Abstract
Although the adverse effects of cocaine use in pregnancy are well recognised, we believe this case highlights the importance of considering the route of administration, and suggests the possibility of multifocal damage relating to intravenous use. A Caucasian female baby of 29-weeks' gestation was spontaneously delivered and subsequently developed multi-organ failure considered unrelated to simple prematurity. Intensive care was re-orientated following the development of massive intraventricular haemorrhage. This case illustrates the need for regular cranial ultrasound in babies of pregnancies at risk due to intravenous cocaine use and also the necessity of counselling women who misuse cocaine in the antenatal period. As such, this article will be of most interest to paediatric and obstetric staff.
Highlights
Introduction: the adverse effects of cocaine use in pregnancy are well recognised, we believe this case highlights the importance of considering the route of administration, and suggests the possibility of multifocal damage relating to intravenous use
Intensive care was re-orientated following the development of massive intraventricular haemorrhage
This case illustrates the need for regular cranial ultrasound in babies of pregnancies at risk due to intravenous cocaine use and the necessity of counselling women who misuse cocaine in the antenatal period
Summary
Cocaine use in pregnancy has been associated with adverse fetal outcomes including congenital malformations. We report a female baby of 29 weeks’ gestation whose mother had extensive polydrug misuse throughout her pregnancy, including the use of intravenous cocaine. The expectant mother reported regular use of heroin, diazepam, ‘street’ methadone and cocaine. An initial cranial ultrasound scan was normal with no evidence of haemorrhage. Laboratory investigations demonstrated marked coagulopathy and abnormal liver function tests (Table 1). Repeat ultrasound at 36 hours of age showed bilateral intraventricular blood with evidence of marked midline shift. A postmortem examination was performed and it demonstrated intraventricular haemorrhage (IVH) (Figure 1) expanding all four ventricles and extending around the brain stem and cerebellum (grade 3). There was hepatic necrosis (Figure 2) and evidence of colonic mucosal ischaemic injury with multiple punctate erythematous areas. The bladder contained an area of large submucosal haemorrhage These urogenital changes probably explain the pinkcoloured urine. ALT, alanine transaminase; APTT, activated partial thromboplastin time; AST, aspartate transaminase; Gamma GT, gamma glutamyl transferase; PT, prothrombin time; TCT, thrombin clotting time
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