Fetal demise and SARS-CoV-2 infection during pregnancy: Histopathological and immunohistochemical findings of three cases referred to the Colombian National Institute of Health

Background: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection during pregnancy is related with adverse maternal, fetal, and neonatal outcomes. Placental SARS-CoV-2 involvement may include various degrees of inflammation and malperfusion leading to diverse pregnancy complications. Methods: Placental, fetal and umbilical cord samples of three fetal demise cases that occurred in the context of maternal SARS-CoV-2 infections were analyzed. Cases were notified to the Colombian SARS-CoV-2 National Surveillance System. RT-PCR and immunohistochemistry (IHC) analysis were employed to identify potential tissue viral involvement. Results: RT-PCR and IHC confirmed the presence of viral genomes and antigens in placental and umbilical cord tissues. Histopathological analysis revealed findings consistent with placental malperfusion and inflammation. Conclusions: SARS-CoV-2 infection during pregnancy can lead to placental dysfunction and damage compromising fetal survival. Many questions regarding SARS-CoV-2 dynamics during pregnancy including placental physiopathology and in utero transmission are still pending definitive answers.