Anonymous cocaine screening in a private obstetric population.

OBJECTIVE: To establish the prevalence of cocaine use in private obstetric patients during their prenatal care and at admission to delivery units. METHODS: Urine samples were collected anonymously during routine sampling from 1425 patients in six private hospitals and four private physicians' offices. RESULTS: Positive cocaine metabolites were identified in three of 555 urine specimens (0.54%) obtained from hospitals and in two of 870 (0.23%) obtained from private offices during prenatal examinations. The total positive urine cocaine results were five of 1425 (0.35%). CONCLUSIONS: Universal screening in a private obstetric population similar to that found in Denver would not be cost-effective. We urge health care providers to ask patients about substance abuse and to screen patients who are at high risk for substance use.

Intrauterine resuscitation with tocolysis. An alternate month clinical trial.

Fifty patients were compared for the purpose of investigating the usefulness of intrauterine resuscitation with tocolysis (IURT). Terbutaline was given, as an intravenous bolus, to 31 women in labor in whom fetal distress was diagnosed and urgent delivery by cesarean section was indicated. In alternate months, a control group of 19 women with similar diagnoses was urgently delivered after standard interventions such as maternal positioning, oxygen administration, hydration, and discontinuation of oxytocin. Improvement in perinatal outcome was shown in infants after IURT. Apgar scores were less than 7 in 42% of the study group and in 71% of the control group at 1 minute (P = .04). Five-minute Apgar scores less than 7 occurred in 7% of the study group and 24% of the control group. A low venous pH was seen in 55% of the control group compared with 29% of the infants resuscitated with terbutaline. Estimated maternal blood loss and hematocrit change was not different in the two groups. Maternal blood pressure and pulse changes following IURT were modest and of doubtful significance. We conclude that intravenous terbutaline administered as a bolus injection at the time of fetal distress in labor improves infant outcome as evidenced by more vigorous Apgar scores and less acidemia without significant adverse physiologic effects on the mother.