//graizoah.com/afu.php?zoneid=3337959 Extragenital Pathology in Obstetrics: Addiction and Pregnancy - methadone-anonymous


Methadone HCL Tablet, Soluble. ... This medication is used to treat addiction to opioids (such as heroin) as part of an approved treatment program. Methadone belongs to a class of drugs known as opioid (narcotic) analgesics.



Friday, December 20, 2019

Extragenital Pathology in Obstetrics: Addiction and Pregnancy

Drug abuse refers to the abuse of drugs or chemicals.

F10-F19 Mental and behavioral disorders due to substance use
The substance of use is indicated by the 2nd and 3rd signs (i.e., the first two digits after the letter F)

F10 Alcohol
F11 Opioids F12
F13 Sedatives and hypnotics
F14 Cocaine
F16 Hallucinogens
F18 Volatile solvents
F19 Combined drug use and use of other psychoactive substances

4th and 5th signs determine the clinical condition

F1x.20 currently abstinence
F1x.21 is currently abstinence, but in conditions that exclude consumption (in a hospital, therapeutic community PTD)
F1x.22 is currently under clinical observation, on maintenance or replacement therapy (e.g. methadone, nicotine chewing gum or sticker)
F1x.23 is currently abstinence, but on the treatment of disgusting PLP with blocking drugs
F1x.24 current drug use (active addiction)
F1x.25 continuous use
F1x. 26 episodic use (dipsomania)
F1x.3 cancel state

According to various sources, the prevalence of drug addiction among pregnant women is about 11%. With drug addiction, the risk of perinatal pathology is significantly increased - spontaneous abortion, intrauterine growth retardation, intrauterine hypoxia, premature birth and development of withdrawal symptoms in the newborn. Concurrent use of alternating use of two or more drugs is called drug addiction. Pregnant women who use drugs often smoke and drink alcohol at the same time. Intravenous drug administration increases the risk of contracting HIV infection and hepatitis. Regardless of the route of drug administration, the risk of hepatitis B and HIV infection is increased. Drug addicts rarely care about their own health, hygiene and nutrition. Often they are depleted, susceptible to tuberculosis and opportunistic infections, they often develop abscesses, phlegmon, thrombophlebitis.
Child Touching His Mother Lamb
Diagnosis of addiction in pregnant women
Complaints and objective investigation.
Complaints in drug addiction are mostly non-specific, and their combination can be described in the form of the main addiction syndromes.

Addiction syndromes are manifested by a constant need for the use of narcotic substances, a disorder of mental activity, somatic and neurological disorders, a drop in working capacity, loss of social connections, and personality degradation.

  • The syndrome of altered reactivity is characterized by the disappearance of protective reactions in case of an overdose of narcotic substances.
  • The syndrome of mental dependence is characterized by an attraction to drug intoxication, the experience of mental discomfort in a state of abstinence and the improvement of mental functions in a state of drug intoxication.
  • Physical dependence syndrome is characterized by a physical (uncontrollable) need for the use of narcotic substances, loss of control over the number of narcotic substances used, improvement of physical functions in a state of drug intoxication, and manifestations of withdrawal.
  • The syndrome of consequences (complications) of chronic intoxication in the mental, neurological, somatic spheres and in social activities.
  • Psychic symptoms of addiction include asthenia, psychiatrization, personality change (coarsening, loss of interests, moral values), affective disorders (mood swings, depression, dysphoria), aggressiveness, suicidal tendencies, psychotic conditions.
  • Neurological symptoms of addiction include acute brain changes, peripheral lesions of the nervous system.
  • Somatic symptoms of dependence are manifested by lesions of the cardiovascular system, respiratory system, stomach, liver and pancreas, kidneys, endocrine system deficiency, and immune depletion.

Laboratory instrumental research
Massive and selective toxicological examinations are used to identify pregnant women who use drugs. Women with low socioeconomic status, pregnant women, and antenatal evaders are examined selectively. The sample screening group includes women who have previously committed criminal offenses, suffered from drug addiction and have signs of injection. It should be noted that the toxicological examination should not be accompanied by punitive actions. Traces of drugs can be found in blood, urine, saliva, hair, as well as in amniotic fluid and meconium. Urinalysis is the most simple and affordable method for diagnosing addiction. Since a pregnant woman regularly conducts a general urine test, a toxicological test can be performed simultaneously.
Person Holding Black Tube

Differential diagnosis.
           Differential diagnosis of drug dependence is carried out in order to clarify the substance of abuse. As a rule, the period of pregnancy is a period of “free" from the use of drugs, but for various narcotic substances. In the presence of certain signs of fetal alcohol syndrome, they speak of an alcoholic lesion of the fetus. The amount of alcohol causing fetal alcohol damage or fetal alcohol syndrome is not exactly known. Fetal alcohol syndrome can develop both against the background of systematic drunkenness, and after isolated cases of a woman consuming a large amount of alcohol.
It was shown that when drinking more than 50 ml/day of alcohol in terms of pure alcohol during pregnancy, 32% of children are born with malformations, and 12% with microcephaly (in the control group - 9 and 0.4%, respectively). In terms of pure alcohol, a glass of wine approximately corresponds to a glass of strong beer or 30 ml of vodka.

       Woman in Black Shirt Being Tattooed in Chest   The most dangerous narcotic substances in terms of consequences for mother and child are opioids. With regular use of opioids, both the mother and the fetus develop a persistent dependence. Opioids cause euphoria and also have a sedative effect. Opioid use is usually preceded by alcohol, marijuana, cocaine or amphetamines. Prolonged administration of narcotic analgesics in chronic diseases accompanied by severe pain can also lead to opium addiction. With a decrease in the dose of the drug, withdrawal symptoms develop. A mild form of withdrawal symptoms is manifested by excitement, sweating, lacrimation, and nasal discharge, severe - cramping abdominal pain (especially in the lower sections), diarrhea, myalgia, and cramps.
         Opioid withdrawal symptoms never lead to death. The danger is an overdose of opioids. Symptoms of an overdose are decreased sensitivity, respiratory depression and severe myosis (pinpoint pupils). Noncardiogenic pulmonary edema may develop. For treatment, opiate receptor blockers naloxone, 0.01 mg / kg iv are used. An opiate receptor blocker naloxone, as well as pentazocine, butorphanol, and nalbuphine can trigger withdrawal symptoms.
        Heroin is an opioid whose use is a serious medical and social problem. Heroin is widespread and highly addictive. The drug is prepared artisanally and contains a different amount of impurities. With heroinism in 12-45% of cases, there is a university. In women taking methadone during pregnancy, children are lagging behind in development. However, methadone is less likely to affect fetal development than heroin. Opioid use is associated with premature birth in 20-35% of cases. The risk of sudden infant death syndrome with opioid use during pregnancy rises to 2-4% (0.25% among the general population). Opioids do not affect the risk of birth defects in the fetus. In 95% of cases of pregnant opioids, a newborn develops withdrawal symptoms, in 12-25% of cases - in a severe form.            If the pregnant woman was treated with methadone, then the withdrawal syndrome in the newborn appears later and proceeds more easily, but for a longer time. With heroin addiction, pregnant women are not recommended to abruptly cancel the drugs, due to the severity of withdrawal symptoms. Pregnant women who use heroin are transferred to methadone maintenance therapy. Methadone is an opioid that is used to treat heroin addiction. With heroinism, methadone is prescribed in a dose sufficient to prevent withdrawal symptoms.
       In order not to cause withdrawal symptoms, the dose of methadone is maintained throughout pregnancy or gradually reduced to 20-40 mg/day. A daily dose of less than 30 mg is considered low. The drug is slowly excreted, so it is prescribed orally 1 time per day. The issue of the safety of methadone use in pregnant women remains controversial since there are reports of premature birth and intrauterine hypoxia during treatment. With the abolition of methadone, withdrawal symptoms develop very rarely, mainly with an uncontrolled
Pile of White Pink and Brown Oblong and Round Medication Tablet

      Examinations of pregnant women from low-income groups of the population show that up to 20% of them use marijuana (this also includes pregnant women with a positive result of a toxicological examination of urine performed before or immediately after childbirth). Drug use (hash and marijuana) is accompanied by euphoria, a feeling of well-being and hallucinations. Marijuana is the most common drug. Found that it is consumed or ever consumed by 10 to 37% of adults. The effect on the fetus is dose-dependent. Tetra-hydrocannabioids poorly penetrate the placenta, so their level in the blood of the fetus is several times lower than in the mother's blood. Most often, intrauterine growth retardation (IOS) develops. The weight of newborns decreases on average by 105 g. Smoking more than five cigarettes with marijuana per week reduces the weight of newborns by about 130 g. Head circumference and fetal length also decrease. Marijuana use can cause premature birth.

The prevalence of cocainism among pregnant women is not exactly known, as a toxicological study yields a positive result.

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