Domestic and Sexual Abuse during pregnancy
What is the epidemiology of domestic and sexual abuse during pregnancy? How are they catered in hospitals?
@lennox Domestic and sexual abuse occurs with alarming frequency during pregnancy. The incidence of domestic violence against pregnant women is 5-20%, depending on the population studied and methods used to identify the abuse. Incidence and characteristics of abuse during pregnancy were examined in a stratified, prospective analysis of 691 African-American, Latino, and white pregnant women attending urban public prenatal clinics in Houston, Tex and Baltimore, Md.
A 17% prevalence of physical or sexual abuse during pregnancy was detected. The abuse was recurrent in 60% of the women, was focused on the head, was associated with drugs or alcohol, was highest among white women, and was associated with late prenatal care. In a larger study using the same screening tool on a similar population, the same authors found an incidence of abuse of 21% among pregnant teenaged women and 15% among adults. Pregnancy complications, low birth weight, and substance abuse were more common in pregnant women who were abused than in pregnant women who were not abused. 
Satin and associates reported data from an urban university setting indicating that 1-3% of women who had been sexually assaulted were pregnant.  They performed a retrospective review of sexual assault on pregnant women in Dallas County, Texas from 1983-1988. Of 5734 total women, 114 were pregnant (2%, 0.55 pregnant women who had been assaulted per 1000 deliveries in Dallas County). The 114 pregnant women who had been assaulted were compared with matched nonpregnant women who had been sexually assaulted. The obstetric outcomes of the pregnant women who had been assaulted were compared with the general obstetric population at Parkland Hospital. The typical person was a black, parous gravida, aged 20-30 years, and was at a mean gestational age of 15 weeks. The location of penetration (ie, vulvar, 95%; oral, 27%; anal, 6%) and the detection of sperm were similar between pregnant and nonpregnant women.
Physical trauma was less common among pregnant women (43% versus 63%; P = 0.004), especially genital trauma (5% versus 21%; P< 0.001) than among nonpregnant women who had been assaulted. Preterm delivery (16%) and low birth weight neonates (24%) were more common among pregnant women who had been assaulted than among the general obstetric population.
Management of domestic and sexual violence is similar to management of blunt trauma unless gunshot and/or stab wounds are a part of the assault. When domestic violence is the primary issue, sexual assault may be an underreported component. If any question exists, perform a sexual assault evaluation. Sexual assault treatment in pregnant women is similar to that in nonpregnant women (except for the need for postcoital contraception).
All emergency departments have a written protocol for the evaluation of sexual assault. These are designed to document the history and physical evidence of the attack, to diagnosis and treat sexually transmitted disease, and to start the psychological recovery of the woman. If the mother and fetus are stable, the emergency department is a better location than labor and delivery to perform a sexual assault evaluation. The emergency department has more experience and is better equipped to preserve the continuity of evidence for subsequent criminal prosecution.