4. Pregnant Patient

Question 1

What endocrine changes occur during pregnancy?

Answer 1

1. Increase estrogen, progesterone, TSH, and GH

2. Gestational diabetes

Question 2

What cardiovascular changes occur during pregnancy?

Answer 2

1. Increased bp
2. Blood volume increases 40-55%
3. CO increases 30%
4. Can have transient heart murmurs

Question 3

What hematologic changes occur during pregnancy?

Answer 3

1. Iron deficient anemia in 20% of pregnancies
2. Leukocytosis - increased neutrophilia
3. Increased clotting factors

Question 4

What respiratory changes occur during pregnancy?

Answer 4

Tachypnea, dyspnea, increased gag reflex

Question 5

What kidney changes occur during pregnancy?

What appointment adjustments should be made?

Answer 5

Increased renal flow and glomerular filtration

- Patient needs to urinate, break time, head call, short appointment

Question 6

What gastric changes occur during pregnancy?

Answer 6

1. GERD
2. Nausea and vomiting increase
3. Frequent snacking

Question 7

What four complications can occur doing pregnancy?

Answer 7

1. Supine hypotensive syndrome
2. Gestational diabetes
3. Preeclampsia
4. Miscarriage

Question 8

Supine hypertension occurs __ (early, mid, late) in pregnancy
It results from an __ increase/decrease in venous return to the heart.
If a patient loses consciousness, move her to the __ (left/right) side.

Answer 8

1. Later in pregnancy
2. Decrease
3. Left

Question 9

Three signs of gestational diabetes?

• Increases or decreases risk for DM later in life?
• Occurs in __% of pregnancies
• Risk increases with what three factors?

Answer 9

1. Polyphagia, polydipsia, polyuria
2. Increases
3. 5%
4. Age >35, obesity, family history of DM

Question 10

What is preeclampsia?

• What level of protein in a 24 hour urine sample?
• What bp levels?

Answer 10

Elevated BP with marked proteinuria
0.3 g protein over 24 hour urine sample
BP >140 > 90 mmHg

Question 11

What are 5 s/sx of eclampsia?

Answer 11

1. Malignant hypertension
2. Blurred vision
3. Seizures
4. Coma
5. Death

Question 12

Percentage of miscarriages?

5 Causes?

Answer 12

15% of pregnancies

1. Advanced age of mother
2. Smoking
3. Infections
4. DM
5. Eclampsia

Question 13

When is it safest to treat a pregnant woman?

Answer 13

2nd trimester and first half of 3rd trimester

Question 14

What is the name for the complication known as “pregnancy tumor”?

Answer 14

Pyogenic granuloma

Question 15

What kind of treatment for pregnancy gingivitis?

Answer 15

OHI, debridement, CHX rinse (gingival irritation resulting in exaggerated inflammatory response secondary to increased estrogen and progesterone)

Question 16

What does the phrase “a tooth for every pregnancy” mean?

Answer 16

1. Teeth may be more mobile

2. Pregnancy will not cause perio disease but can exacerbate it

Question 17

Why does facial pigmentation occur for pregnant women?

Answer 17

1. Increased hormone production

Question 18

What kind of treatment can be provided in first treatment?

Answer 18

Plaque control and OHI (simple scaling and root planing)