Therapeutic and Psychological Challenges Treating Patients in a Covid Maternity

Oana Denisa Bălălău, Mihai Loghin, Cristian Bălălău, Anca Silvia Dumitriu, Stana Paunica, Gabriel Petre Gorecki


On pregnant patients, the SARS COV-2 infection can present a fulminant evolution, because of a small decrease in respiratory volumes and an exacerbation of the systemic inflammatory response. In addition to these pathophysiological mechanisms that cause systemic degradation, neuropsychiatric impairments should also be considered. These are frequently encountered as a result of the modification of the birth plan, the fact that in Romania positive patients with COVID cannot give birth in the maternity hospitals where they were treated before the infection. Another important factor is the deprivation of the newborn mother during hospitalization.

A 26-year-old patient with a 30-week pregnancy and a confirmed SARS COV-2 infection two days ago is admitted to our clinic for deteriorating general condition and acute respiratory failure: dyspnea with orthopnea, tachypnea, decrease in oxygen saturation up to 69% in atmospheric air. During the hospitalization, the patient required intensive therapy with respiratory support in various non-invasive ventilation regimens. It is decided to terminate the pregnancy by emergency segmental-transverse cesarean section for acute fetal distress and severe form of SARS COV-2 infection.

The patient's evolution was slowly favorable. The patient was discharged with the newborn after 25 days. As presented at the end of this article, the patient showed signs and symptoms of postpartum depression at the time of the 6-week postpartum evaluation, most likely with a mixed component, involving both SARS-COV-2 infection and the fact that the patient did not he was allowed to see the newborn during hospitalization.


Sars Cov-2; C-Section; Neuropsychic Manifestations; Pregnancy.

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Al Dhaheri, A. S., Bataineh, M. A. F., Mohamad, M. N., Ajab, A., Al Marzouqi, A., Jarrar, A. H., ... & Cheikh Ismail, L. (2021). Impact of COVID-19 on mental health and quality of life: Is there any effect? A cross-sectional study of the MENA region. PloS one, 16(3), e0249107.

American Academy of Pediatrics. FAQs: Management of Infants Born to COVID-19 Mothers (Accessed on October 28, 2020)

Balalau, O. D., Bacalbașa, N., Loghin, M., Dimitriu, A. S., Paunica, S., & Balalau, C. (2021). Management of Postpartum Depression in the Covid Pandemic. Mediterranean Journal of Clinical Psychology, 9(2).

Bălălău, O. D., Olaru, O. G., Dumitru, A. V., Păunică, I., & Stănescu, A. D. (2020). Maternal infections with an increased risk of transmission to the foetus; a literature review. Journal of Clinical Invest Surgery, 5(2), 66-72.

Balalau, O. D., Răduță, C., Bacalbașa, N., Dumitriu, A. S., Paunica, S., & Balalau, C. (2021). Psychoneuroimmunology and Postpartum Depression. Mediterranean Journal of Clinical Psychology, 9(3).

Bera, L., Souchon, M., Ladsous, A., Colin, V., & Lopez-Castroman, J. (2022). Emotional and Behavioral Impact of the COVID-19 Epidemic in Adolescents. Current Psychiatry Reports, 1-10.

Blanco-Melo, D., Nilsson-Payant, B. E., Liu, W. C., Uhl, S., Hoagland, D., Møller, R., ... & Albrecht, R. A. (2020). Imbalanced host response to SARS-CoV-2 drives development of COVID-19. Cell, 181(5), 1036-1045.

Boelig, R. C., Manuck, T., Oliver, E. A., Di Mascio, D., Saccone, G., Bellussi, F., & Berghella, V. (2020). Labor and delivery guidance for COVID-19. American Journal of Obstetrics & Gynecology MFM, 2(2), 100110.

Bohiltea, R., Turcan, N., Cavinder, C. M., Ducu, I., Paunica, I., Andronache, L. F., & Cirstoiu, M. M. (2020). Risk factors, predictive markers and prevention strategies for intrauterine fetal death. An integrative review. Journal of Mind and Medical Sciences, 7(1), 52-60.

Brietzke, E., Magee, T., Freire, R. C., Gomes, F. A., & Milev, R. (2020). Three insights on psychoneuroimmunology of mood disorders to be taken from the COVID-19 pandemic. Brain, Behavior, & Immunity-Health, 5, 100076.

Cai, J., Tang, M., Gao, Y., Zhang, H., Yang, Y., Zhang, D., ... & Wu, B. (2021). Cesarean section or vaginal delivery to prevent possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate: a systematic review. Frontiers in medicine, 8, 109.

Caputo, A., Vicario, C.M., Cazzato, V., Martino, G. (2022). Editorial: Psychological Factors as Determinants of Medical Conditions, Volume II. Frontiers in Psychology, 13.

Care for Breastfeeding Women. Interim Guidance on Breastfeeding and Breast Milk Feeds in the Context of COVID-19 (Accessed on December 02, 2020).

Carsana, L., Sonzogni, A., Nasr, A., Rossi, R. S., Pellegrinelli, A., Zerbi, P., ... & Nebuloni, M. (2020). Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. The Lancet infectious diseases, 20(10), 1135-1140.

Chambers, C., Krogstad, P., Bertrand, K., Contreras, D., Tobin, N. H., Bode, L., & Aldrovandi, G. (2020). Evaluation for SARS-CoV-2 in breast milk from 18 infected women. Jama, 324(13), 1347-1348.

Cojocaru, L., Crimmins, S., Sundararajan, S., Goetzinger, K., Elsamadicy, E., Lankford, A., ... & Turan, S. (2020). An initiative to evaluate the safety of maternal bonding in patients with SARS-CoV-2 infection. The Journal of Maternal-Fetal & Neonatal Medicine, 1-7.

Conti, E., Sgandurra, G., De Nicola, G., Biagioni, T., Boldrini, S., Bonaventura, E., ... & Battini, R. (2020). Behavioural and emotional changes during covid-19 lockdown in an italian paediatric population with neurologic and psychiatric disorders. Brain Sciences, 10(12), 918.

Cooke, J. E., Eirich, R., Racine, N., & Madigan, S. (2020). Prevalence of posttraumatic and general psychological stress during COVID-19: A rapid review and meta-analysis. Psychiatry research, 292, 113347.

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. The British journal of psychiatry, 150(6), 782-786.

Dantzer, R., Heuser, I., & Lupien, S. (2020). Covid-19: An urgent need for a psychoneuroendocrine perspective. Comprehensive Psychoneuroendocrinology, 1, 100003.

Debnath, M., Berk, M., & Maes, M. (2020). Changing dynamics of psychoneuroimmunology during the COVID-19 pandemic. Brain, Behavior, & Immunity-Health, 5, 100096.

Donders, F., Lonnée-Hoffmann, R., Tsiakalos, A., Mendling, W., Martinez de Oliveira, J., Judlin, P., ... & ISIDOG COVID-19 Guideline Workgroup. (2020). ISIDOG recommendations concerning COVID-19 and pregnancy. Diagnostics, 10(4), 243.

Epifanio, M. S., Andrei, F., Mancini, G., Agostini, F., Piombo, M. A., Spicuzza, V., ... & La Grutta, S. (2021). The impact of COVID-19 pandemic and lockdown measures on quality of life among Italian general population. Journal of Clinical Medicine, 10(2), 289.

Frisone, F., Sicari, F., Settineri, S., & Merlo, E. M. (2021). Clinical psychological assessment of stress: a narrative review of the last 5 years. Clinical Neuropsychiatry, 18(2), 91.

Gale, C., Quigley, M. A., Placzek, A., Knight, M., Ladhani, S., Draper, E. S., ... & Kurinczuk, J. J. (2021). Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. The Lancet Child & Adolescent Health, 5(2), 113-121.

Gilner, J., Kansal, N., Biggio, J. R., Delaney, S., Grotegut, C. A., Hardy, E., ... & Hughes, B. L. (2021). Universal SARS-CoV-2 testing for obstetric inpatient units across the United States. Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America.

Goodman, A. (1991). Organic unity theory: the mind-body problem revisited. American Journal of Psychiatry, 148(5), 553-63.

Gurol-Urganci, I., Jardine, J. E., Carroll, F., Draycott, T., Dunn, G., Fremeaux, A., ... & Khalil, A. (2021). Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study. American journal of obstetrics and gynecology, 225(5), 522-e1.

Hoertel, N., López, S., Peyre, H., Wall, M. M., González‐Pinto, A., Limosin, F., & Blanco, C. (2015). Are symptom features of depression during pregnancy, the postpartum period and outside the peripartum period distinct? Results from a nationally representative sample using item response theory (IRT). Depression and anxiety, 32(2), 129-140.

Hoffmann, M., Kleine-Weber, H., Schroeder, S., Krüger, N., Herrler, T., Erichsen, S., Schiergens, T. S., Herrler, G., Wu, N. H., Nitsche, A., Müller, M. A., Drosten, C., & Pöhlmann, S. (2020). SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell, 181(2), 271–280.e8.

Hunter, C. L., Hunter, C. M., & Kessler, R. (Eds.). (1991). Handbook of clinical psychology in medical settings. Springer US.

Iwata, H., Mori, E., Sakajo, A., Aoki, K., Maehara, K., & Tamakoshi, K. (2016). Prevalence of postpartum depressive symptoms during the first 6 months postpartum: association with maternal age and parity. Journal of affective disorders, 203, 227-232.

Janssen COVID-19 Vaccine

Jiao, W. Y., Wang, L. N., Liu, J., Fang, S. F., Jiao, F. Y., Pettoello-Mantovani, M., & Somekh, E. (2020). Behavioral and emotional disorders in children during the COVID-19 epidemic. The journal of Pediatrics, 221, 264-266.

Karan, A., & Wadhera, R. K. (2021). Healthcare system stress due to Covid-19: evading an evolving crisis. J Hosp Med, 16(2), 127.

Kentner, A. C., Harden, L., de Melo Soares, D., & Rummel, C. (2022). Editorial commentary on the special issue emerging psychoneuroimmunology research: Future leaders in focus. Brain, Behavior, & Immunity-Health, 20, 100423.

Keshky, E., El Sayed, M., Basyouni, S. S., & Al Sabban, A. M. (2020). Getting through COVID-19: The pandemic’s impact on the psychology of sustainability, quality of life, and the global economy–A systematic review. Frontiers in Psychology, 11, 3188.

Keskin, A., & Karslioglu, B. (2021). Did Covid-19 pandemic narrow the spectrum of surgical indications. J Clin Invest Surg, 6(1), 58-63.

Levine, S., Coe, C., & Wiener, S. G. (1989). Psychoneuroendocrinology of stress: a psychobiological perspective. In Psychoendocrinology (pp. 341-377). Academic Press.

Liu, C., Sun, W., Wang, C., Liu, F., & Zhou, M. (2019). Delivery during extracorporeal membrane oxygenation (ECMO) support of pregnant woman with severe respiratory distress syndrome caused by influenza: a case report and review of the literature. The Journal of Maternal-Fetal & Neonatal Medicine, 32(15), 2570-2574.

Mangalmurti, N., & Hunter, C. A. (2020). Cytokine storms: understanding COVID-19. Immunity, 53(1), 19-25.

Martenot, A., Labbassi, I., Delfils-Stern, A., Monroy, O., Langlet, C., Pichault-Klein, V., ... & Kuhn, P. (2021). Favorable outcomes among neonates not separated from their symptomatic SARS-CoV-2-infected mothers. Pediatric Research, 90(1), 8-11.

Martino, G., Caputo, A., Vicario, C. M., Feldt-Rasmussen, U., Watt, T., Quattropani, M. C., ... & Vita, R. (2021). Alexithymia, emotional distress, and perceived quality of life in patients with hashimoto’s thyroiditis. Frontiers in psychology, 12, 1295.

Martino, G., Sardella, A., Bellone, F., Lasco, C., Langher, V., Cazzato, V., ... & Catalano, A. (2019). Executive functions and bone health: a focus on cognitive impulsivity and bone mineral density. Mediterranean Journal of Clinical Psychology, 7(2).

McDevitt, K. E., Ganjoo, N., Mlangeni, D., & Pathak, S. (2020). Outcome of universal screening of neonates for COVID-19 from asymptomatic mothers. Journal of Infection, 81(3), 452-482.

Merlo, E. M., McNabney, S. M., Frisone, F., Sicari, F., Paunica, M., Motofei, C., & Settineri, S. (2020). Compassion and suppression in caregivers: twin masks of tragedy and joy of caring. Journal of Mind and Medical Sciences, 7(1), 61-68.

Merlo, E.M., Sicari, F., Frisone, F., Costa, G., Alibrandi, A., Avena, G., & Settineri, S. (2021b). Uncertainty, alexithymia, suppression and vulnerability during the COVID-19 pandemic in Italy. Health Psychology Report, 9(2), 169-179.

Merlo, E.M., Sicari, S., Frisone, F., Alibrandi, A., Settineri, S. (2021a). Burden and professional quality of life of caregivers: The clinical role of suppression and resilience. Life Span and Disability, 24(1).

Moraes, L. J., Miranda, M. B., Loures, L. F., Mainieri, A. G., & Mármora, C. H. C. (2018). A systematic review of psychoneuroimmunology-based interventions. Psychology, health & medicine, 23(6), 635-652.

Motofei, I. G., & Rowland, D. L. (2015). Solving the mind-body problem through two distinct concepts: internal-mental existence and internal mental reality. Journal of Mind and Medical Sciences, 2(2), 128-141.

Motofei, I. G., & Rowland, D. L. (2018). The mind-body problem; three equations and one solution represented by immaterial-material data. Journal of Mind and Medical Sciences, 5(1), 59-69.

Myles, L. A. M., & Merlo, E. M. (2021). Alexithymia and physical outcomes in psychosomatic subjects: a cross-sectional study. Journal of Mind and Medical Sciences, 8(1), 86-93.

Nagel, T. (1993). What is the mind-body problem. Experimental and theoretical studies of consciousness, 1-7.

Oliver, S.E., Gargano, J.W., Scobie, H., Wallace, M., Hadler, S.C., Leung, K. … Dooling, K. (2021). The Advisory Committee on Immunization Practices' Interim Recommendation for Use of Janssen COVID-19 Vaccine - United States. Morbidity and Mortality Weekly Report, 70:329.

Paulson, J. F., Dauber, S., & Leiferman, J. A. (2006). Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics, 118(2), 659-668.

Paulson, J. F., Keefe, H. A., & Leiferman, J. A. (2009). Early parental depression and child language development. Journal of Child Psychology and Psychiatry, 50(3), 254-262.

Popoviciu, M. S., Marin, V. N., Vesa, C. M., Stefan, S. D., Stoica, R. A., Serafinceanu, C., ... & Stoian, A. P. (2022, January). Correlations between Diabetes Mellitus Self-Care Activities and Glycaemic Control in the Adult Population: A Cross-Sectional Study. In Healthcare (Vol. 10, No. 1, p. 174). Multidisciplinary Digital Publishing Institute.

Putnam, K., Robertson-Blackmore, E., Sharkey, K., Payne, J., Bergink, V., Munk-Olsen, T., ... & Meltzer-Brody, S. (2015). Heterogeneity of postpartum depression: a latent class analysis. The Lancet. Psychiatry, 2(1), 59-67.

Rajcani, J., Vytykacova, S., Solarikova, P., & Brezina, I. (2021). Stress and hair cortisol concentrations in nurses during the first wave of the COVID-19 pandemic. Psychoneuroendocrinology, 129, 105245.

Ronchi, A., Pietrasanta, C., Zavattoni, M., Saruggia, M., Schena, F., Sinelli, M. T., ... & Pugni, L. (2021). Evaluation of rooming-in practice for neonates born to mothers with severe acute respiratory syndrome coronavirus 2 infection in Italy. JAMA pediatrics, 175(3), 260-266.

Salvatore, C. M., Han, J. Y., Acker, K. P., Tiwari, P., Jin, J., Brandler, M., ... & DeLaMora, P. (2020). Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study. The Lancet Child & Adolescent Health, 4(10), 721-727.

Sethuraman, N., Jeremiah, S. S., & Ryo, A. (2020). Interpreting diagnostic tests for SARS-CoV-2. Jama, 323(22), 2249-2251.

Shahar, G. (2021). Interdisciplinarity and Integration: An Introduction to the Special Issue on Psychopathology in Medical Settings. Journal of clinical psychology in medical settings, 28(1), 1-5.

Shek, D. T. (2021). COVID-19 and quality of life: Twelve reflections. Applied Research in Quality of Life, 16(1), 1-11.

Shlomai, N. O., Kasirer, Y., Strauss, T., Smolkin, T., Marom, R., Shinwell, E. S., ... & Eventov-Friedman, S. (2021). Neonatal SARS-CoV-2 infections in breastfeeding mothers. Pediatrics, 147(5).

The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression. (2015). Obstetrics and gynecology, 125(5), 1268–1271.

Walker, K. F., O'Donoghue, K., Grace, N., Dorling, J., Comeau, J. L., Li, W., & Thornton, J. G. (2020). Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. BJOG: an international journal of obstetrics and gynaecology, 127(11), 1324–1336.

Wang, C., Xie, J., Zhao, L., Fei, X., Zhang, H., Tan, Y., ... & Bian, X. W. (2020). Alveolar macrophage dysfunction and cytokine storm in the pathogenesis of two severe COVID-19 patients. EBioMedicine, 57, 102833.

Wieser, M. N., Gourounti, K., & Sarantaki, A. (2021). Modes of birth and their impact on the psychological and physical health of women. Journal of Mind and Medical Sciences, 8(1), 1-4.

Xu, Z., Shi, L., Wang, Y., Zhang, J., Huang, L., Zhang, C., ... & Wang, F. S. (2020). Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine, 8(4), 420-422.

Yonkers, K. A., Vigod, S., & Ross, L. E. (2012). Diagnosis, pathophysiology, and management of mood disorders in pregnant and postpartum women. Focus, 10(1), 51-66.

Zhu, F., Zozaya, C., Zhou, Q., De Castro, C., & Shah, P. S. (2021). SARS-CoV-2 genome and antibodies in breastmilk: a systematic review and meta-analysis. Archives of Disease in Childhood-Fetal and Neonatal Edition, 106(5), 514-521.



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