1H @8 © COVID-19 (sars-cov-2) in OBSTETRICS ‘Too little to know’ Dr. dr. M ADRIANES BACHNAS, SpOG (K) FM + Vice-Coordinator Research Committee - nconesien Scclety of Maternal-Feto! Medicine retary Genera of Netional Cemmitiee an Ubrasound in Obstetrics and Gynecology -Indonesion Scclety of Obstoties end Gynecology Executive Board Member of Committee on Skills Training - Indonesian College of Obstetrics end Gynecology * Executive Board Member of Reducing Notional Maternal MortaltyTosk Force indonesion Society of Obstetrics ard Gynecology + Head of Maternal feta! Medicine Sub-Division- Faculty of Medicine Univerite Sebelas Maret/ Dr. MoewardiHesptal * Secretary General of Residency Program Faculty of Medicine Universitas Sebelas areY Or Moeward! Hospito|) @@8o ‘Too little to know’ What we thought it was... it was not Which we believe itis. And vice versa ETE Ta - INTERNATIONAL g RAPID CHANGING 8 OF POLICY 2 - LOCAL 8 antes - NATIONAL 5 Ee ee - REGIONAL E DES'19- JAN’19, Stow beginning \ 6 Apr: Mask For All (WHO) 7 April: PSBB (INA) 9 Apeil: LMWH (RCO) Number of trials. we Have To HFIGHTASONE ‘No PLACE FOR SHAMING AND staming? §~COFIGHT-20 FOR COVID-1989 COVID-19 (sars-cov-2) in OBSTETRICS ‘OUTLINE OF THIS PRESENTATION’ 1. THE GUIDELINES AND LITERATURES RELATED 2. PREGNANCY AND COVID-19 (PATHOBIOLOGY) 3. THE OBSTETRICS MANAGEMENT ON COVID-19 4. VACCINE AND THE IMPACT 5. POG] RECOMMENDATION (NEW) T DACTOCEPALTEMMR BaT=TE WOE1. THE GUIDELINES AND LITERATURES RELATED COVID-19 IN PREGNANCYTHE GUIDELINES AND LITERATURES RELATED 3 G @6: C3) oT SD Lae Coronavirus: Clinical management and testing CET) Ne To keep abreast of evidence-based news on COVID-19, here a few free reputable resources = World Health Organization + Pan-American Health Organization + US. Centers for Dieaze Control and Prevention + BMY: Coronavirus (Covid-19) Latest News and Resources + JAMA Network: Coronavirus 2019 Lancet: COVID-19 Resource Centre + New England Journal of Medicine: CoronavirusQQ REKOMENDASI PENANGANAN INFEKSI VIRUS CORONA (COVID-19) PADA MATERNAL (HAMIL, BERSALIN DAN NIFAS) BS Tay Cer ruy Penyakit COVID19 PCA ut! "PORIAINTEKS SALURAN REMRODUKSETHE GUIDELINES AND LITERATURES RELATED THE MAJORISSUES IS TO STOP THESPREADING | p2tientt0 Hespitalstatt Patient to Patient REDUCING HOSPITAL LOAD CASE SELECTION (ANC) Gy ; NO ROUTINE -> GO FOR EMERGENCY 50-80% recuction ROUTINE > TELEMEDICINE + INCREASE SPACE FOR PHYSICAL DISTANCING + PPE AND OTHER RESOURCES SUFFICIENCY + RE-ORGANIZE WORKING HOUR @) REDUCING ‘MISSED’ CASES » pws 10% unnoticed cases for symptomatic + STAFF AWARENESS AND READINESS REDEFINING SKILLS AND ATTITUDE PHYSICAL DISTANCING + THE GREATEST IMPACT COMES FROM, Bisa Os THE CHEAPEST ONE ISOLATION ROOM a NEGATIVE PRESSURE OPERATION THEATHRE MASK wee = RAPD TEST (ROI, FoR FORALL x 10, as iE STHAL CSC 68% effectiveness to reduce transmissionTHE GUIDELINES AND LITERATURES RELATED | — DROPLETS FECES AIRBORNE? MASK WILL MAKES OTHER PREVENTION MORE EFFECTIVE2. PREGNANCY AND COVID-19 (PATHOBIOLOGY)PREGNANCY AND COVID-19 (PATHOBIOLOGY) HOW DOES PREGNANCY ACTUALLY RESPOND T0 COVID-19? We don’t know. HOW DOES COVID-19 ACTUALLY ATTACK THE MOTHER OR THE FETUS? We don’t know WHAT IS ACTUALLY THE BEST OPTION BY OPTION OF CLINICAL DECISION? We don’t know ‘Too little to know’ EE Movietone ‘Bg ours Pr cot Steam Sree sara 2s ‘CovID-19 infection among asymptomatic and symptomatic rt, meng can, Mag, We pregnant women: Two weeks of & aeaeopas confirmed presentations to an . SSSI ama wer? : afte pa fer ok iy 84,735 cases co =. i a (Chen H, Guo, Weng et Clinical characte and intrauterine vertical trnasssion pote of {COVtD-19infecton inne pregnant women: z retrospective review ct medial receres. Lancet 2020. Zhu, Warg |, Fg ot Cirial analy o! 10 neonates born to mothors with 2019-nCoV pneurenia. Torl Peat 2020,9:51-€0. Intensive Care Navonal Audit and Research Centre in the UK reported. of the first 2,249 patients admitted to critical care setungs with a diagnosis of COVID-I9, two Were pregnant and ten recently Pregnant nocasesof maternal dethhave not yet been reported in publshed erature‘Bez aihautamaned 2017 Ang 242116) 1612-1423 saeenessesss® ostri mn) HOSS eveioy Hur CBE. 2020, Ab chainof © Morse OK Oe ‘Teropeutc opproachos Intensive Care Med (2020) 46586-590 matret & severity mortality cl Fansmission cl Hum Reseed, 2012 Sep; 19) 482-450 INE??? sysctl placarta cod lod ()3 2 acetals) now ern prorect” Matra vrei i%e {ang etal JANA, 2020)aaa Brest 1 2431 2020 + roammomen sane CONGENITAL DEFECT (-), MISCARRIAGE (-), IUGR (-), IUFD () PREMATURITY (+?) MATERNAL-FETAL OVERALL OUTCOME FAVOURABLE, 77%-Q 1% C-SECTIONiF 3. MANAGEMENT OF COVID-19 AeA TeMANAGEMENT OF COVID-19 IN PREGNANCY | Derived rom Royal London flowchart develeped by Dr Mista Moore RR> 30 Sp02 < 92% NLR > 10 Sars: =] an GanrS ea SES RESTS : sc oo Demam, batuk kering sesak nafas Kontak daerah Lab (limfositopenia), X-Ray/ CT/ Lung USG PneumoniaMANAGEMENT COVID-19 IN PREGNANCY | 1G @6 ue ROUTINE EXERCISE (30” /day) + HEALTHY DIET (LOW carbo, HIGH protein, HIGH fiber) VIT B, C, D, Zinc, Fe Echinacea, astaxanthin (22) NE Cetirizine, phenylpropanolamine, loratadine, ANTITUSSIVE, MUCOLYTIC Ambroxol, n-acetylcysteine NONOEWIN Ge niesan Paracetamol, diclofenac, meloxicam, ibuprofen R ERLE EROID ae vitelt Low Dose Aspirin - LMWH ANTI-COVI "ANTIVIRUS Oseltamivir (B) 75 mg /12 h, Favipiravir (B) 600mg/12.h, Lopinavir/Ritonavir (B) (200 mg/50 mg) 4/12 h ANTIMALARIA | Chloroquine 500 mg/ 12h (C), Hydroxychloroquine (C) 400 mg/d ANTIBIOTIC ‘Azithromycin (B) 500 mg/ d, Levofloxacin (C) 750 mg/d4. VACCINE OF COVID-19 IN PREGNANCY AND THE IMPACT() @@8o VACCINE, 4 co fects of dsease htevertion measures eo ‘Adapted trom CDC / The Econemist sect Pros Prtentosed Zs Casta ie ona ese Pte Bokeh ‘rnin Soman RNA eras Cute Doing Eas Canada Ameria tase a ‘aveten ialvecor Shoham Gow oom nated ace ra vets feuveccine Niwas Emir Detolvone Are Preanbond ‘cuetae ea eccine —_BoNTeahFan Prams shea Ora Nese Err Pregnancy is vulnerabet And ‘scientficaly complex’5. REKOMENDASI POGI TERBARU TERKAIT COVID-191 diantara © persalinan, covid-19 (+) @nenae OI: 10 105€INEIM 2009316 TM1 TM 2/3 PARTUS POST-PARTUM * Untuk * Trimester 2 * Semua di faskes * Tidak IMD Anatomi janin dengan APD level2 || , menyingkirkan fvorttay ||- Ssamnene Ibu menyusui kehamilan njut (opt acdc beri dengan masker N95, ektopik nesses 3 dengan SC (OK + face shield dan ani kesejahteraan telansriniegatt 7 * Anatomi janin s bayi dengan face 2 janin dan atau modifikasi dan ¥ awal (optional) ricnyiapiail apoiesis) shield neonatus persalinan + POPpervaginam | |* Bayi dirawat di * Kortikosteroid yang datang sudah ruang isolasi 12, 20, 28, 38 WGA untuk pematangan ne Si + AKDR pasca = ACOG/ CDC parutidak menggunakan persalinan tetap direkomendasikan delivery chamber dapat dilakukan OBSTETRI EMERGENSISckedar mengingathan kembeli babs... — BOB PENYEBAB KEMATIAN IBU 1. PREEKLAMSIA 2. PERDARAHAN POST PARTUM 3. LAIN-LAIN: PENY. JANTUNG, AUTOIMUN (SLE) PENYEBAB KEMATIAN NEONATUS DINI KOMPLIKASI KEHAMILAN DAN PERSALINAN: PREMATURITAS, IUGR Ds DO NOT COMPROMIZING THE STANDARD ALI Hpae an @ ao ie ui - a! alo you be your kind altention... we Have To #FIGHTASONE #COFIGHT20FORCOVID19