Labor analgesia for the drug abusing parturient: is there cause for concern?
Drug abuse has crossed geographic, economic and social borders, and it remains one of the major problems facing our society today. The prevalence of recreational drug abuse among young adults (including women) has increased markedly over the past two decades. Nearly 90% of drug abusing women are of childbearing age. Consequently, it is not surprising to find pregnant women with a history of drug addiction. Obstetricians and obstetric anesthesiologists become involved in the care of drug abusing patients either in emergency situations, such as placental abruption, uterine rupture or fetal distress, or in more controlled situations, such as request for labor analgesia. The diverse clinical manifestations of maternal substance abuse may result in life-threatening complications and significantly impact the peripartum care of these patients.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader will be able to list the most commonly abused substances during pregnancy, to describe the various effects of particular substances on pregnancy including the mechanism of desired effect for various substances, and to outline the obstetric anesthesia recommendations for the various substances abused during pregnancy.
Kuczkowski
Krzysztof M
KM
Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA 92103-8770, USA. kkuczkowski@ucsd.edu
D000437:Alcoholism; D019969:Amphetamine-Related Disorders; D016362:Analgesia, Obstetrical; D000773:Anesthesia, Obstetrical; D019970:Cocaine-Related Disorders; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications; D012907:Smoking; D015819:Substance Abuse, Intravenous; D019966:Substance-Related Disorders