Obstetrical care and women’s health in the aftermath of disasters: The first 14 days after the 2010 Haitian earthquake

Abstract

Objective: Natural disasters disproportionately injure women and children. Disaster teams need intensive training in the management of obstetrics and women’s healthcare at the disaster site.
Design: This article summarizes the obstetrical experience for the International Medical Surgical Response Team (IMSuRT) stationed at Gheskio in Port Au Prince during the first 2 weeks after the 2010 Haitian earthquake. The world’s literature on the impact of disasters on women is reviewed.
Setting: Sixty-three members of the IMSuRT and Disaster Medical Assistance Team set up a mobile surgical field hospital after the 2010 Haitian earthquake. One member (AG) managed all the obstetrical care and taught the other team members essentials of labor management and assessment in pregnancy.
Patients, participants: Six hundred patients were treated in the first 14 days. Ten percent of these patients were pregnant.There were 12 deliveries.
Interventions: All pregnant patients were evaluated by a Sonosite ultrasound device. Pregnant patients with earthquake-related injuries were treated for their injuries.Women in labor were managed by active management in labor. No cesarean sections were needed.
Main outcome measure(s): Well-being of mother and babies.
Results: Sixty pregnant women presented to the mobile hospital for evaluation from January 17, 2010, through January 28, 2012. Twelve women in labor delivered healthy infants by vaginal delivery. Gestational ages ranges from 34 to 40 weeks. Active management of labor included the use of intravenous Pitocin, which was titrated to contractions. Duration of labor ranged from 2 to 12 hours. Three team members participated in each delivery. Two women were discharged on the same day as their deliveries. Eight women were discharged on the first postpartum day and two on the second postpartum day.
Conclusions: Pregnant women suffered severe injuries. Additionally, pregnant women with pre-existing medical conditions were treated after the earthquake. Active management of labor allowed all women to deliver vaginally. The labor management required tremendous team resources to facilitate vaginal deliveries and avoid cesarean sections. Cesarean sections in an austere environment have the potential for devastating consequences such as sepsis, wound dehiscence, and the long-term risks of uterine rupture with subsequent pregnancies. Our experience highlights the need to include trained obstetrical providers on the first response team.
Oral presentation: Data from this article were included in the presentation, “An urgent need for women’s health specialists in disaster response,” at the Disaster Response Workshop, Annual Meeting Society Maternal Fetal Medicine, Dallas, 2012.