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Males and females are affected differently by natural disasters due to biologic, social, cultural, and reproductive health differences. Out of the female population, 25% are in the reproductive stage of their lives (age 15–45) and 20% of them are pregnant. While as many as 10% of natural disaster victims seeking medical assistance may need an obstetrician or gynecologist, these needs are not usually given high selection priority, whereupon rescue teams are likely to lack those essential specialists. The chapter gives clinical guidelines for managing labor in field hospital settings and dealing with ethical issues arising from treating pregnant women in disaster areas. Based on the literature and the authors’ experience, this chapter covers the effects of a disaster on women’s health in general and especially on pregnant women. The recommendation for the obstetric/gynecologic team composition, the medications and medical equipment needs, and how to arrange an Ob/Gyn department in a field hospital are given. The chapter gives clinical guidelines for managing labor in field hospital settings and dealing with ethical issues arising from treating pregnant women in disaster areas.
The chapter lists the recommendations on prevention and management of the consequences of sexual violence, reduction of HIV transmission, prevention of excess maternal and neonatal mortality and morbidity, and planning of comprehensive reproductive health services in the early days and weeks of an emergency.
This chapter considers some of the ethical issues that surround the management of the extremely preterm infant (EPTI). Such infants are characterized by a gestational age (GA) of less than 28 weeks. The chapter addresses the interpretation of the neurodevelopmental outcomes and what the words "severe", "moderate", or "mild disability" mean to parents and health professionals if these words are not defined during counseling. The dangers of making false assumptions concerning outcome can also be seen when one examines the efficacy of active resuscitation of an EPTI in the delivery room. The longer an EPTI stays in the neonatal intensive care unit (NICU), the more likely it is that the infant will survive. In general, the principle of justice concerns fairness and rights and dictates that an EPTI be treated in the same way as other infants with treatable conditions.
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