Domestic and Sexual Violence __________________________________________________________________
victim or assailant), and the number of assailants. The CDC has published guidelines for the assessment, counseling, and preventive treatment of infection following sexual assault, including common pelvic infections, hepatitis B, human papil- lomavirus (HPV), and HIV [37]. Follow-up within one to two weeks after the initial evalua- tion provides the opportunity to review previous test results, complete an assessment for STDs, and ensure safety and adherence to prescribed medication. CDC guidelines advise that a follow-up examination at one to two months should be considered to re-evaluate for development of anogenital warts, especially in patients who received a diagnosis of other STDs following the assault. If initial tests were negative and infec- tion in the assailant could not be ruled out, serologic tests for syphilis can be repeated at four to six weeks and three months. To exclude acquisition of HIV, tests for acute infection should be repeated at six weeks, three months, and six months after the assault [37]. IMPLICATIONS ON PREGNANCY AND PRENATAL CARE Possible factors that may predispose pregnant women to IPV include young maternal age, unintended pregnancy, delayed prenatal care, lack of social support, and use of tobacco, alcohol, or illegal drugs [39; 40]. Because a gynecologist or obstetrician is frequently a woman’s primary care physician, these healthcare providers should be particularly sensitive to domestic violence issues [41]. According to the CDC, IPV affects as many as 324,000 pregnant women each year [39]. This represents approximately 8% of all pregnant women in the United States. As with all domestic violence statistics, this number is presumed to be lower than the actual incidence as a result of under-reporting and lack of data on women whose pregnancies ended in fetal or maternal death. This makes IPV more prevalent among pregnant women than some of the health conditions included in prenatal screenings, including pre-eclampsia and gestational diabetes [39]. Because 96% of pregnant women receive prenatal care, this is an optimal time to screen for domestic violence and develop trusting relation- ships with the women. Pregnant women indicate they find screening useful but also have concerns regarding confidential- ity and the sharing or information [42]. The overarching problem of violence against women cannot be ignored, especially as both mother and unborn child are at risk. One study found that pregnant women who had been treated at a hospital after a violent incident had an eight-fold increased risk of fetal death [43]. At this particularly vulnerable time in a woman’s life, an organized clinical construct leading to immediate diagnosis and medical intervention will ensure that therapeutic opportunities are available to the pregnant woman and will reduce the potential negative outcomes [16;
44]. Healthcare professionals should also be aware of the pos- sible psychological consequences of abuse during pregnancy. There is a higher risk of stress, depression, and addiction to alcohol and drugs in abused women, and victims are less likely to obtain prenatal care and to develop postpartum depression [43; 45; 46]. Low birth weight can result from either preterm birth or growth restriction in utero, both of which can be directly linked to stress. For example, pregnant women who experi- ence physical violence are five times more likely to give birth to preterm infants and six times more likely to have an infant with low birth weight [47]. Living in an abusive and danger- ous environment marked by chronic stress can therefore be an important risk factor for maternal health, as well as affecting birth weight [48]. The risk of becoming pregnant after vaginal rape is estimated to be 5%, although the risk may be higher for adolescent vic- tims [23; 49]. It is generally recommended that rape victims of childbearing age have a baseline urine or serum pregnancy test performed, in anticipation of offering prophylaxis against pregnancy if the result is negative. Postexposure emergency contraceptive treatment options are available for preventing pregnancy after unwanted intercourse [50]. The simplest and best-studied product is levonorgestrel (Plan B), an oral progestin-only medication developed for this purpose. The dosage regimen is 1.5 mg (two 0.75-mg tablets) administered as a single oral dose. It is considered to be most effective when administered within 12 hours of the assault. In one carefully conducted study, the success rate (prevention of pregnancy) exceeded 95% when administered up to 120 hours after unprotected intercourse [51]. This medication is safe and well tolerated, even if given to someone who is pregnant. Systemic side effects, such as headache, nausea, fatigue, and gastrointestinal/abdominal complaints, occur in less than 10% of patients. Transient vaginal bleeding in the days following treatment is more common (25% to 30%). HEALTH EFFECTS AND IMPLICATIONS OF CHILDREN EXPOSED TO DOMESTIC VIOLENCE Children may be victims of domestic violence either directly (if victims of the perpetrator) or indirectly (if witnessing the violence or suffering the fallout). Witnessing may also include overhearing threats or witnessing the consequences of domes- tic violence [52]. However, there is evidence that child abuse and intimate partner violence often occur within the same household and that exposure to violence in childhood may increase the risk of experiencing or perpetrating different forms of violence later in life [53].
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MDCT2026
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