Domestic violence and obstetric outcome among pregnant women in Ilorin, North Central Nigeria Enang E. Eno a, ⁎, Adegboyega A. Fawole b, c , Abiodun P. Aboyeji b,c , Kikelomo T. Adesina b,c , Abiodun S. Adeniran b,c a Department of Obstetrics and Gynecology, Federal Medical Centre, Keffi, Nasarawa state, Nigeria b Department of Obstetrics and Gynecology, University of Ilorin, Ilorin, Kwara state, Nigeria c Department of Obstetrics and Gynecology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria article info Article history: Received 25 August 2013 Received in revised form 7 November 2013 Accepted 27 January 2014 Keywords: Domestic violence Nigeria Obstetric outcome Pregnancy Pregnancy constitutes a period of heightened risk for domestic vio- lence, which can be physical, sexual, psychological, or emotional. A woman may be at risk irrespective of race, age, socioeconomic status, or educational level [1]. The abdomen is the most common target for physical violence [1]. Women who experience violence during pregnancy have a higher risk of pregnancy loss, preterm delivery, low birth weight neonates, pre- mature rupture of membranes, stillbirth, and increased likelihood of ce- sarean delivery [1]. The main objective of the present study was to investigate pregnancy outcomes among women who had experienced domestic violence compared with women who had not been abused. The study was a prospective case–control study conducted at the Obstetrics and Gynecology department, University of Ilorin Teaching Hospital, Ilorin, Nigeria, from January 1 to June 30, 2012. All pregnant women attending the prenatal clinic were informed about the study and those who provided written informed consent were screened for domestic violence using a modified version of the Abuse Assessment Screen [2]. Monogamous families had 1 wife and polygamous families had 2 or more wives. The sample size was determined by the formula for comparison of groups and the sampling method was purposive sam- pling. Pregnant women recruited to the study were required to affirm or refute whether they had experienced physical, sexual, emotional, or psychological violence during the preceding year or in the index preg- nancy that had been perpetrated by an intimate partner. Physical vio- lence included beating or using objects with intent to hurt, while sexual violence included unwanted fondling or forced sex. Emotional or psychological abuse included verbal abuse, humiliation, and isolation. The control group consisted of pregnant women who had not experi- enced domestic violence matched for parity, age, family type, education level, history of preterm birth, smoking, and ultrasound scan for exclusion of fetal congenital abnormalities. Women with previous uter- ine surgeries were excluded from the study. Maternal outcome mea- sures included preterm labor or delivery, operative vaginal or cesarean delivery, puerperal pyrexia, breastfeeding problems, anxiety, and depression. Presentation with cervical dilatation greater than or equal to 8 cm was termed late presentation. All instrumental deliveries were performed by the same individual. Neonatal outcomes included prematurity, low birth weight, birth asphyxia, intrauterine fetal death, and perinatal mortality. Ethical approval was obtained from the ethics and research commit- tee of the University of Ilorin Teaching Hospital before commencing the study. Data were analyzed using SPSS version 18 (IBM, Armonk, NY, USA). P b 0.05 was considered statistically significant. A total of 200 pregnant women were included in the study, compris- ing 100 women who had experienced domestic violence (subjects) and 100 pregnant women who had not (controls). The age range for both groups was 18–42 years (mean 30.18 ± 4.78 years). For other variables, comparisons between the subject and control groups were: 82% vs 89% monogamous families, 25% vs 28% primiparity, 16% vs 12% late booking, and 96% vs 97% married couples. The perpetrator was the woman’s husband in 96% of cases of domestic violence. Women who had experi- enced domestic violence were significantly more likely to have preterm labor (P = 0.037), instrumental vaginal delivery (P = 0.024), cesarean delivery (P b 0.001), breastfeeding problems (P = 0.015), postpartum depression (P b 0.001), and anxiety disorders (P = 0.008) (Table 1). The neonates of the subject group had statistically significant low birth weight (P b 0.001), and higher rates of birth asphyxia (P b 0.001) and neonatal death (P = 0.008) compared with neonates of the control group (Table 2). All instrumental vaginal deliveries were performed because of a prolonged second stage of labor. Cesarean deliveries were performed for fetal distress in 52% compared with 27% of the subject ⁎ Corresponding author at: Department of Obstetrics and Gynecology, Federal Medical Centre, PMB 004, Keffi, Nassarawa State, Nigeria. Tel.: +234 8035 973 014. E-mail address: enolaseng@yahoo.com (E.E. Eno). Table 1 Pregnancy outcome among women who had experienced domestic violence (subjects) and women who had not (controls). a Outcome Subjects (n = 100) Controls (n = 100) Relative risk X 2 P value Premature rupture of membranes (n = 23) 14 (14.0) 9 (9.0) 1.6 1.228 0.268 Preterm labor (n = 16) 12 (12.0) 4 (4.0) 3.0 4.348 0.037 Mode of delivery Instrumental vaginal (n = 5) 4 (4.0) 1 (1.0) 4.0 5.00 0.024 Cesarean (n = 27) 17 (17.0) 10 (10.0) 1.7 22.88 b0.001 Puerperal pyrexia (n = 4) 3 (3.0) 1 (1.0) 3.0 4.082 0.250 Puerperal sepsis (n = 5) 3 (3.0) 2 (2.0) 1.5 0.205 0.651 Breastfeeding problems (n = 23) 17 (17.0) 6 (6.0) 2.8 5.944 0.015 Depression (n = 26) 18 (18.0) 8 (8.0) 2.3 21.52 b0.001 Anxiety (n = 7) 6 (6.0) 1 (1.0) 6.0 7.00 0.008 a Values are given as number (percentage) unless otherwise indicated. Table 2 Neonatal outcome among women who had experienced domestic violence (subjects) and women who had not (controls). a Outcome Subjects (n = 100) Controls (n = 100) Relative risk X 2 P value Preterm delivery (n = 12) 9 (9.0) 3 (3.0) 3.0 14.00 b0.001 Birth weight, g b2500 (n = 20) 12 (12.0) 8 (8.0) 1.5 16.05 b0.001 2500 - 2.999 (n = 40) 25 (25.0) 15 (15.0) 1.7 35.85 b0.001 3000 - 3499 (n = 104) 46 (46.0) 58 (58.0) 0.8 1.385 0.239 N3499 (n = 36) 17 (17.0) 19 (19.0) 0.9 0.111 0.739 Intrauterine fetal death (n = 4) 2 (2.0) 2 (2.0) 1.0 1.00 0.317 Birth asphyxia (n = 17) 14 (14.0) 3 (3.0) 4.7 17.00 b0.001 Neonatal death (n = 7) 5 (5.0) 2 (2.0) 2.5 7.00 0.008 a Values are given as number (percentage) unless otherwise indicated. 170 BRIEF COMMUNICATIONS