Preterm premature rupture of the membranes associated with recent cocaine use

The objective of this study was to determine the rate of recent cocaine use among a metropolitan population of predominantly Hispanic and African-American women with preterm premature rupture of the membranes (PROM) and to ascertain the impact of cocaine on the latency period between rupture of membranes and delivery. Urine toxicology screens were prospectively obtained on 147 women with preterm PROM. The urine screen did not influence management decisions. All women were expectantly managed without tocolytics until 37 weeks' gestation unless they developed clinical chorioamnionitis, or nonreassuring fetal heart rate tracing or biophysical profile. Demographic information, hours from rupture of membranes to delivery, gestational age, and birth weight at delivery were compared using Fisher's exact, Mann-Whitney U, and randomization tests where appropriate. The rate of positive urine drug screens for cocaine was 8.2%. Women in the cocaine positive group were of higher parity (3, [0-7]vs. 1, [0-6], p = 0.001) and tended to be older (27, [23-42]vs. 25, [14-40]). There was a higher rate of recent cocaine use among African-American women (20.4%) as compared to non-African-Americans (1.2%, p = 0.0001). Cocaine-positive women presented at an earlier gestational age (32 weeks', [24-34]vs. 33 weeks', [23-36], p = 0.02) and had a significantly longer membrane rupture to delivery interval than women with a negative urine drug screen (174 hr, [6-475]vs. 33 hours [1-833], p = 0.01). There was no significant difference in the reason for delivery between the two groups of patients. Recent cocaine use among women with preterm PROM is common in only some segments of an urban population. Women with recent cocaine use present with ruptured membranes at an earlier gestational age and may actually have a longer latency period than women who do not use cocaine.