Terrorism and the pregnant woman.

Pregnant women and their infants are vulnerable, during and following a terrorist event. The threat poses a dual challenge: assessment and treatment of the trauma patient, and assessment and treatment of the pregnant woman. Some injuries in the pregnant woman are obvious; some injuries may not be easily observable. Obtaining an obstetric history coupled with careful nursing assessments ensure prompt and appropriate emergency treatment. Obstetricians, certified nurse midwives, nurse practitioners, and perinatal nurses are uniquely qualified to perform these assessments because of their understanding of the changes in maternal physiology and anatomy during pregnancy. The pregnant woman can sustain injuries owing to trauma or exposure to biological, chemical, or radiological agents. Following trauma, assessment of the gravid uterus is needed, as well as the use of traditional diagnostic, pharmacologic, or resuscitative procedures. The perinatal care provider must be familiar with the hematological changes that normally suppress any immune response to the fetus and how these protective changes increase the risk from biological agents, such as anthrax and smallpox.