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Substance abuse in pregnancy (Definitions (Intoxication Transient…
Substance abuse
in pregnancy
Definitions
Intoxication
Transient syndrome due to recent substance ingestion,
causing physical/psychological impairment
Dependence syndrome
Physiological, behavioural and cognitive involvement
where the substance takes on higher priority than other behaviours that once had greater value
Harmful use
Pattern of substance use causing
damage to physical/mental health
Tolerance
Homeostatic adaptation to chronic administration of a drug, greater amount needed to produce the same effect
Withdrawal
Signs and symptoms (physical and psychological) occurring when a drug is stopped, after a period of chronic use
Epidemiology
5% alcohol, 2% drug dependence
Undereported due to poor history taking, reluctance of mother to report, late booking, poor antenatal attendance, poor communication between HCPs (GPs, SS, MWs, obs)
Complications
Mother
Physical
Neglect of health
Poor nutrition
Poor hygeine
Immunosuppression
If IVDU, BBV, sepsis, abscesses, VTE, endocarditis
Death (often due to OD)
Psychiatric
Personality disorder
Depression, anxiety
Suicide
Social
Employment
Finances
Family relationships
Child protection
Antisocial/criminal acts
Child
Foetus
Preterm
IUGR
Low birth weight
Stillbirth
Neonate
Withdrawal state
Foetal alcohol syndrome
Mortality
Sudden infant death symdrome
Physical and neurological damage
Diagnosis
Investigations
Bloods
FBC, CRP, U+Es, LFTs,
toxicology screen
BBV screen
Swabs
HVS and ECS for STIs
Bedside
Observations
Height, weight (BMI)
Imaging
USS: foetal growth and development
Examination
General
Malnourished, poor hygeine, low mood
Abdominal
SFH smaller than expected
Pelvic/speculum
Likely nil
History
PC
Complications of chronic drug abuse
or acute intoxication
Current pregnancy
Attendance at bloods, scans
Any IUGR, low birth weight
POH
Prrevious preterms, IUGR, stillbirths,
foetal alcohol syndrome, physical disability
DH
Current medications, methadone etc., allergies
PMH
Complications of chronic use
Psychiatric diagnoses
FH: psychological problems, substance misuse
SH
Alcohol, illicit drugs, social services,
alcohol/drug support services
Management
Conservative
MDT care (GP, SS, obs team, addiction services)
Consultant led care (high risk pregnancy)
USS scans: anomaly scan, cardiac scan, serial growth
Contraceptive advice if indicated
Medical
Substitution therapy
Indication: opiate abuse
E.g. methadone