Book of Medical Disorders in Pregnancy - Tintash

Effect of cocaine on pregnancy:
1. It decreases umbilical artery
prostacyclin production and can
deplete antithrombin III and
protein C, thus enhancing the risk
for thrombogenesis.
2. It interferes with the lowpressure,
high flow physiology of
gestation, with predictable ill
effect on both the mother and the
fetus.
2. The mature placenta can convert
cocaine into less active
metabolites, presumably by
placental cholinesterases. Despite
this pot-ential protection for the
fetus, low birthweight, neonatal
withd-rawal, intrauterine fetal
death, fetal vascular complications,
and accelerated fetal
lung maturity are regular
complications.
3. After Cocaine intake, there is a
rapid onset of intense "high"
euphoria. As tolerance develops,
the euphoric effects are quickly
replaced by depression, exhaustion,
and anxiety,
4. Maternal cocaine use produces
decreased uterine blood flow and
there is dose dependent increase
in fetal heart rate. Chronic Cocaine
use appears to be a cause of
maternal cardiomyopathy, which
may be confused with peripartum
cardiomyopathy.
5. Cocaine exaggerates uterine
contractions. Half of cocaineusing
women not receiving
prenatal care deliver prematurely.
Effect of cocaine on fetus:
182
Teratogenicity exclusively to cocaine
use has not been established. Limb
reduction defects, genitourinary malformations,
cardiac anomalies, and gastrointestinal
atresia are commonly reported.
Other complications:
Maternal hyperthermia during cocaine
intoxication may contribute to the
increased incidence of congenital malformations.
Seizures and Pulmonary
complications have been associated with
smoking crack cocaine. Pulmonary edema
and bronchiolitis bitterns have been
less commonly reported. "Crack lung'' is
the name given to the constellation of
hemoptysis, chest pain, and diffuse
alveolar infiltrates. The association
among crack cocaine use, syphilis and
HIV infection is compelling.
Management:
Good prenatal care and sheltered withdrawal
from drugs and the drug scene
are the principal management objectives.
There are no known effective pharmacologic
agents available to block cocaine
craving and to sustain abstinence.
Amphetamines:
These drugs continue to be popular
among drug users and experimenters
because of their euphoric, sympathomimetic
properties. Amphetamine use
increases the risk of serious arrhythmias,
including ventricular tachycardia and
asystole, during obstetric anesthesia.
Inhaled amphetamine ("ice") has repetitive
drug induced vasospasm. It is
thought to be the cause of prematurity,