II. Epidemiology
- Unintended Pregnancy in 80% of cases
- Up to 25 to 35% do not return for postpartum visit
III. Management
- See Opioid Use Disorder
- Mandatory substance use reporting varies by U.S. state
- Opioid Agonists (e.g. Buprenorphine)
- Mood Disorder treatment
- Repeatedly screen for high risk conditions
- Intimate Partner Violence
- Sexually Transmitted Infection (including HIV Infection)
- Tuberculosis Screening
- Hepatitis B Screening
- Hepatitis C screening
- Food insecurity
- Homelessness
- Pregnancy monitoring
- Obtain dating Ultrasound (7 weeks), Fetal SurveyUltrasound (16 to 20 weeks) and third trimester Ultrasound for Fetal Growth
- Involve maternal fetal medicine Consultation as needed
- Ensure adequate access to nutrition
- Support Services
- Refer to social services and case management
- Consider residential treatment
- Family Home Visiting referral (e.g. NFP, HFA, MESCH) via local public health
- Review support plan for pregnancy, delivery and postpartum parenting
- Prepare for Delivery
- Develop a delivery plan including analgesia and Anesthesia
- Prepare for Neonatal Abstinence Syndrome
- May require extended stay following delivery
- Encourage early Breast Feeding and skin to skin contact (may shorten syndrome duration)
- Postpregnancy Contraception
IV. Complications
V. Associated Conditions
- Comorbid mental health disorder (in addition to Substance Abuse)