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Critical needs in caring for pregnant women during times of disaster for non-obstetric health care providers

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
  • 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


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