COCAINE-ABUSING PARTURIENTS UNDERGOING CESAREAN-SECTION - A COHORT STUDY

Background: Cocaine use in the United States is prevalent among pregna nt women from inner city neighborhoods. To determine the anesthetic im plications of cocaine use in parturients undergoing cesarean section d elivery, the authors conducted a cohort study. Methods: One thousand n ine hundred seven women presenting for prenatal care were interviewed regarding substance abuse. Urine was analyzed for benzoylecgonine, tet rahydracannabinol, benzodiazepines, and opioids. Next all parturients who underwent cesarean section delivery were identified and their reco rds reviewed for anesthetic and obstetric outcomes. Results: Among the 51 women who were classified as cocaine abusers, the most frequent re asons for cesarean section were fetal distress (48%) and abruptio plac enta (21%). In a multivariate model, cocaine abuse before delivery was shown to be an independent predictor of preoperative diastolic hypert ension (F = 10.6, P = 0.01). Similarly, univariate analysis showed tha t immediately after intubation, diastolic blood pressure mas significa ntly higher among parturients who used cocaine (99 +/- 13 mmHg v. 87 /- 18 mmHg; P = 0.02). In contrast, epidural anesthesia was associated with hypotension significantly more often among cocaine-abusing partu rients (44% vs. 10%; P = 0.04). A higher rate of perioperative wheezin g was reported among patients who abused cocaine (16% vs. 6%; relative risk = 2.7); this finding, however, did not persist In multivariate a nalysis. Operative blood loss was similar in all groups (P = NS), and no ventricular dysrhythmias or cerebrovascular or coronary ischemic ep isodes were reported in any of the parturients. Conclusions: Although cocaine-abusing parturients are at higher risk for interim peripartum events such as hypertension, hypotension, and wheezing episodes, there is no significant increase in rates of maternal morbidity or death.