Cocaine-associated fetal death in utero

Cocaine and its principle metabolite benzoylecgonine were quantitated in blood and liver in six cocaine-related deaths within the Hennepin County Medical Examiner's jurisdiction. Postmortem blood cocaine and benzoylecgonine concentrations ranged from 0 to 5.6 mg/L and 0.6 to 18.7 mg/L respectively. Postmortem liver concentrations ranged from 0 to 5.0 mg/kg and 0.4 to 24.1 mg/kg, respectively. All cases had benzoylecgonine concentrations greater than cocaine concentrations. Most alarming were the findings regarding the cocaine and benzoylecgonine concentrations in the case of a dead pregnant woman. The amniotic fluid cocaine and benzoylecgonine concentrations of 3.3 mg/L and 1.6 mg/L displayed at parent drug to metabolite ratio greater than 1.0 compared to the blood (0.30) and liver (0.21) ratios. This was likely indicative of very recent exposure.