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Caring for Pregnant Women During Disasters and Evacuations. LCDR John Heusinkveld Chief, OBGYN Northern Navajo Medical Center. Introduction. About 2% of women, or 1% of the population as a whole, is pregnant at any given time

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caring for pregnant women during disasters and evacuations

Caring for Pregnant Women During Disasters and Evacuations

LCDR John Heusinkveld

Chief, OBGYN

Northern Navajo Medical Center

introduction
Introduction
  • About 2% of women, or 1% of the population as a whole, is pregnant at any given time
  • Any population affected by a disaster is likely to contain a significant number of pregnant women
objectives
Objectives
  • Define the problems posed by pregnancy during disasters
objectives4
Objectives
  • Define the problems posed by pregnancy during disasters
  • Discuss types of disasters and how they affect pregnant women
objectives5
Objectives
  • Define the problems posed by pregnancy during disasters
  • Discuss types of disasters and how they affect pregnant women
  • Focus on some common themes and make some suggestions
objectives6
Objectives
  • Define the problems posed by pregnancy during disasters
  • Discuss types of disasters and how they affect pregnant women
  • Focus on some common themes and make some suggestions
real objective
Real Objective
  • Get potential responders thinking about this issue
my background
My Background
  • Board Certified in OBGYN
  • Participated in Katrina Response
my background9
My Background
  • Board Certified in OBGYN
  • Participated in Katrina Response
  • 2 years training in Internal Medicine
defining the problem
Defining the Problem
  • Historically, up to 1 in 10 women died as a result of complications of pregnancy or childbirth
  • Today the number is more like 1 in 100,000
  • Modern care has made pregnancy and childbirth 10,000 times safer
defining the problem11
Defining the Problem
  • How do we maintain this level of safety during emergencies, when patients are unable to reach their usual care providers and facilities?
types of emergencies
Types of Emergencies
  • Natural Disasters
  • Warfare
  • Terrorism
  • Epidemics
natural disasters
Natural Disasters
  • Damage to transportation infrastructure
  • Damage to healthcare infrastructure
  • Physical trauma
  • Exposure to pathogens and toxins
warfare and terrorism
Warfare and Terrorism
  • Damage to transportation and healthcare infrastructure
  • CBR Agent exposure
epidemics
Epidemics
  • Direct pathogen exposure
  • Healthcare facilities may be overwhelmed or closed due to contamination
  • Quarantines
common problems
Common Problems
  • Damage to transportation infrastructure
  • Damage to healthcare infrastructure
  • Physical trauma
  • Displacement
  • Exposures
  • Inectious Diseases
damage to infrastructure and displacement
Damage to Infrastructure and Displacement
  • Patient can’t reach facility or facility is not operating
  • Most pregnant women can go without any care for a few days or even weeks
  • Exceptions:
    • Patients near delivery
    • Patients with pregnancy complications
    • Patients with chronic medical problems
physical trauma
Physical Trauma
  • May cause intra-uterine fetal demise or precipitate premature delivery
    • No intervention is possible until the age of viability
    • After viability, delivery in a tertiary care facility is vital
    • Ability to rapidly assess gestational age and fetal well-being is essential
exposures
Exposures
  • Chemical
    • Little known about teratogenic effects of most agents
  • Radiological
    • Exposure is cumulative for pregnancy
    • Less than 5 rads: probably no risk
    • Greater than 10 rads: significant risk
    • Risk probably decreases with gestational age
  • No intervention possible except minimize exposure
epidemics20
Epidemics
  • Most infectious diseases associated with disasters are unlikely to pose specific risk for pregnant women
  • Biggest risk is non-treatment
  • Responders need to know which medications are safe in pregnancy
the challenge triage
The Challenge: Triage
  • How can non-specialists rapidly identify pregnant patients needing immediate care?
scenario 1 earthquake
Scenario 1: Earthquake
  • Multiple trauma victims
  • 22 year-old woman who says she is pregnant and is having some bleeding
    • Stable vitals
    • No acute distress
    • Unsure of gestational age
scenario 1 earthquake25
Scenario 1: Earthquake
  • Ultrasound reveals 16-week gestation
scenario 1 earthquake26
Scenario 1: Earthquake
  • Ultrasound reveals 16-week gestation
    • Move on to next patient
scenario 1 earthquake27
Scenario 1: Earthquake
  • Ultrasound reveals 16-week gestation
    • Move on to next patient
  • Ultrasound reveals no fetal cardiac activity
scenario 1 earthquake28
Scenario 1: Earthquake
  • Ultrasound reveals 16-week gestation
    • Move on to next patient
  • Ultrasound reveals no fetal cardiac activity
    • Move on to next patient
scenario 1 earthquake29
Scenario 1: Earthquake
  • Ultrasound reveals 16-week gestation
    • Move on to next patient
  • Ultrasound reveals no fetal cardiac activity
    • Move on to next patient
  • Ultrasound reveals 28-week gestation with fetal cardiac activity
scenario 1 earthquake30
Scenario 1: Earthquake
  • Ultrasound reveals 16-week gestation
    • Move on to next patient
  • Ultrasound reveals no fetal cardiac activity
    • Move on to next patient
  • Ultrasound reveals 28-week gestation with fetal cardiac activity
    • Evacuate by air to tertiary care center
scenario 2 hurricane
Scenario 2: Hurricane
  • Large number of patients in Medical Support Shelter
  • 22 year old woman says she is pregnant and has to take shots “for her blood”
scenario 2 hurricane32
Scenario 2: Hurricane
  • Syringes say: “insulin”
scenario 2 hurricane33
Scenario 2: Hurricane
  • Syringes say: “insulin”
    • Monitor blood sugar at relief center
scenario 2 hurricane34
Scenario 2: Hurricane
  • Syringes say: “insulin”
    • Monitor blood sugar at relief center
  • Syringes say: “Lovenox”
scenario 2 hurricane35
Scenario 2: Hurricane
  • Syringes say: “insulin”
    • Monitor blood sugar at relief center
  • Syringes say: “Lovenox”
    • Evacuate to tertiary care center
  • Responders need quick access to expert advice in order to make these decisions
what responders need36
What Responders Need
  • Ability to assess gestational age and fetal well-being
  • Ability to evacuate patients at risk
    • Tertiary care hospitals for acute problems
    • Communities with access to care for chronic problems
  • Access to expertise
some suggestions
Some Suggestions
  • Teams responding to disasters should have doppler and basic ultrasound capability
  • Identify consultants whom responders can easily reach with questions
  • Coordinate with tertiary care centers and communities to which patients can be dispersed
ad