Intrapartum and Postpartum Analgesia for Women Maintained on Methadone During Pregnancy

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the Department of Statistics, University of Vermont College of Medicine, Burlington, VT 05401, USA.
Obstetrics and Gynecology (Impact Factor: 4.37). 09/2007; 110(2 Pt 1):261-6. DOI: 10.1097/01.AOG.0000275288.47258.e0
Source: PubMed

ABSTRACT To determine whether methadone maintenance alters intrapartum or postpartum pain or medication requirements.
Sixty-eight patients treated with methadone for opiate dependence during pregnancy (vaginal n=35; cesarean n=33) were matched retrospectively to control women. Analgesic medication and pain scores (0-10) were extracted from the medical record. The primary endpoint was opiate use postpartum (oxycodone equivalents). The secondary endpoints were pain scores and intrapartum analgesia.
There were no differences in intrapartum pain or analgesia. After vaginal birth, methadone-maintained women experienced increased pain (methadone, 2.7 [1.9-5.0]; control, 1.4 [0.5-3.0], P=.001) but no increase in opiate use ([mean+/-standard deviation] methadone 12.7+/-32.1; control 6.8+/-12.7 mg/24 h, P=.33); after cesarean delivery both pain (methadone, 5.3 [4.1-6.0]; control, 3.0 [2.2-3.9], P=.001) and opiate use (methadone, 91.6+/-51.8; control, 54.0+/-18.6 mg/24 h, P=.001) increased.
Methadone-maintained women have similar analgesic needs and response during labor, but require 70% more opiate analgesic after cesarean delivery.

  • [Show abstract] [Hide abstract]
    ABSTRACT: In Germany we find about 2 000 newborns per year with a mother misusing drugs. It is to be feared that there is a substantial amount of underreported substance abuse in pregnant women. To care for these pregnancies from an obstetric point of view as well as from an addiction treatment point of view is a challenge for all health-care professionals, due to multiple drugs being used and the special psychosocial and health issues these mothers and babies -present.
    Zeitschrift für Geburtshilfe und Neonatologie 08/2014; 218(4):142-8. DOI:10.1055/s-0034-1382068 · 0.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of substance abuse in pregnancy is substantial and affects pregnancy health and outcomes. Multiple challenges exist in the identification of women with substance abuse disorders in pregnancy and the provision of care. A multidisciplinary approach has been shown to be most successful in providing comprehensive and effective care. This article outlines key aspects of prenatal and postpartum care, with a brief overview provided of intrapartum care. Issues covered include screening, opioid replacement therapy, comorbid medical and psychiatric conditions, environmental stressors, parenting preparation, pain management in labor and postpartum, breastfeeding guidance, prevention of relapse, and assistance with postpartum transition to primary care.
    Obstetrics and Gynecology Clinics of North America 06/2014; 41(2):213-228. DOI:10.1016/j.ogc.2014.02.004 · 1.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We review clinical care issues related to illicit and therapeutic opioid use among pregnant and postpartum women, and outline the major responsibilities of obstetric providers who care for these patients during the antepartum, intrapartum, and postpartum periods.Selected patient management issues are highlighted, and case examples are provided. Securing a strong rapport and trust with these patients is crucial for success in delivering high quality obstetric care and in coordinating services with other specialists as needed. Obstetric providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment to patients with drug use disorders. Opioid-dependent pregnant women can often be effectively treated with methadone or buprenorphine. These medications are classified as pregnancy Category C medications by the Food and Drug Administration, and their use in the treatment of opioid-dependent pregnant patients should not be considered "off-label". Except in rare special circumstances, medication-assisted withdrawal during pregnancy should be discouraged due to a high relapse rate. Acute pain management in this population deserves special consideration because opioid-using patients can be hypersensitive to pain and use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, opioid-using pregnant women do not require more intense medical care than other pregnant patients in order to ensure adequate management and best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for opioid-using pregnant and postpartum women.
    American journal of obstetrics and gynecology 10/2013; 210(4). DOI:10.1016/j.ajog.2013.10.010 · 3.97 Impact Factor