Substance abuse during pregnancy is rising and often remains undiagnosed. This harms both the mother and the baby. We conducted an anonymous unlinked study in Blyth valley, Northumberland, to determine the prevalence of substance abuse and alcohol use during pregnancy. Urine toxicology screening was performed on 150 women who attended antenatal clinic for booking. Seven commonly misused substances (amphetamine, benzodiazepine, barbiturates, cannabinoids, cocaine, methadone and opiates) and alcohol were tested in the urine. A total of 16 (10.7%) women were found positive and all 16 of them had denied use of any substance. Amphetamine was the most common among the substances misused. A total of 12 out of the 16 were from social classes 4 and 5. None of the positive women was nulliparous. Because of the difficulty in identifying substance misuse in pregnant women, consideration should be given to the implementation of routine substance screening at the booking antenatal visit in general population with a high incidence of substance misuse.
IntroductionThe frequency of ovarian cysts in pregnancy is reported to be 1 in 1000 pregnancies. Laparoscopic ovarian cystectomy has been described in the literature as case series but this is the first case where an ovarian cyst at 20 weeks' gestation impacted in the pouch of Douglas was managed exclusively by laparoscopy.Case presentationA 31-year-old primigravida woman was diagnosed as having an 11 cm ovarian cyst at 20 weeks' gestation. At the 19th week routine ultrasound scan, the mass appeared to be cystic with no solid component. She was asymptomatic. In view of the size of the cyst, options were discussed with her including laparoscopic ovarian cystectomy which she agreed to. Laparoscopic surgery during pregnancy is reported to be safe and beneficial for pregnant women. At laparoscopy, a transvaginal scan was performed to localize the cyst and an ovarian cystectomy was carried out. The patient had an uneventful recovery and subsequent antenatal period. She had a lower segment caesarean section for non-progress of labour when both ovaries were found to be normal and mobile.ConclusionsLaparoscopic surgery during pregnancy has numerous advantages compared to open laparotomy. This is a rare example of an ovarian cyst in the pouch of Douglas impacted behind the uterus which was managed by laparoscopy and shows the safety of the technique in the presence of an expert laparoscopic surgeon.
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