28 March 2018

Screening for domestic violence during pregnancy

Clinical O&G Women

New national guidelines are recommending that GPs screen all pregnant women for domestic violence.

In the past, GPs have only been advised to screen pregnant women who expressed concerns or showed signs of being exposed to domestic violence.

The updated Pregnancy Care Guidelines expand recommended screening to all pregnant women, as domestic violence often starts or escalates during pregnancy.

“We know that there are poor outcomes in pregnancy both for the mother and the baby if the mother is in a relationship where there is family violence and she is not supported through that process,” Dr Martin Byrne, a GP who was involved in creating the new guidelines, said.

Domestic violence in pregnancy was associated with miscarriage, termination, low birth weight and preterm labour, as well as poor maternal mental and physical health, Professor Kelsey Hegarty, an academic GP at the University of Melbourne and an expert in family violence, said.

The World Health Organisation recommended screening all pregnant women as it was an opportune time to intervene early, she said.

The new guidelines suggest that GPs start a conversation about domestic violence when they are alone with the women, and that GPs explain to the patient that screening is a routine part of antenatal care.

Screening for domestic violence was relatively straightforward, and there were state and territory toolkits available to GPs to help guide the process, Dr Byrne said.

The GP response to domestic violence is called LIVES – Listen, Inquire about needs, Validate experience, Enhance safety, Support. While some GPs were already doing this work, others would need to upskill, Professor Hegarty said.

All women facing domestic violence needed different solutions and collaboration with the patient was essential, according to Dr Byrne. GPs could help by connecting at-risk women with emergency housing, legal assistance, and other support systems. Focused Medicare item numbers support the process.

Increased screening was a big focus in the updated pregnancy guidelines, and domestic violence was just one of many changes, Dr Byrne told The Medical Republic.

In previous guidelines, it was recommended that GPs screen for diabetes in the second trimester of pregnancy (between 24 and 28 weeks’ gestation).

The updated version of the guidelines recommends that GPs screen women who are at high risk of diabetes in the first trimester.

Another major change to the pregnancy guidelines is the recommendation to screen all pregnant women for hepatitis C at the first antenatal visit.

Around 20% of people with chronic hepatitis C are undiagnosed.

Knowing whether a pregnant woman has the disease can help doctors avoid interventions during pregnancy that increase the risk of mother-to-baby transmission, such as amniocentesis.

“Pregnant women diagnosed with hepatitis C in pregnancy can be offered potentially curative treatment postpartum,” Professor Jeremy Oats, an obstetrician and co-chair the expert advisory committee for the pregnancy guidelines, said.

It was currently common practice to test vitamin D levels in pregnant women. But there was little evidence to support this practice, and there were cost implications to testing and buying supplements, the guidelines said.

The new guidelines specifically advise clinicians against routinely recommend testing for vitamin D status in pregnant women.

The new guidelines are available at: http://bit.ly/2FZyArK

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Linda Mann
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2 months 22 days ago
quote GPs could help by connecting at-risk women with emergency housing, legal assistance, and other support systems. Focused Medicare item numbers support the process. I thought Medicare could not suppot work done in the absence of the patient ( which is what is most likely to be needed if I am helping organise housgin, legal and other supports).Can you name the focussed Medicare items please? Have things changed from 2016 quote in a letter to Victoria’s Health Minister Jill Hennessy, Federal Health Minister Sussan Ley wrote that “a range of Medicare items, including GP, allied health and specialist items can… Read more »
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