O#@BO HOW DOES COVID-19 INFECTION AFFECT MOTHER AND BABY?? h® MADRIANES BACHNAS, ERNAWATI, M ALAMSYAH AZIZ, M ADYA F DILMY HIMPUNAN KEDOKTERAN FETOMATERNAL INDONESIA PERKUMPULAN OBSTETRI DAN GINEKOLOGI INDONESIAa HERD IMMUNITY — cents VERY LOW Sr FATALITY RATE eM tare UALS) Bee play DIAGNOSIS, Plateau What we thought it was. Which we believe it is... it is not And vice versa cee 2022 \ RAPID CHANGING e OF POLICY 5 = LOCAL s NATIONAL - REGIONAL 8 sila - INTERNATIONAL f Eee and attitude 5 Bey -JANS. ‘TERMASUK PERUBAHAN DALAM PEMAHAMAN MENGENAI COVID-19 PADA KEHAMILAN SERTA DAMPAKNYA BAGI IBU ‘Slow beginning \ Number of trials DAN JANINO#@BO HOW DOES COVID-19 INFECTION AFFECT MOTHER AND BABY?? THE OUTLINE 1. ATA GLANCE IMPACT 2. OLD DATA - RECENT DATA 3. COVID-19 VACCINATION 4. OTHER MAJOR ISSUE 5. SUMMARY1. AT A GLANCE IMPACT OF COVID-19 FOR MOTHER ANS e yyyCOVID RISKSIN PREGNANCY Pregnant womea wha contact COVID are more likey to mood intone treatmnt tan re thoes witout theinfetion,secording to an analyte of retinal studies. Tei babies a more thal To be born rete though the rik of death was low in babies born te Both groupe ‘© Prognant women with COviD-0 Sampio ze 427 {© Pregnant women without COMI Samp size 608 ator HOW DOES COVID AFFECT para i MOTHER AND BABY? remael TE | (arwesks) Pregnant woren fare worse than others, although the isistothe fetusatesight By Moh Subbereman sae itis miscalculated in the beginning that fatality is the same as non- cent pregnant, recent data shows higher rate for hospitalization compared eat to non-pregnant women (62% higher ICU proportion 88% higher Aisin to Lit 4 need for MV) and higher mortality rate. See Fetal infection i extremely rare, whom positive were still ina good Percomage teced ‘outcome. Preterm is the only solid data regarding fetal morbidity. itis a wrong judgement in the beginning not to put pregnant women for vaccination jab. >20.000 got vaccine and no red flags with equivalent immunogenecity compared to non-pregnant population Nature | Vol 591 | 11 March 2021 |Fret publish Sapurrber24, 2020, do:10-1188/eryerw COUR a0 PREGNANCY AND COVID-19 Eliabeth, , Rebecea Fiona €. Denison, ine A. Maybin, and Hilary 0. D. “Toms Osrtre for Matarnal Heat, Mads! Research Counc (MACICaree Ids, Sara R. van Baeckel, Sarah J. Stock, for Repreductive Hes, ueoris Medial Research neti, Unversy of Edinburgh, Edinburgh, Unted Kingdom: Certe for Carciovacular Sconce, Qucor's MaxealRasgaran nsctur, Unversity of aburgh, Edinburgh, Une Kegsorn, Ushor nett, erst of Ebung, Eamonn Unted Kingdom: MAC Corre or Reproduce Heat, Gucen's Mess! ecoore ineonae, Unverty of Enourgh Edrourgs, Una Kingdom | CLINICAL HIGHLIGHTS Ty The tk of severe coronavirus Gea 2019 (COVID-15) daring ‘ay be higher than inthe general population. HIGH PROPORTION OF ASYMPTOMATIC CASES > POTENTIAL SPREADER ONCE IT GETS TO MODERATE-SEVERE > IT WOULD LIKELY TO BE MORE FATAL. The sk factors for severe are smilarin pregnancy tO ‘the general population, 3) Vertical transmission i plausible, but mechanisms are uncertain. Severe nconatl disease appears toe ate 4) Antenatal corticosteroiduse fr threatened preterm birch sikly to be safe fr the mother, and corcostereid use for severe mater nal disease may be beneficial. 5) Clinicians should ave alow threshold fr thromboprophylaxis in mothers with COVID-19, and for investigation of posible ‘thromboembolic events. 6) Mothers with COVID-19 should be encouraged to breastfeed if they are able, but should wear personal protective equipment to dove. 7) Asymptomatic COVID-19 in pregnancy appears to be common, bats of uncertain clinical — 8) Clinicians should be mindfal ofthe wider implications ofthe ‘pandemic and ensue tha screening takes place for mencal heath distcess and insimate partner violence whenever possible. ‘Abechain of Hb sense malet ORF tab TRANSMISSION& ® oe x DATA JUMLAH KEMATIAN, DOKTER INDONESIA BERDASAR PROFESI2. RESEARCH AND PUBLICATION RELATED FROM PAST TO RECENTMaternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies ioconcner eC ieee nave ule es Nw) Results: Eighteen articles reporting data from 108 pregnancies between 8 December 2019 and 1 April 2020 were included in the current study. Most reports described women presenting in the third trimester with fever (68%) and coughing (34%). Lymphocytopenia (59%) with elevated C-reactive protein (70%) was observed and unit admissions were noted but Conclusions: Although the majority of mothers were discharged without any major compli- cations, severe maternal morbidity as a result of COVID-19 and perinatal deaths were re- 91% of the women were delivered by cesarean section,Miscalculated of Dee auc impact on COVID19 in Poca manne aeons se Pee ce Mune << 2 Seen oe ae publication that showed a . low morbidity and ‘omeargeme Bo SS Reece el ° io fs ¢@ causing vaccination in 7 ¢ 2% Gees pregnancy : ¢ 3 3 § ste Was not considered as ae? es ° ‘eo strikingly important enraecini o 2 suns and also the ‘classic feraiciao aa a : a dogma’ of clinical trial including vaccine a) development that : wee pregnant group was considered as un-ethical to be included. Fer At past: vaccine in pregnancy > benefit << risks@ P@Be 1.3% maternal death equivalent to MMR 1250/100.000 live birth 13.6X increased on fatality rate 45.4% preterm bith on severe ‘5.2% preterm birth on mi ‘BACKGROUND: Eero Is assur at commas demas 2010 erases tw ik of asalaten and mechanic veran f brea patents and or rete deve. However, fe Inoat on rater ally and vbwbee rity Is tery aed by ‘eae seta delay and inst iecton ae rivewn (OBJECTIVE: Is sy aot castbe dana sory an ot comes of sere at repay stone cds 2 rts preg acess he Washo Se, Incung regan cpl ons ad ox, aslo, ad case tly STUDY DESIGN: Prepont pters wih & poymense chan reacien-contrrad sore sede reiraoy spdrore crenarns 2 ifctonbeten Mar, 200, nde 3,200, vere Imes regee ahr hom 35 tsb Weshegn SUae. Ss cred 1% of au se cavers. Caso‘ aes prog) wore compared wih coronas ésoxe 2019 as Silay oped ads Wstingon Sse ang rai rate ferences. tea arden Odes mere campy Pes oh fiona dose srry at tho ioc lio. RESULTS: The pric sy rings were as lows: () rong 240 regan pats in Washrjon Se wth sere ae respratay stone cra 2hetons, 1 n 11 deep sree ta lease, 1 in 10 wre osteo dase 29, 2rd 1 Gene coronas disse 2019-asecatedhaptaaten ‘nas 250 gh tan nly aged ads in Washington Sate (100% ve 28%; at rato, 35; 06% corre neva, 23-5:9, ( proan ators ospiazd fr a respratsy comcern ware are ey to havea corrtidy or undarhng coos indy asthma, patron, ype 2 dats mits, autre dae, ns se ees, (3 mates chs (23) were tage fo Caronves cewasd 2010 fra mera moray re ot 1250 ot 100,000 pegrances 05% confderce inna, 257-3859) 6) fe caronves disease 2019 cae ayn pregrancy was a sient TAG 5% conidece nal, 27-26) hgh ho egret fers thn in simi aped indicus Washington Site wih fan abate cflerence i moray ra of 1.2% (5% conten leer, 0.3 26) ad peta bet mas spfanty note ‘nog woren War sere er cal Coons tess 2018 at City an fx waren wr ha eonered fom coon dra 201945 4% seve ral axes sass 20198 52% mls Carona dso 2019; P01) ‘CONCLUSION: Coorarusdszese 2019 hnsptalzatn and case ‘sya pagan soars we sh cany gh ann lay pe ass nasi St. Thee cts dct ta pera ers re kot ee of cial disease nf matty corer io oregano, an ab at isk for pete ith. Ky words: aay, cons, COWD-1, sms ‘aly, pune, pegrancy, pet ith, SARS-C-2‘Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant ‘Women with Laboratory-Confirmed COVID-19 — COVID-NET, 13 States, March 1-August 22,2020 Sle eee aera On Spm 12 ht pgm AMICR 1 oping cit (Tie (Gants ea spatermaehteiersehgp honk pom ese Gong in wots dnc M15 COI. 1) Uh Tas Yemen amc mere: Ree ‘GOD accel npc Selle Nore pedo nea acre espn {CODA ac du paid pegs ‘naire USES dg hg op 54.5% were asymptomatic. 16.2% admitted Icu ene ih herent SECO ein i opines el ng EnSReowo Moueratdetecbcataacl —Scovih.bem ogee dw eal Dutghtehinhgetncepecnany arti COMDNET cde Ror lad EOMDSEET Sogchidmosete yard COD. edlaegendanle nb COMD Daeg ie Pagers ag bapa pepece nen ak_ ARSC ng ebb na GOuBS SE ctetpegemsninian tung nvr ey pegusimenn SCD Sehawcemmaet wroteon wiky ae sien Ta Scltpalsinnon leaueerensedeori teeter pandf eel ae mae Scticeminioninmterrwentertecnne’ — Secattgr emueciba tc Homiedbepiipconcd hpteonnndiais — Scknbariackapeatennrareaont os Sa Ses ep mn 8.5% used mv 1% vied 2.2% Pregnancy loss Vr ee aah T Meare AND MORBIDITY"Maternal and Neonstl Moc and Martity 18 Countries (Agentina Broa, ‘Among Pregrat Women With an Without COVID 19 ection Egypt France, chang, ina, The NTERCOVID Munna Chor Sty Indonesia ay Japan, Meco, Nigeria, North Macedon, Pakistan, Risglunswicoran Ueand | 44.0% were aus) asymptomatic, 1424 without cond e 706 with covitsa vert trans: [RESULTS A total of706 pregnant worsen with COVIO-9 diagnosis and 424 pregnant women 13.0% neonatus vethout COWD'9 dag were ered al wih brody sna demographic weet {harass (mean [SD] age, 302 ei ye), Ove enyinpresoncy ocasredn 5323 women (48 63) wth COVID dagnost ard554 women (40.20) whut Wome ‘wth COMD-9 agnosis ere at ght rkorpreecampsafeampsia late rk, 176 95% C1272) severfectons (RR 238; 95% Cl 163200 tensivecareUnt ison, $04, 9594 1,312 810), aera maay (RR 222: 99% Cl. 288.72), preterm bith R159; 95% C, 1204198), medal dct preter 197, 95% 115625), severe neonatal mori nde (R266; 95% 169-48), andsevere iat mri and moray index RR, 24; 959 C, 1562.75) Fever sores of brent foray ration wat sexitedwthinreased of severe maeralcomplcrons {8R,256,95%60, 152340) and neonatal compkatons (RR 457, 25% 2511169), ‘Asymotematc wamen wih COVID 19 Sagres remained he sk ony formate moby (R124, 95960, 100-54) and preamps RR. 1.63 95% Cl, 10126), Amon women whotested postive (9896by real time polymere chain reaction, 54 (2) thet ‘Teoates tered postive, Ceratean ever (RR, 295% C1829 but ot brentendng {61309591 066185 was assceted wthincrease i formant tes post. PE/E 4S: 1.76x Severe Infection 1: 3.38x ICU T: 5.08x Severe Infection 1: 3.38x Matern. Mortal. 1: 22.3x Neonat. and Perinat. Morbid. Mortal. 4: 2.66x and 2,56x Preterm (Spt): 1 1.59x Preterm (lat): 1 1.97x CS-> neotus (+) : 4 2.15 x ‘CONCLUSIONS AND RELEVANCE Inthis multinational coort study, COVID19 in pregnancy Was, associated with consistent and substantial inreasesin severe maternal morbcty and ‘morality and neonatal complications when pregnant women with and without COvID19 agnosis were compared. The findings shoul alert pregnantindividualsandciricans to imple strctyall the recormended COMID 19 preventive measures.csremmcs MINTH221 Amin Jounal of sis © Omg 1.81 Maternal and perinatal outcomes of pregnant women ‘with SARS-CoV-2 infection atthe time of birth in England: national cohort study Ow@GbS Increase rates of fetal death, preterm birth and PE Pregnancy Should be considered a priority for vaccination are ‘BACKGROUND: Sones ae aes al waren wh SS Cov 2nsn duty pean aes! oe ahem ‘darlene sens ae lt er ‘OBJECTIVE: Tis ij ates Getrrine easocn Det ‘S48 ca'2 econ ate te tt rd ma ad pt [STUDY DESIGN: Tia peat nd ato ey Engr. ‘rancor ters wer wane ha rca tn rote May 29, 210, ar Jay 3,207, aor aaa esp ‘sinoxrs, Vator and aa ees wr cored Eten Dear amen wh a koralycortned SAEZ econ froma be hep ares wou Sy aanes ne (han ater tjond 24 wens gaat (lr), posre Br (<3? ‘neds ges, get ape if goons {be brtweght ae lum cra pesca er ec ‘ton of or, mote of oh spect mca ca, compte ‘esa abe aucone geome nara and moa rg ct Post saya Gens mow re 2 yeaa 2-0) Ira nen nse, ej es te rs a ‘ee Far fh anes btwn SS Col? econ ee ad ovomes we cased ving bgt eso, edu or tara ge eric, pry, pres dees mel preesng Iporwrr and acon phat meas sy abdoct Mite eprhaton 2018, Modes wee ed wi uscd eres ‘8 oust foplaioe!cteg. Te alas of Be rent | ‘veo vs rep Poze ba toa” wad ae Doxa peem rae presume canon peat ‘roto th S502 ecto RESULTS: he aes nt 342.080 wane, wr 3527 ra ‘ray es SAS 02 eecin Lowy nat SAS- Cor 2rveten wasn carmen n woe we we yg en ‘avetrich, grime reser te res epee 3 ores. etl eat sed sa, 221, 85% cre Iman 158-311; POO") apes Boa at, 217, G0 eortee inal 196-202, C01) exes mre fey weer we) SAS 0-2 ton an ese wet Te ‘att pene ean due cot ra, 35 9% co fete ona, 129—1 85, PCO"). ry ener can oe sn ost, 188 0% rene oa, 151—178, ‘R002 ge ans ate Bn ut a ao. 157 ‘Sh cane ma, A472 PD] we panty Wher ‘enone Sk Cl 2 ecto ora wh. Tee err ‘Spica deca (> 09 itu uote rawr caores re (lara aber ote cs a 145, (ance a, 12716; PO), nd Spelt rea are (aus eso, 12 54 ethos rea, 102-151; P03. {Sn poet rental ten af id os a, 1 ‘Bm crtone mona, 149-1 75, P01) wow iia Potro os wn moter tn tara srtmea SA Ca 2 lls Von anaes os ered rnc caida ‘hr (7 wok) ow ner mo Sat orca pec ees cate = 7, re salt ea eee oh (P22) nora readscon win 4 wows of Gen P08) ‘ores tiem ers nap cota SAS-C ict were more ay hve progestin ater teh (BUI comp mth 1488; add ode rae 1; 95% wie est eas ree ih reco an en (eno esa dey. Thee were ase res Twa ues, he ar Bos reir eer. Prgare waren ‘Sd e coed ero ss SSC cn nd oud "Keywords bh OOD 1a Wl thn ose, BORE recess pone pe ih, becm eO SCR Aaa Vile FOR PREGNANCYMorsay ey rat COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy — Eight Integrated Health Care Organizations, United States, December 14, 2020-May 8, 2021 eect ign Ener ep ea een ‘ont Mb rey DE bse Phe, es Go, DM ‘Sigphiy Cant ne Hun Pj MD Hc ied, Pr Na OD "Gum Zat, Pay Tepe apn MD oer Sgn PADS Pe DO" i ets cee aa oO. cen meyer peptone ce ce ge te ae cease i Ow@be Kalafat et al Ultrasound Obstet Gynecol 2021; 57: 681-686 > ALL PLATFORMS Immunogenicity of COVID-A9 ‘mRNA Vaccines in Pregnant and Lactating Women eee = mie oan itt an Fe ey is son wen f Se oe ea se + NORED FLAGS > SAFE + COMPARABLE IMMUNOGENECITY + TRANSFER OF IMMUNE ‘THROUGH PLASENTA AND BREAST MILK acne US. poplion dp In a Ui aspen ring ey oCONID ‘isan petly A ne oe oo ar peat women (10 el a tae icin eyes, ey conse ‘weed reed pga wun tis ‘Sh low op ae pry so meer Siinecin dot and manent) 00, sate ring ene ne nn of en Seg eat cipro4. OTHER MAJOR CONCERN FOR COVID-19 INFECTION IN PREGNANCYBR q 5 © a@ Systematic Review Yo Be Outcome of coronavirus spectrum infections tions (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis sheraary manp coe meer ec oe, 14.8% were PE Seni " 4.8% were Tames Pooled proportion of the diferent pregnancy outcomes explored in the present systematic review sms-oov MeS-co¥ ‘grain Penk ‘rprances Pole Prgms Pod utes ___ Sus (0 GH EHC Fon Stes fo" GOED” Fo Gao ewer” ow) rerwe 5 vS6eN Io0s05 via 6 OTe! ooma oO RR Ba) _A1.1 SEAT 0 re stws 5 as@se5) man(o7-s.g 08 —-sinarsk) szmjno-saa 65 wanii2sy sOBo-3.) 26, edamgsa 2020) 00-67 02 wages) tasod.-s3) 0 i0(to) et @st-<0s9 6) one 2 Wen) sooms-ey 4802 Oe) OO S1(161% 187308-H5) 0 ra 5 ansqaam) eT coo 0p-2a ° Misarioge 2 ara 80%) o = = = = = = = Goonanechey 5 TMH) r23(41-m) 0-6 SARK) LOMA O ‘wn Gere) O14 T0-O76) ‘te a enn 2 we Sn Er ew ENO iar tcf en in ta rp AOC MI reopen anv or sans-cov-s in nasil 15.7% were PE#@6 PE > High Expression of ACE2 Seaas Receptors?? > lead to higher rate of eof OND 2 fi ern: wae Bc of ace ‘ore td wipes SARS Ca¥ 2 aes COVID-19 INFECTION SS ee COVID-19 INFECTION > inflammation, placental damage, vascular endothelial damage -> PE ?' eval of 0 asi path dig SAS Cv ton nan GEA ete pas re psec ew yew ‘hen gone meng we edn Agee terre oped nO 0 be ‘Sencmalal aver ve (WS There ar oman ang Grape 83 saeSCHEME IN COVID-19 AFFECTING PREGNANCY Histomorphological Changes in SARS-CoV-2-infected Placenta SARS-CoV-2 * es) iS é Perinatal Outcomes Increased kot mp | icariage sbi + preterm abour 5 Fetal retcton + avon pre-eclampsia camp CYtokinestorm camp |. pins Maternal Hypoxia & inflammatory response IL-6, {TNF-a Long term Neonatal Outcomes ‘+ Neurosensorial developmental Intrauterine Transmission olay ey 2ViaACE2 receptor& ep| Bs TMPRSS2 { = =P Alternative routemeans, renee Os@BL ‘The upper panel shows the cut surface of anormal ‘Tho Effects of COVID-19 on Placenta and placenta, which has a spongy texture. The lower panel Pregnancy: What Do We Know So Far? shows a placenta affected by SARS-CoV'2 placenitis. The abnormally pale and solid appearance is due to a Ciumping of placental ili andthe accumulation of substances Such as fibrin and necrotic material. BRENDAN FITZGERALD mmunchistochemisy tests indicated the presence of SARS-CoV? in the placenta and in some ‘cases the virus was detected by PGR. The esearcers are writing up the ress fra pee reviewed publeaton and sh clinicians are alerting collegues about ther observation of ‘lth The Reyal Cllge of Physicians in Ireland leeds on Api 1e“The ‘estat of the pandemic Resuls oda from the babys dats. inieatea ink with the BLT ‘varanof concern which may explain why ths ding was nocaigaicant femur ofthe standCOVID-19 Has a Prolonged Effect OFe@0e for Many During Pregnancy Symptoms Generally Ease After a Month, But Can Persist Longer for 25 Percent of Pregnant Women 25% were affected “The PRIORY sty (renancy Coonan Osteomes Regist) san crating nthe Ute Sie for wenen who ar pagent oruptoswest ater pegrancyandines | With LONG conto or supected ase of COWD-19. launchd March 2,200, covID ‘+ Primary first symptoms were cough (20 percent), sore throat (16 percent), body aches (12 percent), and fever (12 percent); by comparison, fever occurs in 43 percent of non- pregnant hospitalized patients; + Loss of taste or smell was the frst symptom in 6 percent of pregnant women; ‘= Other symptoms included shortness of breath, runny nose, sneezing, nausea, sore throat, vomiting diarrhea, or dizziness: ‘+ 60 percent of women had no symptoms atter four weeks of ilness, but for 25 percent, symptoms persisted, lasting eight or more weeks; ‘+ The median time for symptoms to resolve was 37 days; ‘+ Medical conditions for some participants included hypertension, pregestational diabetes, asthma, cardiac disease, thyroid disease, anxiety and depression.om a) Infant Outcomes Following Maternal Infection With B@Be Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- [eich weight, CoV-2): First Report From the Pregnancy Coronavirus difficulty of Outcomes Registry (PRIORITY) Study breathing, apnea, Ieee | upper-lower —_—s Seaggrninem sonoma respiratory infection Tint oucomes aller materal vere ace respiratory some corenavirus2(SARS-GoV-2) infection are aot wll eerbed na through 8 weeks rsneOmmeyacanmmnttaeSetenrcrnrseeisac saeeenne: | Sfter born wee eee NOT INCREASE Dh mn pgyctiaty ‘Autism and depression could be potentially increase (long effect for baby) ‘toil of 1791 520 Swedish-bor children (48.6% femalos and 51.4% mals) were observed from birth upto age 41 years with ttl of 32 125813 person-years Within te directed acyclic raph fumework of assumptions, fetal exposure to any matemal infection inreased the risk of en inpatient agnosis in the cil of autism (hazard rato [HR, 1.79: 95% Cl, 1 342.40 o depression (HR, 1.24 95% Cl, 1.08-142), Effect estimates for autism and depression were similar following a severe materalinfetion (autism: HR, 1.81; 95% Cl, 118-278; depression: HR, 1.24 95% CI, 08-1.78) or urinary tact infection autism: HR, 1.89; 98% Cl, 123-290; depression: HR, 1.30; 95% CI, 1041.61 and were robust to moderate unknown confounding. Within the direct ayclc graph framework of assumptions, he relationship between infection and depression was vulnerable to bis from Joss to follow-up, but separate data fom the Swedish Death Registry demonstrated increased risk of suicide among individuals exposed to pregnancy Infection, No evidence was found for ineresed risk of bipolar disorder or psychosis among children exposed to infection i utero. Conclusions and Relevance ‘These findings suggest that fetal exposure tow matemal infection while hospitalized increased the isk or etism and depresion, but not bipolar or psychosis, during the child’ life. These results emphasize the importance of avoing infections during pregnancy, which may impart sul feta brain injuries contributing to development of autism and depression.5. DATA NASIONAL (4 RS RUJUKAN UTAMA COVID-19) RSCM, RSHS, RSDS, RSDMTotal Kasus Kematian Maternal Kematian Perinatal CovInig + PE Kematian Maternal COvIDI9 + PE Mayoritas Umur Kehamian Saat Penanganan Lahir (SC+Pervag) sc RSCM JAKARTA, DRRIMA DR DIDO dan TIM 209 (pr'20-Apr'28) 1.9% 4.3% 16.7% 90.2% 81.18% RSHS BANDUNG DR. ALAMSYAH- dan TiM 270 (and 20) 10.7% 4.4% 8.5% 13% 94.5% 35% RSDS SURABAYA DR. ERNAWATI- den TIM 641 (9or20-Jun'24) 3.7% 9.2% 26.2% 10.7% 36 minggu 96.7% 53.4% RSDM SOLO DR ADRIANES: dan TIM 218 UUantun 24) 3.6% 2.7% 23.8% 15.3% 39 minggu 86.3% 60.7% INDONESIA 1338 49% 5.15% 18.8% 13.3% menjelang persalinan 91.9% 57.57%OTARESUME DATA MENUNJUKKAN MORBIDITAS DAN MORTALITAS, MATERNAL DAN PERINATAL PADA INFEKSI COVID-19 TINGGI: > PRIORITAS VAKSINASI > PERLU PENANGANAN YANG KHUSUS > PANDUAN PENANGANAN BAIK, TIM BAIK, KETERSEDIAAN FASILITAS, ALAT-BAHAN, OBAT, dan mungkin diperlukan RS RUJUKAN MATERNAL COVID PROPORSI KEHAMILAN DENGAN COVID-19 ASIMTOMATIK TINGGI: * Potential spreader > SKRINING DI AWAL (bukan sekedar saat persalinan) COVID-19 + PE * ANGKA KEMATIAN MATERNAL SANGAT TINGGI > SUPER PRIORITAS VAKSINASI (PE + HIGH RISK PE) > PREDIKSI DAN PREVENSI PE LONG COVID-19 PADA IBU DAN BAYI > PERHATIAN KHUSUS UNTUK TATA LAKSANA JANGKA PANJANG