Book of Medical Disorders in Pregnancy - Tintash

multiple sexual users, often results in
drug abuse. Evaluation of drug using
mother must include search for sexually
transmitted pathogens in unexpected and
multiple orifices.
Drug abuse and syphilis are important
associates of human immunodeficiency
virus (HIV) infection.
Immunodeficiency syndrome and the
opportunistic infections are associated
with immuno incompetence.
Hepatitis B is also common among drug
users. A variety of microbes not usually
regarded as sexually transmitted can be
spread by oro genital, oro anal, and a
genital sexual practice, including
Haemophilus influenzae type B, Giardia
lamdia, Entamoeba histolytica,
Campylobacter jejuni, Shigella and
Salmonella.
Indigenous flora such as staphylococci,
streptococci, aerobic gram-negative rods
(especially pseudomonades) and various
anaerobes including Bacteroides clostridial
species, and fungi, such as Candida.
Septic thrombophlebitis, superficial
Cellulitis, and abscess formation are
common associates’ conditions. Clinical
tetanus may follow subcutaneous
injection ("skin popping"). Bacteremia
following UN sterile intravenous
injection may cause pyrogen reactions,
septicemia, metastatic abscess of bone
and cartel-age, and even endocarditis.
Management:
History and physical examination:
The specific questions about substance
must be asked and urine testing for drugs
must be carried. The physician must be
alert to the psychosocial clues of drug
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abuse and to the complications. The
appearance of needle tracks or tattoos
which are used to cover needle tracks
cause unusual infections in unusual
locations, signs of physical torture.
Unexplained indifference to the need for
careful prenatal nutrition and care are
often good clues to potential drug abuse.
Questions about drug-using behavior and
urine testing must be repeated, some
times with every visit, because the
presence of drugs and drug metabolites
in the urine is transient and because drug
use may occur in binges, not continuously.
False positive results on urine
tests can be caused by urinary tract infections
and the use of anesthetic
lubricants for urinary catheters or for
sexual purposes. A coordinated team
approach including drug abuse treatment
social and legal services along with
obstetric and medical care yield good
results. Drug abuse is a lifetime problem.
Pregnancy can be unique opportunity to
help the drug using woman learn a
different way of life.
Alcohol in pregnancy: Some adverse
fetal effects can be attenuated by
abstinence in the second half of
pregnancies. The capacity of heavy
drinkers to disguise their drinking is
strong. Questions about drug use enquiry
should include: "Have you ever had a
drinking problem?" and "When was your
last drink?" History of motor vehicle
accidents or tickets for risky driving, are
important clues for further investigation.
Management: 2 to 6 days of treatment
with a short acting barbiturate, such as
pentobarbital, is preferable in pregnancy.
Concern about the possible
teratogenicity and neonatal effects of the
benzodiazepines has restricted their use
in pregnancy. Disulfiram (Antabuse) is a