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
- Have you been hit, kicked, slapped, punched or otherwise hurt by someone in the past year?
- Do you feel safe in your current relationship?
- Is there a partner from a previous relationship who is making you feel unsafe now?
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).
Minimum criteria for clinical diagnosis (one or more of the following minimum clinical criteria should be present) are as follows:
- Bilateral lower abdominal (uterine) tenderness (sometimes radiating to the legs)
- 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,
- 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.
- Transvaginal ultrasound is the diagnostic tool of choice for tubal ectopic pregnancy.
- Tubal ectopic pregnancies should be positively identified, if possible, by visualising an adnexal mass that moves separate to the ovary.
- A serum beta-human chorionic gonadotrophin (β-hCG) level is useful for planning the management of an ultrasound visualised ectopic pregnancy.
- Expectant management is an option for clinically stable women with an ultrasound diagnosis of ectopic pregnancy and a decreasing β-hCG level initially less than 1500 iu/l.
- Systemic methotrexate may be offered to suitable women with a tubal ectopic pregnancy. It should never be given at the first visit, unless the diagnosis of ectopic pregnancy is absolutely clear and a viable intrauterine pregnancy has been excluded.
- Surgical methods of management are associated with a high failure rate and should be reserved for those women suffering life-threatening bleeding.
- Offer anti-D prophylaxis as per national protocol to all RhD-negative women who have surgical removal of an ectopic pregnancy, or where bleeding is repeated, heavy or associated with abdominal pain.