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Does Physical Abuse To Pregnant Mother Affect The Baby?

Did you know that physical violence to a pregnant woman can cause intrauterine growth restriction (retardation)? Strange as it may sound, yes, physical abuse of a pregnant woman can indeed to several perinatal complications. Worse the fetus may be dead by the time he is born.

This was the topic during the first day of the convention I attended, though I failed to catch the first part of the talk. What struck me was the slide showing a strong association between violence towards pregnant woman and adverse outcome of the baby.

With that, I searched for any articles online, any study on physical violence and its adverse effect among pregnant women. I found a study conducted in Canada, but it is a large scale one involving 4750 study population. Independent variable (cause) studied was the physical abuse, which may have occurred even as early as before pregnancy. The dependent variables (outcome/effect) were presence of antenatal (before birth) hemorrhages, intrauterine growth retardation, and perinatal death (death between 20 weeks of pregnancy until 7 days after delivery). The study has shown that there is higher risk for occurrence of antenatal hemorrhage, intrauterine growth retardation and perinatal death among abused pregnant women.

(Reference: Patricia A. Janssen, PhD,a,c,d Victoria L. Holt, PhD,a Nancy K. Sugg, MD, MPH,b Irvin Emanuel, MD,a Cathy M, Critchlow, PhD,a and Angela D Henderson, PhDd/  Intimate partner violence and adverse pregnancy outcomes: A population-based study. Am J Obstet Gynecol 2003;188:1341-7.)

The speaker in the lecture explained why physical abuse restricts the growth of the fetus. Abuse causes the woman to be stressed. During stress, there is a release of stress hormones and substances, including epinephrine (otherwise known as adrenaline). This causes an rise on the resistive index at the level of the umbilical vessels.

Image

(http://www.fetal.com/IUGR/treatment.html)

During ultrasonography, the sonologist can focus on the umbilical cord and obtain the resistance index on the blood flow that goes to the baby. (Resistance index is almost similar also to the resistance along an electric wire; the higher the resistance, the lesser the output in the end). If the resistance index is increasing, it means to say that blood flow through the umbilical cord going to the baby is decreasing. Because of lack of blood supply, the baby receives less nutrition and oxygen– the basic baby’s requirement for rapid growth in utero. As a result, baby ends up smaller than expected for his age of gestation.

The chronic the stress of the mother is, the worse the fetal outcome. And as I have previously stated, worst case scenario may end up in fetal death, not from the physical trauma but from the reversal of blood flow to the fetus due to very high resistance index.

(Will include the lecturer’s name later when I get hold of my program).

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Posted by on October 2, 2012 in neonates, Physical Abuse, Pregnancy

 

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