WOMEN’S MEDICINE CRISESObstetric and Gynaecological Emergencies 391(d) emergency contraception is recommended if more than two
pills are missed from the first seven tablets in a packet.2 Progestogen-only pill
Over 3 h late, continue normal pill taking, but abstain from sex or use an alter-
native barrier method of contraception for the next 7 days.
Domestic violence to females
DIAGNOSIS
1 Domestic violence affects women of every class, race and religion. It may
commence at times of acute stress such as unemployment, first pregnancy or
separation.
2 The victim may present with injury, abdominal or other pain, substance
abuse, attempted suicide, sexual assault or with multiple somatic complaints.
3 Victims may delay attending, and may be evasive and embarrassed. Their
partner may answer for them or act unconcerned.
MANAGEMENT1 Ensure privacy by interviewing alone without the partner. Ask gently but
directly about the possibility of violence, which may initially be denied.
2 Record all injuries, measuring bruises or lacerations with a ruler, and insti-
tute any urgent treatment to save life.
3 Enquire about any additional risk of physical or sexual abuse to other
members of t he household, par ticularly children (see p. 372).
4 Call the duty social worker. Offer admission if it is unsafe for the patient to
return home or if acute psychiatric illness is present, e.g. depression.
5 However, if the patient wishes to return home, give written contact numbers,
including:
(i) GP.
(ii) Women’s refuge.
(iii) Domestic violence 24-h specialist helpline.
(iv) Local police.
Female rape
Follow a standard procedure in all cases of alleged rape in which the patient
requests or accepts police involvement.
Tip: a similar management approach to domestic violence is applicable
✓ to both sexes, as well as in the elderly.