Caring for the patient who is pregnant Flashcards
Maternal Changes in Pregnancy
(4)
endocrine
cardiovascular
hematologic
respiratory
endocrine
multiple hromonal changes
cardiovascular
increase of 20-40% in CO, tachycardia, and flow murmurs
hematologic
increase of 30% in maternal blood volume
respiratory
increased rate of respiration
spontaneous abortions
probability of –% during first trimester
possible relationship to (2)
15
stress or bacteremia
ectopic pregnancy
fertilizations and implantation of the fetus in the fallopian tube, resulting in abdominal pain and heavy bleeding
eclampsia
pre-eclampsia is marked by (2)
eclampsia is characterized by (3)
hypertension and proteinuria
malignant hypertension, seizures, and encephalopathy
Eclampsia - a condition in which high blood pressure and proteinuria lead
to (4)
encephalopathy, coma, miscarriage and death
Hormonal changes can either cause (2)
hypertension or syncope
— is monitored to screen for eclampsia
Hypertension
Syncope can lead to traumatic injury; prodromal symptoms should be addressed
by assuming a — position
prone
anemia
secondary to increased hematologic demands
cardiovascular disease
exacerbation of underlying disease in response to increased demand
oral
exacerbation of underlying periodontal disease
Pregnancy Gingivitis and Exacerbated Periodontitis Exacerbated by:
- Lack of attention to —
- Increased (2) from increased (2)
- Increased —
Oral Hygiene
systemic fluid levels & capillary fragility
progesterone and estrogen
anaerobic bacterial plaque counts
Oral Complications in Pregnancy
* Exacerbation of underlying —
* May cause a —
periodontal disease
granulomatous reaction with a more significant
vascular component
Pyogenic granuloma
Epulis gravidarum
Pregnancy Tumor
(3)
- not an actual granuloma as there is proliferation of vascular tissues as well proliferation
of fibrous tissue - forms submucosally and takes the shape a nodular growth
- Thought to be an exacerbated response to plaque and bacteria precipitated by the
changes in hormonal levels
Pyogenic granuloma
Epulis gravidarum
Pregnancy Tumor
Treatment
(2)
- variable
*conservative management is an option
*conservative management is an option
(3)
- May resolve post-partum
- Gentle curettage with electocautery
- Excision to the periosteum and removal of calculus and plaque
Dental Evaluation in Pregnancy
general guidelines
take a hx of the trimester and note complications and blood pressure
Dental Evaluation in Pregnancy
first trimester
fetus is especially susceptible to teratogenic influence and abortion
Dental Evaluation in Pregnancy
second trimester
optimal trimester for dental care
Dental Evaluation in Pregnancy
third trimester
(2) risk are greatest secondary to —.
– demands are greatest.
there is increased risk of —, the highest risk of —, and increased risk of —
syncope and hx
fetal position
CV
anemia
eclampsia
htn
Dental Evaluation in Pregnancy
specific guidelines
1. preventative dental prophylaxis should be undertaken at the …
2. all — dental care should be deferred
3. nondeferrable tx (ex caries control) should be completed during the — trimester
4. radiographs are …
5. there should be medical clearance for all drugs, including (3)
beginning of the second trimester and third trimester
elective
second
contraindicated in all but emergency situations. when taken lead shielding is mandatory
local anesthetics, analgesics, and abx
New and recall pregnant dental patients:
* Radiographs should be …
* long term benefit to the health of the mother from new patient or recall exam radiographs
* BUT no benefit to the …
* unborn child faces greater risks from the radiation exposure than the mother, without any …
* National Council on Radiation Protection and Measurements (NCRP Report 177, 2019)2
recommends …
* radiation exposure thresholds for pregnant radiation workers is lowered to the same
thresholds as the —
* SoD Dental Radiography recommendation guidelines for Pregnant Patients mirrors these
NCRP recommendations
postponed until post-partum
health of developing child
benefit to their health
different radiation exposure thresholds for pregnant radiation workers than
non-pregnant radiation workers
general population
Patient Shielding During
Dentomaxillofacial Radiology
Recommendations
(2)
- discontinuing shielding of the gonads, pelvic
structures, and fetuses during all dentomaxillofacial
radiographic imaging procedures - thyroid shielding not be used during intraoral,
panoramic, cephalometric, and CBCT imaging as the
risks of thyroid cancer are negligible from
contemporary maxillofacial imaging radiation doses
Emergency pregnant dental patients:
* necessary radiographs are part of the standard of care to treat and diagnose a
condition that …
* lack of radiographs compromises the emergency care (2)
* this will directly impact the health of the —.
* primary beam is not directed toward the —
threatens the health of the mother and the unborn child
diagnosis and treatment,
unborn child
child-bearing area
- there should be medical clearance for all drugs, including local anesthetics, analgesics, and abx
a. (4) are generally approved
b. (3) are relatively contraindicated
c. (3) are absolutely contraindicated
d. (1) is now frequently prescribed BUT only in low doses
lidocaine, penicillin, erythromycin, and acetaminophen
aspirin and vasoconstrictors in LA and all drugs causing respiratory depression
diazepam, NO, and tetracycline
low dose ASA
Gestational Diabetes
*
* In some instances, it may also be —
* gestational diabetics are at higher risk of
developing — later in life
* Generally —
high blood sugar affecting pregnant women who
have insufficient insulin production relative to
metabolic needs
insulin resistance
type 2 diabetes
asymptomatic
Gestational Diabetes
* Presents at
mid term; ~24-28 weeks
Gestational Diabetes
Treatment
(5)
- daily blood sugar monitoring
- Special meal plans emphasizing a healthy diet
- exercise
- monitoring the baby
- daily blood glucose testing and insulin injections
If the above conservative measures are not
responsive and blood sugar remains high, medication
is needed
(2)
- IM - Insulin
- PO - Metformin (preferred)
