The pregnancy and neonatal periods create unique challenges for medical providers in disaster settings. Maternal physiology is altered during the gestational period, and toxic and teratogenic potential to the fetus are a significant concern. As in the nondisaster setting, a basic principle to be followed is maintaining maternal survival in order to maximize fetal survival.

According to the CDC, “Decisions about the treatment or prophylaxis of emerging infections must take into account effect on mother’s health and potential risks for the embryo or fetus. Although limiting fetal exposure to treatments that may pose unknown risks is optimal, protecting the life of the mother is key in protecting the fetus. In an emergency setting with a high risk for life-threatening exposure to an infectious pathogen, recommendations likely will call for the use of vaccination and prophylactic medications, when they are available, for pregnant women, despite unknown risks to the fetus. Other measures that can protect persons who are unable or choose not to receive vaccination or prophylactic medications include limiting exposure to persons who may be infectious, avoiding public gatherings, and restricting travel to affected areas.”¹

This article will address disaster agents and unique risks and management issues for the pregnant woman, her fetus, and the neonate.

Refer to the Perinatal Disaster Management tool on www.ACEP.org. This tool, which corresponds to sections in this following article, summarizes key management issues. It can be used as a standalone tool in its paper format. This can become essential in a disaster setting where rapid resource access is critical and electronic technology may be compromised.

A number of recommendations are drawn from the Working Group on Civilian Biodefense consensus for measures to be taken by medical and public health professionals following the use of biological weapons against a civilian population. These will be referred to as WGCB in this article.

Emerging Infections

According to the CDC, “Planning for a future influenza pandemic must include specific considerations for pregnant women. Because pregnancy has been shown to increase the risk for influenza-associated complications, pregnant women are considered a high-risk group and are recommended to receive influenza vaccination during inter-pandemic years. This vaccine is inactivated and is considered safe for pregnant women. It is reformulated each year to include the anticipated viral strains of the upcoming influenza season. Pregnant women also should be considered at increased risk from influenza infection in the event of pandemic influenza.”²