Preventatively, the American College of Obstetricians and Gynecologists (2012) recommend universal screening for intimate-partner violence at the initial prenatal visit, during each trimester, and again at the postpartum visit (Chap. 9, p. 162). Others recommend a case-finding approach based on clinical suspicion (Robertson-Blackmore, 2013).
According to the National Intimate Partner and Sexual Violence Survey (Black, 2014), an estimated 1.2 million women will be sexually assaulted each year. Satin and coworkers (1992) reviewed more than 5700 female sexual assault victims in Dallas County and reported that 2 percent were pregnant. Associated physical trauma is common (Sugar, 2004). From a forensic standpoint, the evidence collection protocol is not altered (Linden, 2011).
In addition to attention to physical injuries, exposure to sexually transmitted diseases must be considered. The CDC (2015) recommends antimicrobial prophylaxis against gonorrhea, chlamydial infection, bacterial vaginosis, and trichomoniasis (Table 47-7). If the woman is not pregnant, another very important aspect is emergency contraception, as recommended by the American College of Obstetricians and Gynecologists (2016; 2017a) and discussed in Chapter 38 (p. 696).
Finally, the importance of psychological counseling for the rape victim and her family cannot be overemphasized. A 30-to 35-percent lifetime risk each for posttraumatic stress disorder, major depression, and suicide contemplation follows sexual assault (Linden, 201r1) .
At least 3 percent of pregnant women are involved in motor vehicle accidents each year in the United States. Using data from PRAMS, Sirin and colleagues (2007) estimated that 92,500 gravidas are injured annually. Motor-vehicle crashes are the most common causes of serious, life-threatening, or fatal blunt
FIGURE 47-8 Illustration showing correct use of three-point automobile restraint. The upper belt is above the uterus, and the lower belt fits snugly across the upper thighs and well below the uterus.
trauma during pregnancy (Brown, 2013a; Mendez-Figueroa, 2013,r2016; Vladutiu, 2013). Mattox and Goetzl (2005) report these accidents to be the leading cause of traumatic fetal deaths as well. This was also true from our experiences from Parkland Hospital (Hawkins, 2007). Traic crashes are most frequent in the second trimester (Redel meier, 2014). As with all motor vehicle crashes, alcohol use is often associated. But sadly, as many as half of accidents occur without seat-belt use, and many of these deaths would likely be preventable by the three-point restraints shown in Figure 47 8 (Luley, 2013; Schuster, 2016). Seat belts prevent contact with the steering wheel, and they reduce abdominal impact pressure (Motozawa, 2010).