Amphetamine-exposed mothers and infants in public hospitals of NSW and the ACT are at significantly higher risk of adverse social and perinatal outcomes even when compared with mothers and infants exposed to other drugs of dependency. Increased vigilance for amphetamine exposure is recommended due to a high prevalence of use, especially in Australia, as a recreational drug.

Our regional study highlights a substantial prevalence of drug use in pregnancy with considerable adverse perinatal and hospital outcomes in infants born to these mothers. Coordinated health care and resources are needed to support these mother-infant pairs because of their social, medical and mental-health issues.

Psychiatric comorbidity, especially depression, is common and affects almost half of drug-using mothers. Antenatal care, drug use and social outcomes are worse for DD mothers and their infants. It is recommended that all drug-using women be assessed antenatally for psychosocial disorders so that timely mental health intervention can be offered, if required.

Preterm infants were just as likely to be monitored for withdrawal as term infants, but their Finnegan scores were lower and fewer preterm infants were treated for NAS. Whether this indicates decreased NAS severity or physiological immaturity is uncertain. Other means of evaluating NAS in preterm infants are warranted, especially long-term outcomes.

References Wrong turn-dead end (Received 20 July 2000)Sir;We were most interested by the recent articles by Kent and colleagues (Vol 107, May 2000)', proposing the phenomenon of transperitoneal migration of sperm. In this article the authors describe a case of successful reversal of sterilisation on the right which was not attempted on the left due to the lack of patency of the proximal part of the uterine tube. She subsequently went on to develop an ectopic in the distal remnant of the left tube which was excised laparoscopically. We write in support of their recommendation of total salpingectomy, including fimbrial ends of an affected tube, when reanastomosis is not possible, and also in support of the theory originally proposed by Ansari and Miller* of transperitoneal spermatozoa migration following partial salpingectomy. A thirty year old woman was admitted under our care with a suboptimal rise in human chorionic gonadotrophin hormone and a transvaginal ultrasound scan showing an empty uterus with a rightsided ectopic pregnancy. This was confirmed at surgery and a right salpingectomy was performed. The left tube and ovary appeared normal. Histology confirmed an ectopic pregnancy.Six months previously, the same patient had presented shocked, with a ruptured ectopic pregnancy in the isthmic portion of the right tube and had undergone a laparotomy with removal of the affected part of the tube. A distal lump was left. Our experience in this case supports the theory of transperitoneal migration of spermatozoa and highlights the sequelae of leaving distal stumps. Our practice in the management of ectopic pregnancy where salpingectomy is required is to perform a total salpingectomy, where reimplantation of the remaining portion of the tube as an interval procedure is felt impossible.L. Hinton, G.