Critical needs in caring for pregnant women during times of disaster for non-obstetric health care providers
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What are the critical reproductive health care messages for women and their health care providers?
Pregnancy awareness
- Half of all pregnancies are unplanned; women may not be aware they are pregnant and that they have special health care needs.
- Pregnancy testing must be available to confirm suspicions of pregnancy when there is doubt; the first 8 weeks of pregnancy are critical for organogenesis so it is important for women to have access to health care information.
- Pregnancy prevention requires access to contraception and this can be a problem when access to care has been interrupted.
All pregnant women should receive prenatal care.
- Find an alternate source of routine care if their health care facility is closed.
- Prenatal vitamins should be taken daily.
- There is no known safe amount of alcohol during pregnancy.
- Mass vaccination or prophylaxis must consider the special circumstance of pregnancy; live attenuated vaccines such as varicella and MMR are contraindicated in pregnant women. Influenza vaccine is recommended for all women who are pregnant during influenza season. A summary of recommendations for adult immunization can be found at http://www.immunize.org/catg.d/p2011b.htm.
- Pregnant women should avoid children with rashes and adults with shingles in order to minimize the potential exposure to varicella.
What are the critical issues for prenatal care?
General considerations
- Records from prior prenatal care may not be available; providers may have to “start from scratch”
- Consider giving a copy of prenatal records to patients if care is likely to be episodic or the woman is likely to be transient
During the first trimester (before 13 weeks):
- First trimester laboratory testing: Blood type, Rh type, Antibody screen, Hct, Hgb, Platelets, Rubella, RPR, Urine screen/culture, Hgb electrophoresis, PPD , Chlamydia/GC, Pap Smear, HIV
During the second trimester (From 13 to 26 weeks):
- Prenatal visits every 4 weeks
- Assess blood pressure, fundal height, weight gain, and address concerns
- Consider ultrasound, if available, for confirming due date
- Screening for diabetes with glucose challenge test (26-28 weeks)
During the third trimester (From 24 to term [>37 weeks])
- Prenatal visits every 2 weeks from 28 until 36 weeks
- Assess blood pressure, fundal height, weight gain, and address concerns
- Prenatal visits every week after 36 weeks:
What signs and symptoms require emergency obstetric services?
Seek emergency obstetric care for the following:
- Preterm (<37 weeks) contractions
- Contractions every 10 minutes or more (Cramping)
- Pelvic pressure
- Low, dull backache
- Abdominal cramps with or without diarrhea
- Regular painful uterine contractions at term (increasing in frequency and duration)
- Vaginal bleeding and/or severe abdominal pain
- Leakage of fluid (obvious or suspected ruptured membranes)
- Decreased fetal movement
Page last modified June 29, 2007