II. Risk Factors: Child Abuse Associations

  1. Substantial increase in risk of maltreatment
  2. Risk of change in primary Caregiver before age 2 years
  3. Breast Feeding exposure to illicit substance
  4. Deliberate Poisoning with illicit substance
  5. Passive inhalation of illicit substance
  6. Accidental Ingestion of illicit substance
  7. Physical or Sexual abuse
  8. Household or neighborhood Violence

IV. Complications: General

  1. Lack of Prenatal Care and other health care
  2. Fetal Growth Restriction
  3. Placental Abruption
  4. Preterm Labor
  5. Preterm Death
  6. High Risk Behavior (e.g. prostitution)

V. Management: Preterm Recommendations for Obstetric Visits

  1. Every 2 weeks until 30 weeks
  2. Every week until delivery after 30 weeks

VI. Labs: Sexually Transmitted Disease screening

VII. Imaging: Obstetric Ultrasound

  1. Baseline: late first or early second trimester
  2. Serial Ultrasound for Intrauterine Growth Retardation

VIII. Monitoring

  1. Random Urine Drug Screening (obtain permit)
  2. Obstetric Ultrasound as above
  3. Nonstress Test
    1. Every two weeks from 30 to 35 weeks
    2. Weekly after 35 weeks
  4. Meconium Drug Screen from fetus after delivery

IX. Management

  1. Child Protective Services reporting is required by most states in U.S.
  2. See Cocaine Abuse in Pregnancy
  3. See Opioid Use Disorder in Pregnancy
  4. See Alcohol Abuse

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