Opioid Use Disorder: Approach to Intrapartum and Postpartum Management

AbstractPurpose of ReviewThe care of pregnant people with opioid use disorder (OUD) presents unique challenges that have escalated with the opioid epidemic in the USA. The pregnancy-related mortality attributable to OUD, as well as the increased contact with the healthcare system during pregnancy, make the opportunities for intervention and engagement in care in the intra- and postpartum period critical, particularly given that the birth hospitalization is an almost universal experience. We aim to summarize an evidence-based approach for intra- and postpartum care and to review the important controversies that remain.Recent FindingsThe pregnancy-related mortality attributable to substance use, mostly OUD, is astounding at around 40% in many studies, and maternal mortality reviews have identified the postpartum period as being a particularly vulnerable time. In order to save lives, universal screening for substance use should be implemented using evidence-based approaches like SBIRT, and, when appropriate, medications for OUD (MOUD) should be offered. Trauma-informed multidisciplinary care and multimodal pain control remain cornerstones of the intrapartum period, while close follow-up and connection to resources are important in the postpartum period. The role of urine toxicology testing in pregnancy, opioid detoxification in pregnancy, and breastfeeding for patients in early recovery with ongoing illicit use remain controversial topics.SummaryWhile we have made progress in un...
Source: Current Obstetrics and Gynecology Reports - Category: OBGYN Source Type: research