REKOMENDASI PENGGUNAAN

APD PADA PASIEN OBSTETRI DAN

GINEKOLOGI DI ERA COVID-19
EVERT S. PANGKAHILA

DIVISI KEDOKTERAN FETOMATERNAL

DEPARTEMEN OBSTETRI DAN GINEKOLOGI FAKULTAS KEDOKTERAN UNIVERSITAS UDAYANA
= TYPE I
TYPE IIR SURGICAL MASK
• Pregnant women admitted with suspected COVID-19 or
who develop symptoms consistent with COVID-19 during
admission should be prioritized for testing.
• Testing of asymptomatic pregnant women is at the
discretion of the healthcare provider and facility.
• Asymptomatic patients and presymptomatic patients may present
to the labor and delivery unit
• For this reason, in areas where infection in the community is
widespread, we believe testing all patients upon presentation to
labor and delivery (or the day before if a scheduled admission)
with a rapid SARS-CoV-2 test is reasonable. (Vincenzo, 2020).
• This information is useful to inform infection control precautions
both intrapartum and postpartum, including newborn care
REKOMENDASI APD DI RUANG BERSALIN
• COVID-19 infection is highly contagious, and this must be taken
into consideration when planning intrapartum care.
• All medical staff caring for potential or confirmed COVID-19
patients should use personal protective equipment (PPE)
including respirators (eg, N95 respirators)
• (ACOG, 2020).
• In areas where universal testing is not employed and adequate
PPE is available, universal PPE, including respirators (eg, N95
respirators) is recommended until the patient’s status is
known.
Although individual physicians, after careful consideration, may opt
to provide care without adequate personal protective equipment,
physicians are not ethically obligated to provide care to
high-risk patients without protections in place.
 2nd stage = Aerosol??

• ACOG continues to review questions and data regarding the potential

for aerosolization in the context of forceful exhalation during the
second stage of labor.
• According to CDC, based on limited data, forceful exhalation during the
second stage of labor would not be expected to generate aerosols
to the same extent as procedures more commonly considered to be
aerosol-generating (such as bronchoscopy, intubation, and open suctioning).
Untuk menurunkan risiko penularan, mengingat 13.7% ibu hamil
tanpa gejala bisa menunjukkan hasil pemeriksaan PCR Covid 19
yang positif, maka penolong persalinan harus menggunakan alat
pelindung diri minimal sesuai level 2 (POGI, 2020).
POGI,2020
WHAT IS THE RECOMMENDATION?
KESIMPULAN

• Pasien rawat jalan tanpa gejala saluran pernafasan  Level

1 atau 2 + face shield/eye protection + hand washing
• TYPE IIR surgical mask / N95
• APD di ruang bersalin minimal Level 2++
• + N95 dan Faceshield + Eye protection sampai status
COVID diketahui.
• Confirmed case, rapid test positif, PDP/ODP/OTG  Level 3
KESIMPULAN

• Apakah setiap persalinan dengan SC harus level 3 tanpa

memandang status covid??
• Pertimbangkan :
• Ketersediaan APD
• Cost effectiveness
• Prioritas APD
• Alternative  Level 2++ (N95/Eye protector/Faceshield)
• Proteksi area wajah, mata dan saluran pernafasan
 VHP (VAPORIZED
HYDROGEN PEROXIDE)
Duke University Hospitals investigators plan
to decontaminate and reuse their N95
masks up to 30 cycles, with the limiting
factor being degradation of the elastic
straps (after 30 cycles, the masks might no
longer fit properly).

3M continued to insist, that “no disinfection method

has met all four” of the criteria mentioned above,
when repeated five to ten times
THANK YOU