Domestic violence

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

Domestic Violence: a Neglected Epidemic in O&G Training Cox-George C, Moffatt J, Jones K. Domestic violence: a neglected epidemic in obstetrics and gynaecology training. TOG 2017;19:199–203. doi:10.1111/tog.12374

up to 30% 16/1000 35 WOMEN PRESENTING AS DV VICTIMS IN FETAL MORTALITY, AFFECTED PREGNANCIES EPISODES OF DV BEFORE HELP SOUGHT (DOH PREGNANCY EST.)

DO N' T-M IS S FA C TS

  1. DV starts or escalates in pregnancy in one-third of cases (MBRRACE-UK); fetal mortality ~16/1000 affected pregnancies

  2. DV incidence in pregnancy 4–12% – higher than pre-eclampsia/GDM (2–5%)

  3. Victims see 5 professionals on average before effective support; 35 episodes of abuse (DoH est.) before help sought

  4. NICE 2014: DV education must be part of the undergraduate curriculum and CPD; ask routinely in antenatal/postnatal care

  5. Selective screening (gynaecology/HIV clinics) has evidence base; universal screening lacks proven long-term benefit

  6. No requirement for DV in RCOG undergraduate curriculum; no specific reference in RCOG postgraduate curriculum, despite MOET inclusion and a past MRCOG Part 2 question

  7. RCGP/RCEM/Royal College of Psychiatrists all have DV guidance; ACOG, SOGC, RANZCOG have structured DV training – UK O&G lags behind

  8. Simulation (e.g. Shefet et al., Israel) with structured debrief improves detection/referral – proposed as best-fit multidisciplinary teaching model

CURRICULA WITH DV PROVISION VS RCOG GAP

Have DV guidance/curriculum: RCGP, RCEM, Royal College of Psychiatrists, ACOG, SOGC, RANZCOG

No formal DV requirement: RCOG undergraduate & postgraduate O&G curricula

ABBREVIATION KEY

DV — domestic violence ACOG — American Congress of Obstetricians and Gynecologists

NICE — National Institute for Health and Care Excellence SOGC — Society of Obstetricians and Gynaecologists of Canada

RCOG — Royal College of Obstetricians and Gynaecologists RANZCOG — Royal Australian and New Zealand College of Obstetricians and Gynaecologists MBRRACE-UK — Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK MOET — Managing Obstetric Emergencies and Trauma course

CPD — continuing professional development IDVA — Independent Domestic Violence Advocate

GMC — General Medical Council CSEW — Crime Survey for England and Wales

RCGP — Royal College of General Practitioners GDM — gestational diabetes mellitus

RCEM — Royal College of Emergency Medicine

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — 2017;19:199–203. doi:10.1111/tog.12374

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