| Sažetak | Uvod: Ključna značajka infekcije COVID-19 je endotelna disfunkcija uzrokovana vezanjem
virusa na ACE2 receptor na endotelnim stanicama, što dovodi do stanja koagulopatije. U općoj
populaciji COVID-19 je povezan s visokom stopom tromboembolijskih komplikacija, dok u
trudnoći povećava rizik od preeklampsije, prijevremenog poroda i drugih nepovoljnih ishoda
trudnoće kao što su pobačaj, mrtvorođenost i rana neonatalna smrt. Trudnoća je, sama po sebi,
hiperkoagulabilno stanje pa ne čudi da tijekom trudnoće i u babinju COVID-19 infekcija može
imati dodatne ili sinergističke čimbenike rizika za trombozu. Navedeno upućuje da bi COVID19 mogao biti povezan sa stanjima hiperkoagulabilnosti koja rezultiraju uteroplacentalnom
malperfuzijom. RCOG je preporučio uvođenje LMWH profilaktički za sve COVID-19
pozitivne trudnice, osim ako se porod ne očekuje unutar sljedećih 12 sati. Od morfoloških
promjena na posteljici uočena je veća učestalost MVM-a, FVM-a i povećanje periviloznog
taloženja fibrina. Pandemija je donijela mnoge restrikcije što je rezultiralo otežanim pružanjem
medicinske skrbi svima pa i trudnicama, čime se povećala mogućnost nepovoljnog tijeka i
ishoda trudnoće.
Cilj: Glavni cilj istraživanja bio je odrediti patohistološke karatkteristike posteljica iz COVID19 trudnoća s osvrtom na tromjesečje primoinfekcije i terapiju niskomolekularnim heparinom.
Sekundarni ciljevi istraživanja bili su odrediti je li za vrijeme COVID-19 pandemije došlo do
porasta nepovoljnih ishoda trudnoća, kao što su pobačaji, mrtvorođenost i rana neonatalna smrt
u KBC-u Split.
Materijali i metode: Za prvi dio istraživanja prikupljene su 104 posteljice i podatci rodilja
koje su imale pozitivan PCR test na SARS CoV-2 u trudnoći, a rodile su u vremenskom
razdoblju od 01.04.2021. do 01.09.2021. u KBC-u Split. Posteljice su poslane na
patohistološku analizu. Prikupljeni podatci su podijeljeni u tri skupine ovisno o tromjesečju
trudnoće u kojem je došlo do infekcije COVID-19 virusom, a potom na dvije skupine na
temelju primjene LMWH. U drugo istraživanje uključene su sve trudnice koje su imale
nepovoljan ishod trudnoće kao što su spontani pobačaj, intrauterina smrt ploda, kao i rana
neonatalna smrt u KBC-u Split. Ispitanice su podijeljene u dvije skupine: “prije pandemije” te
“za vrijeme pandemije” te su podatci statistički obrađeni.
Rezultati: U 38% trudnica početak infekcije COVID-19 bio je u prvom tromjesečju trudnoće,
u 27% u drugom i 35% trudnica bilo je zaraženo je u trećem tromjesečju. Pojava FVM-a bila je statistički značajno veća u skupini LMWH− i ako je početak infekcije bio u drugom
tromjesečju, dok je vjerojatnost taloženja periviloznog fibrina rasla ako se infekcija COVID19 dogodila u prvom tromjesečju trudnoće. Nije bilo statistički značajne razlike u učestalosti
nepovoljnih ishoda trudnoće u skupini prije pandemije i tijekom pandemije COVID-19.
Zaključak: Vrijeme infekcije s COVID-19 utječe na oštećenje trofoblasta i naknadni
morfološki izgled posteljice. Korištenje LMWH kod COVID-19 pozitivnih trudnica smanjuje
stopu FVM-a u ispitanim posteljicama. Naše je istraživanje pokazalo da pandemija nije imala
negativan učinak na trudnice i njihov plod. Nije bilo povećanja broja pobačaja, intrauterine
fetalne smrti ili perinatalne smrti tijekom godine pandemije. Iako naša početna hipoteza nije
potvrđena, rezultati studije pokazuju da je KBC Split uspio trudnicama pružiti kvalitetnu
zdravstvenu skrb, unatoč trenutnoj pandemiji i dodatnim ograničenjima koja su uvedena. Sve
to nije imalo negativan učinak na konačni ishod njihove trudnoće. |
| Sažetak (engleski) | Introduction: A key feature of the COVID-19 infection is endothelial dysfunction caused by
binding of the virus to the ACE2 receptor on endothelial cells, leading to a state of
coagulopathy. In the general population, COVID-19 is associated with a high rate of
thromboembolic complications, while in pregnancy it increases the risk of preeclampsia,
premature birth and other adverse pregnancy outcomes such as miscarriage, stillbirth and early
neonatal death. Pregnancy, by itself, is a hypercoagulable state, so it is not surprising that
during pregnancy and in the puerperium the infection of COVID-19 can have additional or
synergistic risk factors for thrombosis. The above indicates that COVID-19 could be associated
with a state of hypercoagulability that results in uteroplacental malperfusion. The RCOG
recommends the introduction of LMWH prophylactically for all COVID-19 positive
pregnancies, unless delivery is expected within the next 12 hours. The morphological changes
on the placenta such as a higher frequency of MVM, FVM and an increase in perivillous fibrin
deposition were observed. The pandemic brought about many restrictions, which resulted in
difficult provision of medical care to everyone, including pregnant women, which increased
the possibility of an unfavorable pregnancy outcomes.
Aim: The main aim of the study was to determine the pathohistological characteristics of
placentas from COVID-19 pregnancies according to the trimester of primary infection and
therapy with low molecular weight heparin. The secondary objectives of the research were to
determine whether during the COVID-19 pandemic there was an increase in adverse pregnancy
outcomes, such as miscarriages, stillbirths and early neonatal deaths in KBC Split.
Matherials and methods: For the first part of the research, 104 placentas and data of mothers
who had a positive PCR test for SARS CoV-2 during pregnancy, and who gave birth in the
time period from April 1, 2021. until 01.09.2021. in The University Hospital Split, were
collected. The placentas were sent for the pathohistological analysis. The collected data were
divided into three groups depending on the trimester of pregnancy in which the infection
occurred, and then into two groups based on the use of LMWH. The second study included all
pregnant women who had an unfavorable pregnancy outcome, such as miscarriage, intrauterine
fetal death, as well as early neonatal death in The University Hospital Split. Women were
divided into two groups: "before the pandemic" and "during the pandemic", and the data were
statistically processed.
Results: In 38% of patients the onset of COVID-19 infection was the 1st trimester of
pregnancy, in 27% in the 2nd and 35% of women were infected in the 3rd trimester. FVM
occurrence was statistically significantly higher in the LMWH− group and if the onset of
infection was in the 2nd trimester, while the perivillous fibrin deposition was most likely to
happen if the COVID-19 infection occured in the 1st trimester of pregnancy. There was no
statistically significant difference in the incidence of adverse pregnancy outcomes in the period
prior to the pandemic and during the year of the COVID-19 pandemic.
Conclusion: The onset of COVID-19 infection has the influence on trophoblast damage and
subsequent morphological appearance of the placenta. LMWH use in COVID positive
pregnant women decreases the rate of the FVM in examined placentas. Our study showed that
the pandemic did not have a negative effect on pregnant women and their fetuses. There was
no increase in miscarriage, intrauterine fetal demise, or perinatal death during the year of the
pandemic. Although our initial hypothesis was not confirmed, the study’s results do indicate
that the University Hospital of Split was able to provide pregnant women with the high-quality
health care, despite the ongoing pandemic and additional restrictions that were introduced. All
of which had no adverse effect on the final outcome of their pregnancies. |
