Reports to the Navy's Family Advocacy Program: impact of removal of mandatory reporting for domestic violence.

The impact of mandatory reporting laws on domestic violence reports is unclear. In 2006, the Department of Defense removed its requirement for mandatory reporting of domestic violence against adults. Our objective was to determine if there was a change in the incidence of domestic violence reports to the Navy's Family Advocacy Program after the shift from mandatory reporting to a policy allowing restricted reporting. Reports of domestic violence to the Navy Central Registry between fiscal year (FY) 2000 and 2010 were studied. Frequencies and rates of domestic violence reports, type of abuse, and victim and offender gender were studied. Over the past 11 years, the total number of unrestricted domestic violence reports to the Navy Central Registry has decreased by just over a third. In addition, the number of substantiated reports has decreased by approximately 50%. Since the collection of data on restricted reports in 2008, the aggregated reporting rate of substantiated reports is significantly smaller, 0.87% for FYs 2008 to 2010 compared to 1.34% for FYs 2000 to 2005, p < 0.01. Domestic violence reports to the Navy Central Registry have declined over the past 11 years, even with the removal of the requirement for mandatory reporting of domestic violence.

Prevalence of domestic violence in a pregnant military population.

OBJECTIVE: To estimate the prevalence of domestic violence and the characteristics of pregnant women reporting domestic violence in a military setting. METHODS: This was a prospective observational study of patients presenting for prenatal care to a Naval hospital from January 2007 to March 2008. Participants were screened anonymously for domestic violence using the Abuse Assessment Screen. Data were summarized using medians, interquartile ranges, and frequency distributions. Univariable comparisons between groups were conducted using Mann-Whitney tests for continuous data and chi2 tests for categorical outcomes RESULTS: Of the 1,162 surveys, 14.5% screened positive for abuse (either current or past), and 1.5% of respondents reported current pregnancy abuse. Relative to married women, single women (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.04-3.16, P=.036) and separated or divorced women (OR 3.45, 95% CI 1.59-7.46, P=.002) were at an overall increased risk of physical or emotional partner abuse. Compared with married women, the single women (OR 2.80, 95% CI 1.35-5.78, P=.005), but not the separated or divorced women (P=.172), were at increased risk for partner abuse in the previous 12 months. A family history of abuse also was associated with an increased risk of abuse within the previous 12 months (OR 5.99, 95% CI 2.99-11.99, P<.001). CONCLUSION: The prevalence of domestic violence in our pregnant military population was 14.5%, which is in the upper range of the prevalence reported in a nonmilitary population (0.9-23%). Unmarried status and a history of abuse may indicate a higher abuse risk. LEVEL OF EVIDENCE: III.

Factors affecting caesarean operative time and the effect of operative time on pregnancy outcomes.

AIM: To determine the factors that influence caesarean operative time and operative time effects on pregnancy outcomes. METHODS: Prospective observational study of women undergoing a caesarean delivery (CD). Multiple antepartum, intrapartum and neonatal outcomes were assessed for their influence on the time of the CD and the time effect of CD on pregnancy outcomes. RESULTS: There were 386 (23%) caesarean deliveries performed < or = 30 min, 1070 (65%) between 31 and 60 min, and 200 deliveries > or = 60 min. Women younger than 18 years (P= 0.004) and who had caesarean for fetal labor intolerance were associated with shorter operation time (P < 0.001). Factors associated with an increased operation time were age > 35 years (P = 0.049), body mass index (BMI) > or = 30 (P < 0.001), pre-existing hypertension (P = 0.001), prior low segment transverse scar (P < 0.001), uterus incision other than transverse (P < 0.001), first-year resident as primary surgeon (P < 0.001) and accompanying sterilisation procedure (P < 0.001). Operation time was significantly related to blood loss (P < 0.001), likelihood of umbilical artery cord gas pH < 7.1 (P < 0.001) and Apgar scores at five minutes < 7 (P= 0.009). CONCLUSIONS: Operative time is shortened by age < 18 and delivery for fetal labor intolerance, lengthened by age > 35, BMI > 30, prior caesarean, uterine incision, operating surgeon inexperience and accompanying sterilisation. Increased operative time was linked with an increased blood loss, low five-minute Apgar scores and umbilical arterial pH < 7.1.

Postpartum insertion of levonorgestrel--intrauterine system at three time periods: a prospective randomized pilot study.

BACKGROUND: The study was conducted to determine the feasibility of levonorgestrel-intrauterine system (LNG-IUS) insertion at three different times postpartum. STUDY DESIGN: From August 2009 to January 2010, all women desiring LNG-IUS for postpartum contraception were offered enrollment into our study and randomized to three insertion times: immediate (within 10 min of placenta delivery), early (10 min to 48 h postpartum) or interval (≥6 weeks postpartum). RESULTS: Forty-six women met inclusion criteria and were analyzed. There was no difference in utilization rates at 3 and 6 months between groups (p=.931). Expulsion rates were significantly higher and pain during insertion was significantly lower in the immediate and early groups (p<.001) when compared to the interval group. CONCLUSION: Insertion of LNG-IUS ≤48 h postpartum is feasible in our institution and may be associated with similar utilization at 6 months, increased expulsion rates and decreased pain at insertion when compared to placement after 6 weeks.

An early abdominal wall ectopic pregnancy successfully treated with ultrasound guided intralesional methotrexate: a case report.

Background. The upper anterior abdominal wall is a very unusual location for an ectopic pregnancy making optimal management uncertain. Case. We report the case of a 26-year-old gravida 4, para 1, aborta 2 with a rising quantitative human chorionic gonadotropin level following a negative diagnostic laparoscopic examination. She was subsequently diagnosed with an abdominal wall ectopic pregnancy 2 cm inferior to the liver. A single percutaneous intralesional injection of methotrexate was successful after initial failure with systemic methotrexate. Conclusion. Systemic methotrexate is a logical first choice for management of a stable early abdominal wall pregnancy. Direct intralesional injection of methotrexate as the next treatment choice may avoid the morbidity linked with operative management.