Pregnancy is a time of increased risk from intimate partner violence. Pre-existing patterns of abuse may intensify from verbal to physical abuse or from mild to severe physical abuse. Up to one in five women experiences some form of abuse during pregnancy, which has been associated with delayed prenatal care, low infant birth weight, or even murder of the mother and fetus.
ACOG recommends universal screening of all women for domestic violence without regard to socioeconomic status, including pregnant women at the first prenatal visit and at least once each trimester.32 For a direct nonjudgmental approach, ACOG recommends the statement and simple questions listed below.
ACOG Screening Approach for Intimate Partner Violence
Initial Statement: “Because violence is so common in many women’s lives and because there is help available for women being abused, I now ask every patient about domestic violence.”
Screening Questions:
1. "Within the past year—or since you have been pregnant—have you been hit, slapped, kicked, or otherwise physically hurt by someone?"
2. "Are you in a relationship with a person who threatens or physically hurts you?"
3. "Has anyone forced you to have sexual activities that made you feel uncomfortable?"
Watch for nonverbal clues of abuse such as frequent last-minute appointment changes, unusual behavior during visits, partners who refuse to leave the patient alone during the visit, and bruises or other injuries. It may take several visits for the patient to admit to abuse due to fear about safety and reprisal.
Once the patient acknowledges abuse, ask about the best way for you to help her. She may set limits on sharing information. Accept her decisions about how to handle her situation safely, with the caveat that if children are involved, you may be required to report harmful behaviors to the authorities. Maintain an updated list of shelters, counseling centers, hotline numbers, and other trusted local referrals. Plan future appointments at more frequent intervals. Finally, complete as thorough a physical examination as the patient permits, and document all injuries on a body diagram.
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