Cocaine abuse has been declining among pregnant women, but estimating rates of illicit use is difficult as a large majority of women who abuse cocaine also report abusing other drugs. Chronic use leads to depression, decreases in maternal cortical function, significant end organ damage, and increases in rates of infectious diseases. Acute intoxication can be mistaken for preeclampsia/eclampsia as hypertension is common, seizures can occur, and proteinuria accompanies the renal damage of long term abuse. There is little evidence for an increased risk for congenital anomalies. Obstetric management is complicated by higher rates of fetal distress during labor and placental abruption. Early placement of neuraxial analgesia for labor is recommended because urgent and emergency cesarean delivery are more likely and the wide swings in maternal hemodynamics that accompany a general anesthetic many be avoided.
KeywordsAddiction Obstetric anesthesia Cocaine Simulants
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