Intimate partner violence (IPV) is physical, sexual or emotional abuse or control by a current or former partner, and it can start or get worse during pregnancy. It raises the risk of injury, miscarriage, preterm birth and homicide, so every pregnant patient should be screened in private.
Key symptoms
- Injuries that do not match the story, or delay in seeking care
- Missed prenatal visits
- Partner who answers for the patient or will not leave the room
- Depression, anxiety, substance use or suicidal thoughts
- Injuries to the belly, breasts or genitals
What you find on exam
- Screen alone, without the partner or family members as interpreters
- Full skin exam: bruises of different ages, bite marks, strangulation marks
- Fetal heart rate and fundal height after any belly trauma
- Mental health and safety assessment
Tests
- Validated screening questions asked in private
- Fetal monitoring after trauma to the abdomen
- Rh status and Kleihauer-Betke test after significant trauma when indicated
- Careful documentation and photos with consent
Treatment basics
- Believe and support the patient without judgment
- Assess immediate danger, including strangulation and weapons
- Safety planning and referral to advocates, shelters and hotlines
- Follow local mandatory reporting laws and protect confidentiality
- Treat injuries and arrange close prenatal follow-up
Red flags
- History of strangulation or a weapon in the home
- Threats to kill or escalating violence
- Belly trauma with pain, bleeding or reduced fetal movement
Practice it in Making Synapses
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Related guides
Sources: NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs); Open RN, Nursing Fundamentals 2e. Written by Making Synapses. Making Synapses is not affiliated with these organizations.