Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

Abstract

Background. There is general consensus that methadone maintenance is the gold standard in the management of pregnant heroin users. However, in South African state hospitals, methadone withdrawal is the routine procedure offered to these patients, as methadone maintenance programmes are unavailable in the public sector. Objectives. To conduct a systematic review of the literature on heroin detoxification in pregnancy, and to document pregnancy outcomes in heroin users detoxified with methadone at Groote Schuur Hospital (GSH), Cape Town, from 2006 to 2010. Methods. A literature search was undertaken to identify key publications on the management of heroin addiction in pregnancy. Patients for the study were identified from the GSH methadone registry, and data were collected from the clinical files. Results. A total of 20 relevant publications were identified and reviewed. Early case reports described an increased risk of stillbirths and fetal distress after methadone detoxification, but more recent case series involving larger numbers of patients showed positive outcomes. In our study, six pregnant patients received methadone withdrawal over a 5-year period at GSH, and all the neonates had good Apgar scores and were discharged home within 3 days of delivery. Conclusions. There is limited evidence on the management of heroin addiction during pregnancy, and the only two guidelines identified suggest that methadone maintenance is preferable to methadone withdrawal. The favourable pregnancy outcomes in this small sample of patients managed with methadone withdrawal suggest that it may be safe and deserves further study.

Anesthetic Management in An Acute Heroin User Undergoing Emergency Cesarean Section with the Indication of Preterm Labour

“…Yenidoğanda, YYS tedavisi için ilk tercih morfin, ikinci tercih metadondur. Çoklu madde kullanımında fenobarbital, klonidin ve diazepam da kullanılabilmektedir (1) . Bizim yenidoğan ünitemizde fenobarbital tercih edildi.…”

“…Dünyada 14 milyondan fazla bağımlı eroin kullanıcısı olduğu düşünülmektedir (1,2) . Morfinden 2 kat daha potent olan eroin kullanımında eksitatör fenomen %50 oranında daha sık görülmektedir (3) .…”

“…Morfinden 2 kat daha potent olan eroin kullanımında eksitatör fenomen %50 oranında daha sık görülmektedir (3) . Opiat kullanımı, menstrüel siklüs bozukluğu, düzensiz sosyal yaşamı olan bağımlı kadınlarda yüksek oranda plansız gebeliğe neden olmaktadır (1) . Madde bağımlısı annenin antenatal takibinde aksamalar yaşanmakta, bu anneler çoğunlukla eşlik eden beslenme bozukluğu ile gebeliğini malnutre halde sürdürmektedir (4) .…”