AUST.AND N.Z. JOURNAL OF OBSTETRICS A N D GYNAECOLOGY
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Caesarean if required and appropriate guidelines for the management of labour (16). In this way, most women with a previous Caesarean section can vaginally and the current low maternal and perinatal morbidity can be maintained.
References 1. Department of Health. Report on Confidential Enquiry into Maternal Deaths in England and Wales 1982-84. Her Majesty's Stationery Office, London 1989. 2. Department of Health, NSW. 1987 Maternal and Perinatal Report. NSW Department of Health, Sydney 1987. 3. National Health and Medical Research Council 1984. Report of the working party to investigate variations in Caesarean section rates in Australia. AGPS, Canberra 1985. 4. Renwick MY. Caesarean section rates, Australia 1986: variations at state and small area level. Aust NZ J Obstet Gynaecol 1991; 31: 299-304. 5. Molloy BG, Sheil 0, Duignan NM. Delivery after Caesarean section: a review of 2176 consecutive cases. Br Med J 1987; 294: 1645-1647. 6. Phelan JP, Clark SL, Diaz F, Paul RH. Vaginal birth after Cesarean section. Am J Obstet Gynecol 1987; 157: 1510-1515. 7. Targett C. Caesarean section and trial of scar. Aust NZ J Obstet Gynaecol 1988; 28: 249-262.
8. Flamm BL, Lim OW, Jones C, Fallon D, Newman LA, Mantis JK. Vaginal birth after Caesarean section: results of a multicenter trial. Am J Obstet Gynecol 1988; 158: 1079-1084. 9, Meehan FP, Burke G, Casey C, Sheil JG. Delivery following Cesarean section and perinatal mortality. Am J Perinatol 1989; 6: 90-94. 10. Nielson TF, Ljungblad U, Hagberg H. Rupture and dehiscience of Cesarean section scar during pregnancy and delivery. Am J Obstet Gynecol 1989; 160: 569-573. 11. Chua S, Arulkumaran S, Singh P, Ratnam SS. Trial of labour after previous Caesarean section: obstetric outcome. Aust NZ J Obstet Gynaecol 1989; 29: 12-17. 12. Duff P, Southmayd K, Read JA. Outcome of trial of labour in patients with a previous low transverse Cesarean section for dystocia. Obstet Gynecol 1988; 71: 380-384. 13. Ngu A, Quinn MA. Vaginal delivery followingCaesarean section. Aust NZ J Obstet Gynaecol 1985; 25: 41-43. 14. Krishnamurthay S, Fairlie F, Cameron AD, Walker JJ, Mackenzie JR. The role of postnatal x-ray pelvimetry after Caesarean section in the management of subsequent delivery. Br J Obstet Gynaecol 1991; 98: 716-718. 15. Dhall K, Mittal SC, Grover V, Dhall GI. Childbirth following primary Cesarian section - evaluation of a scoring system. Int J Gynaecol Obstet 1987; 25: 199-205. 16. NIH Consensus Development Task Force statement on Cesarean childbirth. Am J Obstet Gynecol 1981; 139: 902-909.
Aust NZ J Obstet Gynaecol 1992; 32: 3: 216
Narcotic Addiction in Pregnancy with Adverse Maternal and Perinatal Outcome S. K. Lam', W. K. To', S. J. Duthie2 and H. K. Ma3 Department of Obstetrics and Gynaecology, University of Hong Kong, Ban Yuk Hospital, Hong Kong
Summary: A retrospective case controlled study was carried out on 51 Chinese gravidas who had abused narcotics and who were delivered in a teaching hospital in Hong Kong. Heroin was the most commonly abused drug. The number of patients who changed from heroin to methadone was small. The major antenatal complications were late antenatal booking (average 28 weeks), prematurity (410'/0), small for gestational age baby (27.5%), antepartum haemorrhage (13.7%) and high prevalence of venereal disease (23.5%). The babies born to drug addicted mothers were on average 629 g lighter at birth, 5 cm smaller in head circumference and 7 cm shorter in body length. Neonatal withdrawal symptoms occurred in 83% of all drug exposed neonates. The perinatal mortality rate was 19.6 per 1,000 total birth which was 2.5 times that of the control group. There was one maternal death in our series. Drug addiction in pregnancy poses a major risk to both mother and child.
1. Medical Officer. 2. Lecturer. 3. Professor. Address for correspondence: Dr. S. K. Lam, Department of Obstetrics and Gynaecology, University of Hong Kong, Tsan Yuk Hospital, Hospital Road, Hong Kong.
S. K. LAMET AL
Narcotic addiction is a major social and medical problem in many parts of the world. Routine testing of urine in 1,643 labouring women in a hospital in California (1) showed opiates in 1% of specimens; 8% had metabolites of cocaine and 6% had metabolites of amphetamine in the urine. Irr Australia, Oats (2) estimated the incidence of narcotic addiction during pregnancy as 0.06%. In Hong Kong, the extent of this problem is not known as the prevalence of narcotic abuse complicating pregnancy has hitherto been unreported. The data in our hospital over the past 10 years showed that the average incidence was 1 in 1,000 deliveries. This figure is lower than that reported in the United States but higher than the figures reported from Australia. The problems of narcotic abuse have special significance for Hong Kong. Firstly, Hong Kong was leased to Great Britain in 1841 after the Opium War and 1997 is the year when this lease will expire. Secondly, the close proximity of Hong Kong to other South East Asian countries which produce narcotics ensures that heroin is easily available. Thirdly, the proportion of female addicts has steadily increased and especially so among young women. In 1981, 10% of newly reported drug addicts were female but in 1989, 19% were female (3). It is of special concern to obstetricians and gynaecologists that 90% of these women were in the reproductive age group (3). Therefore, the number of pregnant addicts will certainly increase in the future. The detrimental effect of narcotic addiction on the mother, the fetus and the child amongst Hong Kong Chinese has never been reported previously. The purpose of this study is to review the problems and complications encountered by this special obstetrical population. MATERIALS AND METHODS A patient was considered to be addicted to narcotics if she had been abusing heroin or methadone at any time during her pregnancy. A retrospective case controlled study was performed. The study period was 1983 to 1990 (inclusive). During this period there were a total of 42,332 deliveries in Tsan Yuk Hospital. Cases were identified by going through the obstetric register. The hospital records of these patients were analyzed with regard to their history of drug addiction, antenatal complications and neonatal outcome. An age and parity matched control was selected for each case by going though the birth register. According to the policy of the hospital, once a history of drug addiction is obtained, patients are introduced to the methadone maintenance programme of the Hong Kong Government. In this programme, methadone is administered to the mother orally on a daily outpatient basis in order to decrease the morbidity associated with parenteral substance abuse. Acute detoxification was not attempted because of the risk of intrauterine fetal death (4). The Chi-square and Student’s t test were used for statistical analysis.
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RESULTS During the 8-year period from 1983 to 1990, there were 42,332 deliveries in our hospital of which 53 were complicated by maternal narcotic addition. The incidence was 0.13%. The annual incidence did not fluctuate widely. Two patients had actually stopped drug addiction before they became pregnant, so they were excluded from analysis.
Maternal characteristics The average age of the study group was 29.2. Two thirds of the study group were multiparous and one third primiparous. Concerning the past obstetrical history, there was no significant difference between the number of spontaneous abortions, stillbirths or ectopic pregnancies. However, 35% of the study group did have a history of infertility compared with only 8% in the control group (p
216
Caesarean if required and appropriate guidelines for the management of labour (16). In this way, most women with a previous Caesarean section can vaginally and the current low maternal and perinatal morbidity can be maintained.
References 1. Department of Health. Report on Confidential Enquiry into Maternal Deaths in England and Wales 1982-84. Her Majesty's Stationery Office, London 1989. 2. Department of Health, NSW. 1987 Maternal and Perinatal Report. NSW Department of Health, Sydney 1987. 3. National Health and Medical Research Council 1984. Report of the working party to investigate variations in Caesarean section rates in Australia. AGPS, Canberra 1985. 4. Renwick MY. Caesarean section rates, Australia 1986: variations at state and small area level. Aust NZ J Obstet Gynaecol 1991; 31: 299-304. 5. Molloy BG, Sheil 0, Duignan NM. Delivery after Caesarean section: a review of 2176 consecutive cases. Br Med J 1987; 294: 1645-1647. 6. Phelan JP, Clark SL, Diaz F, Paul RH. Vaginal birth after Cesarean section. Am J Obstet Gynecol 1987; 157: 1510-1515. 7. Targett C. Caesarean section and trial of scar. Aust NZ J Obstet Gynaecol 1988; 28: 249-262.
8. Flamm BL, Lim OW, Jones C, Fallon D, Newman LA, Mantis JK. Vaginal birth after Caesarean section: results of a multicenter trial. Am J Obstet Gynecol 1988; 158: 1079-1084. 9, Meehan FP, Burke G, Casey C, Sheil JG. Delivery following Cesarean section and perinatal mortality. Am J Perinatol 1989; 6: 90-94. 10. Nielson TF, Ljungblad U, Hagberg H. Rupture and dehiscience of Cesarean section scar during pregnancy and delivery. Am J Obstet Gynecol 1989; 160: 569-573. 11. Chua S, Arulkumaran S, Singh P, Ratnam SS. Trial of labour after previous Caesarean section: obstetric outcome. Aust NZ J Obstet Gynaecol 1989; 29: 12-17. 12. Duff P, Southmayd K, Read JA. Outcome of trial of labour in patients with a previous low transverse Cesarean section for dystocia. Obstet Gynecol 1988; 71: 380-384. 13. Ngu A, Quinn MA. Vaginal delivery followingCaesarean section. Aust NZ J Obstet Gynaecol 1985; 25: 41-43. 14. Krishnamurthay S, Fairlie F, Cameron AD, Walker JJ, Mackenzie JR. The role of postnatal x-ray pelvimetry after Caesarean section in the management of subsequent delivery. Br J Obstet Gynaecol 1991; 98: 716-718. 15. Dhall K, Mittal SC, Grover V, Dhall GI. Childbirth following primary Cesarian section - evaluation of a scoring system. Int J Gynaecol Obstet 1987; 25: 199-205. 16. NIH Consensus Development Task Force statement on Cesarean childbirth. Am J Obstet Gynecol 1981; 139: 902-909.
Aust NZ J Obstet Gynaecol 1992; 32: 3: 216
Narcotic Addiction in Pregnancy with Adverse Maternal and Perinatal Outcome S. K. Lam', W. K. To', S. J. Duthie2 and H. K. Ma3 Department of Obstetrics and Gynaecology, University of Hong Kong, Ban Yuk Hospital, Hong Kong
Summary: A retrospective case controlled study was carried out on 51 Chinese gravidas who had abused narcotics and who were delivered in a teaching hospital in Hong Kong. Heroin was the most commonly abused drug. The number of patients who changed from heroin to methadone was small. The major antenatal complications were late antenatal booking (average 28 weeks), prematurity (410'/0), small for gestational age baby (27.5%), antepartum haemorrhage (13.7%) and high prevalence of venereal disease (23.5%). The babies born to drug addicted mothers were on average 629 g lighter at birth, 5 cm smaller in head circumference and 7 cm shorter in body length. Neonatal withdrawal symptoms occurred in 83% of all drug exposed neonates. The perinatal mortality rate was 19.6 per 1,000 total birth which was 2.5 times that of the control group. There was one maternal death in our series. Drug addiction in pregnancy poses a major risk to both mother and child.
1. Medical Officer. 2. Lecturer. 3. Professor. Address for correspondence: Dr. S. K. Lam, Department of Obstetrics and Gynaecology, University of Hong Kong, Tsan Yuk Hospital, Hospital Road, Hong Kong.
S. K. LAMET AL
Narcotic addiction is a major social and medical problem in many parts of the world. Routine testing of urine in 1,643 labouring women in a hospital in California (1) showed opiates in 1% of specimens; 8% had metabolites of cocaine and 6% had metabolites of amphetamine in the urine. Irr Australia, Oats (2) estimated the incidence of narcotic addiction during pregnancy as 0.06%. In Hong Kong, the extent of this problem is not known as the prevalence of narcotic abuse complicating pregnancy has hitherto been unreported. The data in our hospital over the past 10 years showed that the average incidence was 1 in 1,000 deliveries. This figure is lower than that reported in the United States but higher than the figures reported from Australia. The problems of narcotic abuse have special significance for Hong Kong. Firstly, Hong Kong was leased to Great Britain in 1841 after the Opium War and 1997 is the year when this lease will expire. Secondly, the close proximity of Hong Kong to other South East Asian countries which produce narcotics ensures that heroin is easily available. Thirdly, the proportion of female addicts has steadily increased and especially so among young women. In 1981, 10% of newly reported drug addicts were female but in 1989, 19% were female (3). It is of special concern to obstetricians and gynaecologists that 90% of these women were in the reproductive age group (3). Therefore, the number of pregnant addicts will certainly increase in the future. The detrimental effect of narcotic addiction on the mother, the fetus and the child amongst Hong Kong Chinese has never been reported previously. The purpose of this study is to review the problems and complications encountered by this special obstetrical population. MATERIALS AND METHODS A patient was considered to be addicted to narcotics if she had been abusing heroin or methadone at any time during her pregnancy. A retrospective case controlled study was performed. The study period was 1983 to 1990 (inclusive). During this period there were a total of 42,332 deliveries in Tsan Yuk Hospital. Cases were identified by going through the obstetric register. The hospital records of these patients were analyzed with regard to their history of drug addiction, antenatal complications and neonatal outcome. An age and parity matched control was selected for each case by going though the birth register. According to the policy of the hospital, once a history of drug addiction is obtained, patients are introduced to the methadone maintenance programme of the Hong Kong Government. In this programme, methadone is administered to the mother orally on a daily outpatient basis in order to decrease the morbidity associated with parenteral substance abuse. Acute detoxification was not attempted because of the risk of intrauterine fetal death (4). The Chi-square and Student’s t test were used for statistical analysis.
217
RESULTS During the 8-year period from 1983 to 1990, there were 42,332 deliveries in our hospital of which 53 were complicated by maternal narcotic addition. The incidence was 0.13%. The annual incidence did not fluctuate widely. Two patients had actually stopped drug addiction before they became pregnant, so they were excluded from analysis.
Maternal characteristics The average age of the study group was 29.2. Two thirds of the study group were multiparous and one third primiparous. Concerning the past obstetrical history, there was no significant difference between the number of spontaneous abortions, stillbirths or ectopic pregnancies. However, 35% of the study group did have a history of infertility compared with only 8% in the control group (p
