Emergency Obstetrics

Intimate Partner Violence

EMKF
Every 6 days a woman is killed at the hands of her partner. Victims of intimate partner violence and domestic violence that we see in the ED typically involve an abuse story of repeated escalating violence over time that ends up in a crisis situation.

Universal Screening for Intimate Partner Violence

Start with a normalizing statement

“Because violence is so common in many women’s lives and because there’s help available for women being abused, I now ask every patient about domestic violence.”

The Partner Violence Screen

  1. Have you been hit, kicked, slapped, punched or otherwise hurt by someone in the past year?
  2. Do you feel safe in your current relationship?
  3. Is there a partner from a previous relationship who is making you feel unsafe now?

Tranexamic Acid in PPH – WOMAN Trial

EMKF

Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008).

Acute PID

EMKF

Diagnostic criteria;

Minimum criteria for clinical diagnosis (one or more of the following minimum clinical criteria should be present) are as follows:

  1. Bilateral lower abdominal (uterine) tenderness (sometimes radiating to the legs)
  2. Cervical motion tenderness – Positive cervical motion tenderness is defined as increased discomfort from a normal pelvic examination, as stated by the patient. Of note, cervical motion tenderness is neither sensitive nor specific for gynaecologic pathology, is a sign of nonspecific peritoneal inflammation,
  3. Bilateral adnexal tenderness (with or without a palpable mass)

One or more of the following additional criteria can be used to enhance the specificity of the minimum criteria and support a diagnosis of PID:

  • oral temperature >101° F (>38.3° C);
  • abnormal cervical or vaginal mucopurulent discharge;
  • presence of abundant numbers of WBC on saline microscopy of vaginal fluid;
  • elevated erythrocyte sedimentation rate;
  • elevated C-reactive protein; and
  • laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis.