Details of Ethics Approval:
The study was approved by the Medical Ethics Committee of the Union Hospital, TongJi Medical College of HuaZhong University of Science and Technology [2020, NO. 0144]. Written informed consent was obtained from the patients before enrolment and when data were collected.
Funding
Our study has been funded by the National Natural Science Foundation of China, Hubei Provincial Natural Science Foundation of China.
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Figure Legend
Fig 1. Chest CT image of the cases.
A1, B1, C1 were the CT scanning images of pregnant women complicated with COVID-19. Multiple or scattered membranous glass density shadows/dense porphyry shadows surrounding the parenchyma of both lungs could be seen at the onset of Covid-19, which indicated the possibility of viral pneumonia is high. A2,C2 were the CT image which showed lesions in lung were improved after being treated for 7 days. A3, B2, C3 were the CT image at the time before delivery, no obvious abnormality was observed.
Fig 2. Pathological findings of placental tissue
Case A : Pregnant woman of 24weeks complicated with Covid-19, and delivered at 40 weeks. Placental chronic ischemia was shown : presence of multiple placental calcifications (black arrow) and dense small villi with increased syncytial knots (blue arrow) . (1: HE ×40, 2: ×100)
Case B: Pregnant woman of 26 weeks complicated with COVID-19, and delivered at 35 weeks. Placental chronic infarct was seen at the maternal side (40 times magnification) . In the middle part of the placenta, normal villi structure could be seen. (100 times magnification).
Case C: Pregnant woman of 6 weeks complicated with COVID-19, and the pregnancy was terminated at 12 weeks. Part of the villous was edema and fibrosis (Arrow) (40 times).” No definite thrombosis was found.
Case D: Pregnant women of 38 weeks who was serum IgG positive asymptomatic case. Chronic placental ischemia infarction could be seen. (1: HE ×40, 2: ×100).
Fig 3. Representative ACE2 Immunohistochemical staining in placenta.
ACE2 was positive in both villi and decidua, which was mainly expressed in membrane and cytoplasm. It expressed stronger in 12 weeks (Case C) (× 100 times). ACE2 evaluation criteria: the area quartering method was 1, 2, 3 and 4 scores, and the staining intensity was 1 (weak), 2 (medium) and 3 (strong), respectively. The total scores were area scores multiply staining intensity scores.