Use of medication during pregnancy--a prospective cohort study on use and policy of prescribing.

Pregnancy is associated with special problems with respect in selection of medication and dosage, primarily due to potential teratogenic or toxic effects on the fetus by the drug itself, and secondly due to the physiologic adjustments in the mother in response to pregnancy. This prospective survey was designed to record the use of medications and the policy of prescribing during the course of pregnancy. In total, 5851 pregnant women residing in a county in southwestern Finland during the period June 15, 1987 and June 14, 1988 were studied, which is 69% of the total amount of births in the same area. Iron and vitamin supplementation was used by all the pregnant women during the third trimester, and by 35% and 88% during the first and second trimesters, respectively. Analgetics were used on an irregular basis by 12% of the pregnant women, and no correlation to the length of pregnancy could be observed. 9% of the women used medication on a regular basis for reasons such as bronchial asthma, arterial hypertension and hyperthyreosis. Some kind of a symptomatic medication was taken by 43% of the women with no correlation of the length of pregnancy, the most common symptoms needing medication being candidiasis, cough, reflux esophagitis and pregnancy-associated hyperemesis. Tocolytic agents had been given to 8% of the pregnant women. Most tocolytics were used during the end of the second trimester and beginning of the third one. It is concluded that the general use of medicines is quite reasonable in the normal pregnant population in Finland. Iron supplementation should probably be more individualized instead of regular use.

Effect of diazepam on emergence from ketamine anaesthesia. A double-blind study.

The series comprises 109 healthy females aged 14-49 years (mean age 28 years) hospitalized for legal abortion or diagnostic curettage. The patients were premedicated with morphine-scopolamine 0.4-0.7 ml i.m. (morphine 20 mg/ml, scopolamine 0.6 mg/ml) and atropine 0.01 mg/kg i.v. Ketamine 1.5 mg/kg was administered i.v. and immediately thereafter 2 ml of a coded solution i.v. consisting either of diazepam 10 mg or its solvent only. Supplementary doses of ketamine 0.2-0.4 mg/kg were administered when needed. Diazepam reduced the incidence of unpleasant dreams and experiences to a significant degree (p less than 0.01) according to the postanaesthetic interviews of the patients. Nausea occurred in the diazepam group in 2 per cent and in the placebo group in 17 per cent (p less than 0.01). In respect to the differences in opinion presented in literature the authors consider the time of administration of diazepam at induction to be of decisive importance and find prophylactic prevention of dreams justified as it cannot be predicted which of the patients will have unpleasant or even terrifying dreams. Dreams and/or experiences or their memories must be prevented at the stage at which the effect of ketamine commences. The authors do not, however, recommend ketamine anaesthesia for young adults, even when supplemented with diazepam. On the other hand, the authors consider the positive observations made during the study to be applicable to all other ketamine anaesthesias.