Important, This Is POGI's Recommendation Regarding The Spike In Cases Of Pregnant Women With COVID-19

JAKARTA - The increase in cases of pregnant women with confirmed COVID-19 in a number of major cities in Indonesia in severe cases (severe cases) and the discovery of new variants entering Indonesia has caused the population of pregnant women to become more vulnerable and experience deterioration more quickly to death.

Therefore, the protection of pregnant women and health workers as the front line is important.

The Indonesian Obstetrics and Gynecology Association (POGI) calls for the need to take steps and recommendations related to prevention so that there is no massive increase in cases and efforts to accelerate and expand vaccination can be part of efforts to prevent and control COVID-19. This was reported by Antara.

Throughout the pandemic, research doctors around the world have conducted various studies on the benefits of vaccination for pregnant and lactating women based on a number of recommendations from world bodies/professional organizations/national and international health institutions related to the COVID-19 vaccine, which has a trusted reputation.

In addition, there are also evidence-based policies regarding COVID-19 in pregnant women, including: CDC (Centers for Diseases Control and Prevention) which states that pregnant women will experience more severe conditions than women who are not pregnant and thus require hospitalization. , intensive care room or ventilator and other breathing apparatus.

WHO (World Health Organization) has also stated that pregnant women over the age of 35 years, high BMI and have comorbidities (comorbidities) such as diabetes and hypertension, as well as high risk groups exposed to COVID-19, are recommended to receive Sinovac vaccination.

"Based on data from the POGI Reproductive Tract Infection Working Group and POGI Branch during April 2020 to April 2021, there were 536 cases of COVID-19 in pregnant women. From this data, around 51.9 percent of them were pregnant women without symptoms and without respiratory assistance (OTG). ), 72 percent of gestational age above 37 weeks, 3 percent of deaths from COVID-19 complications, and 4.5% of maternal intensive care (ICU) admissions to the ICU. Meanwhile, data on the number of deaths of Indonesian doctors by profession (Team data) Mitigation of PB IDI Doctors until June 2021), shows that 27 obstetrics and gynecology specialists are in second place after general practitioners," said the General Chair of POGI, dr. Ari K. Januarto SpOG(K)-Obginsos in his statement, Sunday.

“COVID-19 increases the risk of preterm labor and other pregnancy complications. Although until now there is no scientific data regarding the effectiveness or potential dangers of administering the COVID-19 vaccine for pregnant and lactating women, considering that they are classified as vulnerable population groups. However, getting vaccinated during pregnancy will prevent pregnant women with severe symptoms when exposed to COVID-19," said Prof. Dr. dr. Budi Wiweko, SpOG(K)-FER, MPH, Secretary General of the POGI Central Management.

Theoretically, pregnancy does not change the efficacy of a vaccine, but this needs further research. There can be transfer of IgG from mother to fetus so that it can provide passive immunity in neonates. Vaccines that enter the body will enter the cells, then are captured by APC / antigen presenting cells and broken down into small peptides bound by MHC, after which they will be presented to helper T cells / CD4.

CD4 cells will stimulate B lymphocyte cells to secrete various cytokines which then develop into plasma cells to produce antibodies. The antibodies produced are IgM, IgG and neutralizing antibody.

This process takes approximately two weeks. If someone has already vaccinated against COVID-19, if there is a COVID-19 infection, the body that already has memory B cells will recognize the antigen faster so that neutralizing antibodies will be formed in a short time.

For the safety of pregnant women and fetuses from the transmission and effects of COVID-19, POGI calls for support for the implementation of PSBB (Large-Scale Social Restrictions) in areas with COVID-19 incidence rates ranging from yellow to black zones, as well as updating and increasing socialization of maternal handling guidelines. pregnant and maternity mothers who are infected with COVID-19 to all health workers and health service facilities who carry out pregnancy and childbirth examinations.

"We also ask that the government appoints and prepares COVID-19 referral centers for mothers and children in every province and district/city equipped with negative pressure delivery rooms, maternal isolation rooms, newborn isolation rooms, as well as ICU and NICU. We hope that the government will increase the coverage of Covid 19 vaccination for all Indonesian people, especially for nuclear families where one of the family members is pregnant, and protect health workers who are pregnant by regulating the division of groups and working hours as well as vaccinations for health workers who are pregnant. pregnant women with high risk of being exposed, as well as vaccinations for pregnant women with low risk after receiving explanations from health workers and being willing to make their choice to carry out COVID-19 vaccinations," said dr. Ari K. Januarto SpOG(K)-Obginsos.

Prof. Dr. dr. Budi Wiweko, SpOG(K)-FER, MPH said that delaying pregnancy is not recommended for mothers who have received a complete COVID-19 vaccination and vaccination has no effect on infertility. And for mothers who have received the COVID-19 vaccination and then become pregnant, pregnancy and vaccination can be continued by reporting to the PP POGI ISR working group for inclusion in the research registration.

Although the recommendations suggested by POGI have been based on existing scientific studies, as well as based on the implementation of recommendations from similar organizations in the world to improve the quality of Indonesian reproductive health services, the Chairperson of POGI, dr. Ari K. Januarto SpOG(K)-Obginsos said that the Central Board of POGI did not rule out changing this recommendation considering the dynamic developments and the possibility of finding the latest scientific evidence.

Currently, the International Federation of Obstetrics and Gynecology (FIGO) has strongly emphasized the inclusion of pregnant and lactating women in phase 3 of the COVID-19 vaccine research for all COVID-19 vaccine manufacturers.