Reporting of sexual assault in pregnancy may be obligatory. (Depends on State, Gestational Age).
"Sexual assault of an OB patient involves two victims, not just one ... and depending on the gestational age, along with individual state statutes, there is potential for an additional felonious count of 'intent to harm' with respect to the fetus," said Katherine G. King, a sexual assault nurse examiner at the Chattanooga (Tenn.) Sexual Assault Center.
"You may have no choice than to report this to protect the fetus. Know what your state requires, because this can be legal quicksand for the provider," she said at an obstetrics conference sponsored by Symposia Medicus.
Ms. King recommends encouraging a full forensic exam even in cases where the victim seems reluctant to report the incident.
"If she comes back to you next week and has decided to report it, you have no evidence because evidence should be collected within 72 hours of the incident. If you do the exam and she doesn't want to pursue it, you can just throw it all away" she said.
Thorough and extensive documentation is essential because the average time from the exam to the court case can be anywhere from 1.5 to 3 years. "Traditionally, a full forensic exam performed by a forensic specialist takes an hour to an hour-and-a-half," said Ms. King.
Requirements for sample collection vary among jurisdictions, so physicians should check with their local law enforcement agencies and keep a forensic collection kit in their office. Basic evidence should include oral, anal, and vaginal samples--all meticulously labeled, dried, and placed in paper evidence containers--with the exception of blood, which should be stored in blood tubes.
Evidence should be kept in careful custody because this is the first place a defense attorney will look to throw out evidence. "If it can be demonstrated that there was a break in the 'chain of custody'--who had the evidence before it reached its proper destination-- the case can be thrown out of court. I work with a woman who carried the evidence around with her for 2 days until she could give it to the right person, she said.
Ms. King said she recommends using photography to document injuries; a Wood's lamp to check for semen on clothing; hyperpigmentation from subclinical bruising, bite marks, or strangulation; a microscope to check for sperm; and a colposcope and toluidine blue dye to check for vaginal and perineal lacerations.
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|Publication:||OB GYN News|
|Date:||May 15, 2002|
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