Addiction in pregnancy: high risk intrapartum management and outcome.
Drug-dependent women (DDW) have an increased incidence of medical and obstetrical complications; however, little information exists on the intrapartum course and management of these patients. Within the context of Family Center, a study was undertaken to determine if the DDW had normal patterns of labor and if standard intrapartum management is appropriate. The study population included 336 women of which 112 were DDW (72 per cent receiving methadone maintenance). The comparison group of 224 non drug dependent women was matched for gravidity, parity, and socioeconomic background. The incidence of premature delivery, abruptio placentae, breech presentation, and intrauterine growth retardation were significantly greater in the DDW. The average duration of the first, second, and third stages of labor compared well with the normal course of labor and matched the results of the comparison group. Labor abnormalities and cesarean sections were of no greater incidence, but there were more than twice as many forceps deliveries which coincides with the 40 per cent increased use of epidural anesthesia. Analgesia and anesthesia were in excess of that which is given to the average patient. There were three stillborns, one neonatal death, and one maternal death. Apgar scores and the incidence of fetal distress and meconium staining were identical in both groups. Postpartum complications were more common in the DDW, but most were secondary to the use of subclavian intravenous lines inserted due to the presence of sclerotic veins. These data suggest that high risk prenatal management and careful monitoring in the intra- and postpartum periods utilizing epidural anesthesia identifies and usually prevents untoward complications in DDW.
D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death; D005316:Fetal Distress / Q000209:etiology; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications; D019966:Substance-Related Disorders / Q000150:complications*