![]() ![]() ![]() Approximately 24 h after admission, fetal tachycardia and maternal fever occurred, and the diagnosis of chorioamnionitis was made. Throughout labor, the patient rejected recommendations to have an epidural catheter placed. Oxytocin was gradually increased until there were regular uterine contractions. The patient initially refused oxytocin, but eventually gave informed consent for induction with oxytocin at about 15 h after PROM. The estimated fetal weight was 3600 g, and the fetal heart rate was reassuring. On admission, her cervix was 1 cm dilated, not effaced, with the vertex at −3 station. She did not mention her history of drug use during her prenatal care, and physical examinations done by both obstetricians were unremarkable. At 34 weeks, she moved to a different city where she continued prenatal care with another private obstetrician. She received prenatal care from a private obstetrician from the 6 th week of pregnancy. CaseĪ 33-year-old primiparous pregnant woman was admitted to the hospital at 38 weeks with a history of premature rupture of membranes (PROM) about 5 h before admission. Because these women often do not openly admit to using drugs, they are often not identified by their practitioners and are thus deprived of optimal medical care. Women who have used drugs before pregnancy or are using drugs during pregnancy are an elusive population, and common beliefs that substance abuse occurs only in the ethnic minority, the poor, or the young population are inaccurate. Illicit use of drugs has been reported to lead to adverse pregnancy outcomes such as abruptio placentae, intrauterine growth restriction, and preterm birth, and is also associated with an increased risk of sexually transmitted diseases such as HIV and hepatitis C. ![]()
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