Obstetric management of pregnant patients during an earthquake

The Kahramanmaraş Earthquake, often referred to as the "disaster of the century," occurred on February 6, 2023. Following the 7.7 magnitude earthquake, extensive destruction and significant loss of life occurred across 10 provinces. This study aims to analyze the outcomes and share the surgical and radiologic algorithm applied to live, trauma-affected pregnant patients who were referred to the obstetrics and gynecology emergency department of our hospital following the earthquake.

This is a retrospective observational study. The study included pregnant patients affected by the earthquake who were admitted to and/or referred to the obstetrics and gynecology emergency department of a tertiary hospital between February 6 and March 6, 2023. Demographic data, trauma-related findings, surgical details, and obstetric outcomes were recorded.

A total of 58 pregnant earthquake victims were evaluated. The mean gestational age was 22.24±10.59 weeks. The most common obstetric complaint was pelvic pain or contractions (36.3%). Eleven patients gave birth, two via vaginal delivery and nine via cesarean section. The mean gestational age at delivery was 32.81 weeks. Curettage was performed in three patients, and hysterotomy in one patient. There were six live births and five stillbirths. In patients undergoing cesarean section, a midline incision was made. After delivery, the uterus was sutured, and intra-abdominal organs were evaluated. In cases of pelvic or other fractures, intraoperative scope devices were used. When necessary, patients were consulted by general surgery and orthopedics departments and were transferred to either the ward or the intensive care unit, depending on their clinical condition.

Ultrasound has become the primary diagnostic tool for emergency evaluation in pregnant women. For earthquake victims who lack access to radiological assessment and require rapid clinical decisions, the recommended surgical approaches, particularly midline incisions, and intraoperative evaluations (such as the use of intraoperative scope after delivery) can be life-saving for both the baby and the mother.