Lessons Learned in Conducting Universal Psychosocial Screening in a High Risk Obstetrics and Gynecology Clinic

Low birth weight and preterm delivery are among the leading causes of infant mortality in the United States. Life events reported during pregnancy as highly stressful are associated with shorter mean gestation age, an increased risk of preterm delivery, and low birth weight. Abuse during pregnancy, a significant stress inducing event, is associated with these outcomes. In a systematic review, Murphy (2001) concluded that pregnant women who reported physical or sexual abuse were 40% more likely than non-abused women to deliver low-birth-weight infants. Because stress has been associated with these adverse pregnancy outcomes, the American College of Obstetricians and Gynecologists committee on Health Care for Underserved Women (2006) recommends screening for psychosocial risk factors associated with stress. A comprehensive method for screening psychosocial stress is being implemented for our OB patients. This screening includes assessment for:(1) current and lifetime physical, sexual, or psychological abuse (2) perceived stress, (3) housing instability, (4) unplanned pregnancy, (5) substance use, and (6) depressive symptoms. This screening protocol, launched in March 2008, is being conducted by trained nurses through a new electronic medical record system. Here, we will present the challenges of implementing psychosocial screening in the state of Kentucky in which spouse abuse reporting is mandatory. An interim evaluation of staff knowledge, attitudes, and behaviors towards psychosocial screening will also be presented. Finally, based on chart audits we will report the proportion of our screened patients and the frequency with which these women displayed one or more of the aforementioned psychosocial risk factors.