Cocaine abuse in pregnancy--anesthetic implications.

Substance abuse, including that of cocaine, has crossed social, economic and geographic borders and remains one of the major problems facing society today. The prevalence of cocaine abuse in young adults (including women) has increased markedly over the past two decades. Nearly 90% of cocaine-abusing women are of childbearing age. Consequently it is not surprising to find pregnant women who abuse this drug, and numerous case reports of cocaine abuse in pregnancy have been published. The diverse clinical manifestations of cocaine abuse combined with physiologic changes of pregnancy, and pathophysiology of coexisting pregnancy-related disease might lead to life-threatening complications and significantly impact the practice of obstetric anesthesia. A complete understanding of the physiology of pregnancy, pathophysiology of pregnancy-specific disorders and anesthetic implications of cocaine abuse in pregnancy is essential to tailor a safe anesthetic plan for this high-risk group of patients.