Sexual assault during pregnancy harms the patient and can also injure the pregnancy, and it is often linked to intimate partner violence. Care focuses on safety, consent at every step, medical treatment, evidence collection if wanted and protecting the fetus.
Key symptoms
- Genital or abdominal pain, bleeding or injuries
- Fear, shock, numbness or self-blame
- Contractions, vaginal bleeding or fluid leak
- Less fetal movement
What you find on exam
- Ask consent for each part of the exam; offer a sexual assault nurse examiner (SANE)
- Full injury check, including signs of strangulation
- Gentle pelvic exam for injuries, bleeding and fluid
- Fetal heart rate and, after 20 weeks, fetal monitoring
Tests
- Forensic evidence kit if the patient agrees
- Tests for gonorrhea, chlamydia, trichomonas, HIV, syphilis and hepatitis B
- Ultrasound to check the pregnancy
- Rh status, and Kleihauer-Betke test if Rh negative after trauma
Treatment basics
- STI prophylaxis safe in pregnancy: ceftriaxone, azithromycin and metronidazole; HIV prophylaxis when indicated
- Hepatitis B vaccine and tetanus update as needed
- Rh immune globulin if Rh negative
- Safety planning, an advocate and mental health follow-up
Red flags
- Vaginal bleeding, contractions or abdominal pain
- Abnormal or absent fetal heart rate
- Strangulation, ongoing danger at home or suicidal thoughts
Practice it in Making Synapses
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.