ABSTRACT
The objective of this study was to determine the rate of recent cocaine use among
a metropolitan population of predominantly Hispanic and African-American women with
preterm premature rupture of the membranes (PROM) and to ascertain the impact of cocaine
on the latency period between rupture of membranes and delivery. Urine toxicology
screens were prospectively obtained on 147 women with preterm PROM. The urine screen
did not influence management decisions. All women were expectantly managed without
tocolytics until 37 weeks' gestation unless they developed clinical chorioamnionitis,
or nonreassuring fetal heart rate tracing or biophysical profile. Demographic information,
hours from rupture of membranes to delivery, gestational age, and birth weight at
delivery were compared using Fisher's exact, Mann-Whitney U, and randomization tests
where appropriate. The rate of positive urine drug screens for cocaine was 8.2%. Women
in the cocaine positive group were of higher parity (3, [0-7] vs. 1, [0-6], p = 0.001) and tended to be older (27, [23-42] vs. 25, [14-40]). There was a higher
rate of recent cocaine use among African-American women (20.4%) as compared to non-African-Americans
(1.2%, p = 0.0001). Cocaine-positive women presented at an earlier gestational age (32 weeks',
[24-34] vs. 33 weeks', [23-36], p = 0.02) and had a significantly longer membrane rupture to delivery interval than
women with a negative urine drug screen (174 hr, [6-475] vs. 33 hours [1-833], p = 0.01). There was no significant difference in the reason for delivery between the
two groups of patients. Recent cocaine use among women with preterm PROM is common
in only some segments of an urban population. Women with recent cocaine use present
with ruptured membranes at an earlier gestational age and may actually have a longer
latency period than women who do not use cocaine.
Keywords
Cocaine, pregnancy - preterm PROM - latency
