medical University from December 20, 2022 to March 1, 2023 were selected. A total of 30 pregnant women who were infected with SARS-CoV-2 in late pregnancy (28 to 41 weeks) and cured were set as a study group. Meanwhile, another 30 normal late pregnant women who were admitted without SARS-CoV-2 infection were set as a control group. After admission, nucleic acid antigen was detected. Their general information was recorded, and real-time reverse transcription polymerase chain reactions (RT-PCR) was used to detect new coronary virus RNAs in newborn swallows and amniotic fluid samples. The placenta was observed for pathological examinations to evaluate the presence of inflammatory reactions, infarction stoves and thrombosis formation.Results All pregnancy women infected with SARS-CoV-2 in the late pregnancy were subject to maternal cesarean section. Then, SARS-CoV-2 detection showed negative results, using maternal amniotic fluid and neonatal throat swabs. Most of the placenta presented normal pathological characteristics, such as chronic fluffy inflammation and fibrin in the wall, with poor results similar to placental blood flow. These pregnant women and newborns had good prognosis.Conclusions The current study has not shown poor pregnancy outcome in pregnant women who are cured after SARS-CoV-2 infection in the late pregnancy, as well as evidence concerning mother-to-infant vertical transmission. However, increases in female inflammatory response in the short term may result in insufficient perfusion of fetal tissue and placenta blood flow, leading to adverse obstetrics, such as neonatal pneumonia, acute respiratory distress syndrome, and neonatal jaundice.

       

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