Endotoxin stimulates endothelial cells to up regulate tis sue factor and thus procoagulant production (Cunningham, 2015). Consumptive coagulopathy associated with sepsis is dis cussed in Chapter 41 (p. 782). At the same time, it decreases the anticoagulant action of activated protein C. Several agents developed to block coagulation, however, did not improve outcomes. Some include recombinant activated protein C, anti thrombin II, platelet-activating actor antagonist, and tissue ac tor pathway inhibitor (Munford, 2015; Wenzel, 2012).
Depending on deinitions used, 10 to 20 percent of gravidas suffer physical trauma (Jain, 2015; Lucia, 2016). Moreover, injuryrelated deaths are the most commonly identiied nonobstetrical cause of maternal mortality (Brown, 2013a; Horon, 2001). In a California study of4.8 million pregnancies, almost 1 in 350 women were hospitalized for injuries from assaults (El Kady, 2005). From Parkland Hospital, motor vehicle accidents and falls accounted for 85 percent of injuries sustained by 1682 pregnant women (Hawkins, 2007). From the National Violent Death Reporting System, Palladino and colleagues (2011) found 2.0 pregnancyassociated suicides per 100,000 live births. he rate was 2.9 per 100,000 for pregnancy-associated homicides. Notably, intimatepartner violence may be linked to these suicides (Martin, 2007). Finally, injury prevention and education of high-risk patients may help to decrease morbidity (Chisolm, 2017; Lucia, 2016).
According to the CDC, llltlmate-partner violence describes physical, sexual, or psychological harm by a current or former partner or spouse (Breiding, 2015). Such violence afects 1 in 5 women each year. One goal in violence prevention for Healthy People 2010 was the reduction of physical abuse directed at women by male partners. The Pregnancy Risk Assessment Monitoring Systems (PRAMS) report showed some improvement in these areas (Suellentrop, 2006).
Even more appalling is that physical violence directed at women continues during pregnancy. Abuse is linked to poverty, poor education, and use of tobacco, alcohol, and illicit drugs (Centers for Disease Control and Prevention, 2008). Unfortunately, abused women tend to remain with their abusers, and the major risk factor for intimate-partner homicide is prior domestic violence (Campbell, 2007). Finally, women seeking pregnancy termination have a higher incidence of intimatepartner violence (Bourassa, 2007).
exposure is high aFor nonpregnant women, doxycycline, 100 mg orally twice daily for 7 days, can be given instead. bpregnancy category C.
HIV = human immunodeficiency virus; 1M = intramuscularly. Data from Centers for Disease Control and Prevention, 2015.
The woman who is physically abused tends to present late, if at all, for prenatal care. In one study, pregnant women hospitalized in California as a result of assault had signiicantly increased perinatal morbidity rates (El Kady, 2005). Immediate sequelae included uterine rupture, preterm delivery, and maternal and perinatal death. Subsequent outcomes included increased rates of placental abruption, preterm and low-birthweight newborns, and other adverse outcomes. Silverman and associates (2006) reported similar results from PRAMS, which included more than 118,000 pregnancies in 26 states.