Peripartum care of the cocaine-abusing parturient: are we ready?

Cocaine abuse in the United States is widespread, affecting more than 30 million people. Nearly 90% of cocaine-abusing women are of childbearing age. Cardiovascular complications of cocaine intoxication include dysrhythmias, ischemia and/or infarction, and account for most cocaine-related deaths. Pregnancy enhances the cardiovascular toxicity of cocaine. While the epidemiology, pathophysiology, clinical symptomatology and implications on pregnancy of cocaine addiction in pregnancy have received significant attention over the past 25 years, far too little attention has been given to the therapeutic considerations and peripartum care of the cocaine-abusing parturients. The timely treatment of acute cocaine-induced cardiovascular toxicity in pregnancy is by far the best predictor of good maternal and fetal outcome. However, no specific treatment guidelines are currently available for cocaine-induced cardiac dysrhythmias. This article discusses briefly several agents (and considers their mechanism of action) that have been proposed for the treatment of chest pain and other cardiovascular side-effects of cocaine toxicity in pregnancy.