Prevalence and complications of physical violence during pregnancy

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Abstract

Objectives: To assess the incidence of self-reported physical violence in pregnancy and describe the association with foeto-maternal complications and birth outcome. Method: Seven thousand one hundred and five pregnant women over a 3 year period were assessed for self-reported physical violence. Maternal ante-natal hospitalization, low birth weight and pre-term delivery. Odd ratio (OR) and 95% confidence interval (CI) were calculated to measure association between physical violence, maternal morbidity and birth outcome. Results: The prevalence of physical violence was 21%. Women who reported/experienced physical violence, were more likely to be hospitalized ante-natally for maternal complications such as trauma due to blows/kicks on the pregnant abdomen, abruptio-placenta, pre-term labor and kidney infections. There was a positive association between physical violence during pregnancy and cesarean section, abruptio-placenta, fetal distress, and pre-maturity. Conclusion: Physical violence during pregnancy is common and is associated with adverse materno-fetal outcome.

Introduction

The prevalence of physical violence during pregnancy varies between 0.9 and 21% and the research predominantly comes from the USA and Scandinavia [1], [2], [3]. British studies report rates of 1.8–5.8% [1], [2], [3], although higher rates are elicited with direct questioning by trained health professionals.

Five studies [4], [5], [6], [7], [8] show no association between physical violence and low birth rate inclusive of pre-term labor whereas three [9], [10], [11] found a positive association.

Data on physical violence during pregnancy is sparse in Saudi Arabia. We conducted a study to examine the prevalence and possible associations with adverse pregnancy outcomes.

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Materials and methods

From September 1996 to 1999, 7557 consecutive pregnant women in the first trimester of pregnancy attending the ante-natal clinics of two universities teaching hospital (inclusive of their emergency obstetrics units) were recruited for the study after obtaining ethical committee approval and written consent. The population is representative of the local population as nearly all pregnant women have all their ante-natal care at these hospitals.

Case files of women experiencing physical violence and

Results

Twenty one percent of women reported physical violence, 87% reported that the husband had perpetrated physical violence and the remainder stated that they had been involved in fights with their husband and in laws, resulting in physical injury.

Among women experiencing violence 40% reported ante-natal hospitalization before delivery. The following maternal conditions leading to hospitalization were found to be closely associated with physical violence: premature labor (OR 3.4; 95% CI 1.4, 2.8);

Discussion

Studies suggest that pregnancy often triggers domestic violence or exacerbates a pre-existing problem and moreover the pattern of violence may change with assaults directed to the abdomen breasts and genitals [8], [9], [10], [11], [12] which was also noted in this study (Table 2). Physical violence during pregnancy is a second leading cause of trauma during pregnancy after vehicle accidents [13]. In this study, the prevalence of physical violence during pregnancy (20.9%) is within the range of

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