During foetal life, the liver plays the important roles of connection and transient hematopoietic function. Foetal liver cells develop in an environment called a hematopoietic stem cell niche composed of several cell types, where stem cells can proliferate and give rise to mature blood cells. Embryologically, at about the third week of gestation, the liver appears, and it grows rapidly from the fifth to 10th week under WNT/β-Catenin signaling pathway stimulation, which induces hepatic progenitor cells proliferation and differentiation into hepatocytes. Development of new strategies and identification of new cell sources should represent the main aim in liver regenerative medicine and cell therapy. Cells isolated from organs with endodermal origin, like the liver, bile ducts, and pancreas, could be preferable cell sources. Furthermore, stem cells isolated from these organs could be more susceptible to differentiate into mature liver cells after transplantation with respect to stem cells isolated from organs or tissues with a different embryological origin. The foetal liver possesses unique features given the co-existence of cells having endodermal and mesenchymal origin, and it could be highly available source candidate for regenerative medicine in both the liver and pancreas. Taking into account these advantages, the foetal liver can be the highest potential and available cell source for cell therapy regarding liver diseases and diabetes.

We present the case of a stillbirth in a paucisymptomatic mother affected by SARS-CoV-2. At gross examination, the placenta showed a diffuse marbled appearance and a focal hemorrhagic area. Multiple areas of hemorrhagic/ischemic necrosis with central and peripheral villous infarctions and thrombosis of several maternal and fetal vessels with luminal fibrin and platelet deposition was observed. All the lesions appeared to be synchronous. Virus particles were identified by Electron Microscopy within the cytoplasm of endothelial cells whereas, by real time rRT-PCR assay, SARS-CoV-2 RNA was detected in placental tissue. In this case, fetal vascular malperfusion was likely casually associated with the infection; indeed, our EM images clearly showed that the marked SARS-CoV-2 endotheliotropism involved the intravillous fetal capillaries. We confirmed that syncytiotrophoblast is the major target cell type for SARS-CoV-2 infection of the placenta. In conclusion, the possible consequences of the action of the placentotropic SARS-CoV-2 include the occurrence of vertical transmission, as reported in literature, and/or stillbirth: this latter possibility may be triggered by a hampered maternal and/or fetal perfusion of the placenta. The diffuse thrombosis and subsequent ischemia of fetal capillaries induced by COVID-19 cannot be predicted by standard clinical surveillance.

What are the novel findings of this work? Fetal magnetic resonance imaging (MRI) can detect additional brain anomalies in about 10% of fetuses with congenital cytomegalovirus (CMV) infection and normal neurosonography. CMV viral load was the only independent predictor of fetal anomalies on MRI later in gestation, thus confirming its prognostic value, mostly when associated with antenatal imaging. What are the clinical implications of this work?The findings of this study support the value of detailed imaging follow-up throughout the remainder of the pregnancy after the diagnosis of fetal CMV infection and the use of fetal MRI even in cases of negative neurosonography to better predict the postnatal prognosis of infected newborns.

ObjectivesCongenital cytomegalovirus (cCMV) infection can negatively affect pregnancy outcomes, but may be prevented by simple precautions. Literature suggests that gynaecologists do not always adequately inform about preventive behaviour and most pregnant women have a low-level knowledge regarding cCMV infection. The aim of this study is to evaluate knowledge and risk behaviours related to cCMV infection in an unselected group of pregnant women.MethodsAn institutional based cross-sectional study was conducted in three Maternal and Fetal Divisions in Rome between November and February 2019 on 296 pregnant women, their knowledge on cCMV was measured using six cytomegalovirus (CMV) related questions.ResultsOut of the 296 respondents, 59.1% had heard, read or seen information about cCMV infection. Regarding the way of transmission, 96/296 (32.4%) correctly recognize children as a potential source of the infection but only 25/296 (8.44%) knew all prevention practices, 28/296 (9.5%) of women reported that they have never performed cCMV test during pregnancy.ConclusionsThe results of this survey show that knowledge on cCMV infection among pregnant women is poor. This highlights the need to improve counselling on all preventive practices for cCMV infection during perinatal care consultation.