The prevalence of substance abuse in patients with suspected preterm labor

Article Abstract:

Preterm labor (labor occurring between the 22nd and 36th week of pregnancy) is associated with a poor pregnancy outcome. Maternal cocaine use has been associated with preterm labor, early separation of the placenta, fetal growth retardation, and congenital abnormalities. Pregnant women who abuse drugs are at risk for preterm labor and delivery. However, many substance abusers deny illicit drug use, and the prevalence of substance abuse in patients who are in early labor is unknown. Preterm labor was suspected among 141 women seen at Northwestern Memorial Hospital between July 1988 and December 1988. The results of routine urine tests that measure drug metabolites, were compared with those of 108 women in labor without pregnancy complications. Women who were taking prescription drugs, or women who admitted to substance abuse, were not included in the study. Drug abuse was detected by urine toxicology screening in 24 patients (17.0 percent) in suspected preterm labor, and in three patients (2.8 percent) in the comparison group (term labor). Cocaine was the most commonly detected drug, and was found in 14 women in preterm labor, in one patient in term labor. Of the women experiencing preterm labor, 22 out of 86 (25.6 percent) were clinic patients, and were positive for illicit drugs; 2 out of 55 (3.6 percent) of the private patients tested positive for illicit drugs. Six patients tested positive for more than one drug. It was noted that the age of the fetus at delivery and fetal birth weights were similar in the women who tested positive and negative for drugs. However, the magnitude and frequency of drug use was not ascertained. Although a cause and effect relationship was not clearly demonstrated by these results, it is highly likely that a significant percentage of positive drug results may found in women with suspected preterm labor. Therefore, all women in suspected preterm labor should have routine drug screening so that appropriate medical management strategies can be implemented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drugs, Causes of, Physiological aspects, Pregnant women, Drug use, Drug abuse in pregnancy

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Awaiting cervical change for the diagnosis of preterm labor does not compromise the efficacy of ritodrine tocolysis

Article Abstract:

Preterm labor (labor that begins too early in pregnancy) is typically diagnosed when regular uterine contractions and cervical effacement (shortening) and dilation are noted. In such cases, tocolytic drugs, which inhibit uterine contractions, are administered. Waiting for changes in the cervix to become apparent may involve waiting past the point at which tocolytic drugs are most effective; on the other hand, if given only on the basis of preterm uterine activity (before cervical changes), the drugs may expose patients who are not really in labor to side effects. Ritodrine, like other tocolytics, is best used only to treat 'true' preterm labor. To compare its effectiveness after cervical change and after uterine activity only (without change in the cervix), records from 209 women (237 infants) were reviewed. The patients were grouped according to the extent of their cervical dilation upon admission (if any), and all received ritodrine after persistent, regular uterine contractions were detected. Seventy-five patients had documented cervical dilation. Results showed that the 36 patients with three centimeters dilation or more had a poorer outcome, according to all measures, than the women who were dilated less than three centimeters. Ninety-eight of the 173 patients dilated less than 3 centimeters had no cervical change prior to tocolysis. No differences in any measure related to outcome were found between the groups with and without documented cervical change. Thirty-one women experienced side effects severe enough to change the treatment. The results suggest that no harm is done if patients with uterine contractions who are less than three centimeters dilated merely rest, under observation, to await the further progression of labor. Ritodrine may still be effective even if first given only after cervical change is noted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Dosage and administration, Tocolytic agents, Ritodrine

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Reducing cesarean births at a primarily private university hospital

Article Abstract:

A drop in the rate of cesarean sections occurred after initiation of a three-step process to encourage vaginal delivery at a university hospital. Cesarean sections accounted for 27.3% of all deliveries at Northwestern Memorial Hospital in Illinois in 1986. Under a new system introduced in 1987, doctors were required to document that they had offered a trial of labor to a woman who had previously had one cesarean section. In 1988, the number of cesarean sections performed by each obstetrician was circulated to other physicians. A new protocol for dealing with labor complications was developed in 1990 to encourage more active management of labor before resorting to surgery. As result, the hospital was able to reduce cesarean section rates by up to 42% over six years. At the same time the newborn mortality rate dropped from 10.3 in 1986 to 3.8 in 1991.

Usage, Cesarean section

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