Intimate partner violence and pregnancy: screening and intervention
Intimate partner violence and pregnancy: screening and intervention
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DOI：
10.1016/j.ajog.2017.05.043
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发表时间：
2017-08-01
影响因子：
9.8
通讯作者：
Ferguson, James E. (Jef), II
中科院分区：
文献类型：
--
作者：
Chisholm, Christian A.;Bullock, Linda;Ferguson, James E. (Jef), II
在这篇综述的第一部分，我们提供了目前公认的亲密伴侣暴力的类别和子类别的定义，并讨论了亲密伴侣暴力在非怀孕和怀孕妇女中的患病率和健康影响。在此，我们回顾了目前关于亲密伴侣暴力筛查的建议以及有关亲密伴侣暴力干预有效性的证据。对亲密伴侣暴力的筛查可只包括确定亲密伴侣暴力的受害者，或同时确定受害者并对其进行干预。直到最近，许多专业组织都不建议对亲密伴侣暴力进行普遍筛查，因为缺乏证据表明筛查的有效性，缺乏证据表明筛查无害，和/或对最有效的筛查工具缺乏共识。缺乏支持干预措施的证据对筛查造成了额外的障碍。美国妇产科医师学会一直是普遍的亲密伴侣暴力筛查的坚定倡导者，即使其他团体要么不支持筛查，要么只建议对高危妇女进行筛查。最近公布的数据证实，在确定怀孕期间和非怀孕妇女的亲密伴侣暴力受害者方面，筛查比通常的护理更可靠。同样，最近公布的数据表明，对亲密伴侣的暴力行为进行筛查没有明显的危害，筛查行为可能对妇女产生增强权能的作用，并改善她们与保健提供者的关系和对其的信任。尽管有这些发现，亲密伴侣暴力筛查的执行率仍然很低。最令人鼓舞的是，最近的数据显示，在对亲密伴侣暴力行为进行筛查后采取的干预措施对减少抑郁症状和暴力事件以及改善怀孕的某些结果是有效的。尽管对于哪种筛查工具可能最有效仍缺乏共识，但我们建议所有妇产科医生定期对所有妇女进行亲密伴侣暴力筛查，并熟悉现有的社区资源，以帮助那些通过筛查被确定为遭受亲密伴侣暴力的妇女。
In the first part of this review, we provided currently accepted definitions of categories and subcategories of intimate partner violence and discussed the prevalence and health impacts of intimate partner violence in nonpregnant and pregnant women. Herein we review current recommendations for intimate partner violence screening and the evidence surrounding the effectiveness of intimate partner violence interventions. Screening for intimate partner violence may include exclusively identification of victims of intimate partner violence or both the identification of and intervention for victims. Until recently, many professional organizations did not recommend universal screening for intimate partner violence because of a lack of evidence of effectiveness of screening, lack of evidence demonstrating that screening is not harmful, and/or a lack of consensus regarding the most effective screening tool. The lack of evidence supporting an intervention posed an additional barrier to screening. The American College of Obstetricians and Gynecologists has been a staunch advocate for universal intimate partner violence screening, even when other groups either did not endorse screening or recommended it only for high-risk women. Recent published data confirm that screening is more reliable than usual care in identifying victims of intimate partner violence, both during pregnancy and in nonpregnant women. Likewise, recent published data show that there are no apparent harms of screening for intimate partner violence and that the act of screening may have an empowering effect on women and improve their relationship with and trust in their health care providers. Despite these findings, the implementation rate of intimate partner violence screening remains low. Most encouraging are the recent data showing that interventions performed after screening for intimate partner violence are effective in reducing depression symptoms and episodes of violence as well as improving some outcomes of pregnancy. Although there remains a lack of consensus regarding which screening tool may be the most effective, we exhort all obstetrician-gynecologists to screen all women for intimate partner violence at regular intervals and to familiarize themselves with available community resources to assist those women who have been identified as experiencing intimate partner violence through screening.