UTERINE RUPTURE IN ASSOCIATION WITH ALKALOIDAL (CRACK) COCAINE ABUSE

The use of alkaloidal (''crack'') cocaine in pregnancy can result in s ystemic and focal vasoconstriction and abnormal uterine contractions f orceful enough to cause the complete rupture of a gravid uterus along a previous vertical cesarean section scar. A 43-year-old woman was adm itted to the emergency department with acute abdominal pain at 34 week s' gestation. She had had a low vertical cesarean section 3 years prev iously for breech presentation with acute fetal distress at 28 weeks' gestation. The patient had a history of heavy ''crack'' abuse and admi tted to inhaling ''crack'' throughout the day until 4 hours before adm ission. Within 15 minutes after presentation a laparotomy was performe d, revealing an infant floating in the abdominal cavity. A live baby w as promptly delivered, and the ruptured uterus was repaired. The patie nt was discharged 4 days post partum. ''Crack'' cocaine, through its k nown effects on the vasculature and contractility of the myometrium, l ikely facilitated the uterine rupture in this patient. The edges of th e rupture wound were surprisingly clean, with little bleeding, perhaps owing to the drug's vasoconstrictive effects. It was therefore feasib le to repair the uterus as an alternative approach to hysterectomy.