Biomedical Engineering Reference
In-Depth Information
12 Bioterrorism and Obstetrics
The Exposed Pregnant Patient
RENEE A. BOBROWSKI, JOHN F. GREENE, JR., AND JOEL SOROSKY
Women go into labor and delivery regardless
of a potential or on-going crisis. Access to labor
and delivery must be maintained. Thus, the police
and security personnel must be able to grant
hospital access and triage healthy and unexposed
women for routine obstetrical care. With a national
cesarean section rate of greater than 30%, attention
must be directed to scheduled cesarean sections and
induction of labor. For elective and non-emergent
planned or scheduled deliveries, a short delay
of several days may be appropriate to optimally
utilize the available resources for the immediate
crisis.
A formal triage team should be formed that
include leadership representation from anesthesi-
ology, NICU, maternal fetal medicine, and general
obstetrics. This triage team will prioritize care
based upon the available resources and the medical
need. Decisions from this triage must be success-
fully communicated to in hospital personnel as well
as patients who may not be in the hospital but are
scheduled for obstetrical intervention within the
next several days. This leadership team must also
reassure the community that adequate access to
labor and delivery is available. A dedicated obstet-
rical phone triage person should be available to
communicate information from the leadership team
to the community. This phone triage person should
also be available to handle scheduling and confir-
mation of information from both inside and outside
of the institution. The phone triage person will
also provide information regarding the obstetrical
protocols that are in effect. This will also include
the available to NICU beds.
12.1 Introduction
This chapter focuses on the management of
pregnant women in the setting of a bioterrorist
attack. Pregnancy poses unique challenges for
both maternal and fetal concerns. The mother is
at increased risk for infection while the infec-
tious agent and medications required for treat-
ment can having a variety of effects on the fetus.
This chapter will be limited to specifics of preg-
nancy as more detailed information is regarding
the various biologic agents is contained elsewhere
within this text.
12.2 Obstetrics Staff Training
Information regarding training for obstetrics staff
in the area of bioterrorism is limited. The obstet-
rics team of care providers will function best
in concert with their colleagues who are bioter-
rorism experts. Nevertheless, given the recent
threats of bioterrorism, continuing education semi-
nars would appear to be the optimal method of
maintaining proficiency on the part of the OB
team. Virtually all obstetrical units at tertiary care
centers have standardized procedures and proto-
cols for ensuring adequate staffing in the labor
and delivery unit. This includes nursing, clerical,
and ancillary personnel. Commonly, these proto-
cols involve increasing the length of work shifts
and calling staff in from home. The institutional
“call rooms” facilities can be used to accommodate
staff that need to remain in the hospital for several
days.
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