Kashmiri M, Dar K, Gul M, Sabir A.
The management of substance dependent pregnant women — a clinical audit.
J Pak Psych Soc Jan ;4(2):118-20.

Eight in-patients who were pregnant opiate dependent were included in the audit. This was the total number identified from existing case records. Guidelines for the management of Opiate dependent pregnant women are available for use by medical/nursing staff on the MGU to ensure optimum co-ordination between agencies and safety of both mother and baby. Current procedures for staff at the time of admission as per the Guidelines. RESULTS All women were aged between 22 and 30. 62.5% were single. The rest were in a cohabiting relationship whose partners were all substance users. 50% had children (range 1-4) and none were living with their mothers. They were either in foster-care or living with grand parents under a guardianship order. There was only one current child care proceeding in court. 75% of the cases were admitted during the 2nd (5/ 8) and 3rd trimester (1/8). The rest in their 1st trimester (one admission at 6 weeks gestation). All cases were opiate dependent. 50% used heroine as their primary drug of choice whereas 50% were poly-drug users using heroine, cocaine, cannabis, benzodiazepines and alcohol. 25% were actively injecting at time of admission. All cases used alcohol of which 25% were dependent. 87.5% smoked nicotine, on average 10-30 cigarettes per day. 25% were Hepatitis C positive and 12.5% Hepatitis B positive. 37.5% had a comorbid mental illness. 2 cases had moderate depressive disorder and 1 case had generalised anxiety disorder. 5/8 cases were admitted for methadone detoxification out of which 3/8 completed the detox. The rest were maintained on a lower dose of methadone (Table 1). This was mainly due to caution being exercised to prevent premature labour. 7/8 completed treatment, however only one discharged against medical advise during the last 2 drug free days due to conflict over her partner being not allowed on the as he also had drug dependence. All patients had an aftercare plan prior to admission. 2 cases proceeded to a residential rehabilitation programme, others continued to engage in day programmes, AA meetings and maintained contact with their key workers. 3/8 cases had suspected signs and symptoms of premature labour during the period of admission. All were referred to the obstetrics team at the Ealing General hospital. 2 had normal ultrasound scan reports but unfortunately one miscarried. (Short Communication).

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