EXAM I Pregnancy Flashcards
in the treatment of the pregnant patient, is the maternal health sacrificed for the benefit of the fetus?
no
in the treatment of the pregnant patient, what types of circumstances will predicate decisions?
trimester, dental abscess, airway compromise, elective choices
during pregnancy, blood volume increases by ___%, which can cause ___
- 50%
- secondary anemia
during pregnancy, cardiac output increases or decreases? and during which trimester?
increases during 3rd trimester
during pregnancy, a ___ murmur develops; a sudden deceleration of blood flow from ___ to ___; ___ during pregnancy
- S3 (third sound)
- left ventricle to left atrium
- mitral valve prolapse
what happens to BP during pregnancy?
decreases and then increases
what is preeclampsia?
- a condition that only occurs during pregnancy
- characterized by hypertension, proteinuria, blurred vision, and edema
- eclampsia can occur - seizures/coma
describe the changes in respiration during pregnancy
- increased oxygen demands
- tidal volume and ventilation rate (per minute) due to displacement of diaphragm
- rise in intrathoracic pressure
- anterior-posterior diameter of chest and increase in oxygen demand
- hypoxia/hypercapnea/dyspnea; 50% 2nd trimester and 75% at the 3rd trimester
- hyperventilation - accounts for change in volume due to diaphragm displacement
- increase of mucus in airways; severe rhinitis, URI: due to increase levels of estrogen
what are the hematological alterations that occur during pregnancy?
- increase in number of erythrocytes, leukocytes, erythrocyte sedimentation rate (ESR)
- clotting factors increased: VII, VIII, IX, X; fibrin split products increase hypercoagulopathic
- plasma volume increases
- increase leukocytes, cortisol, catecholamines
- leukocytosis seen: 12-15,000
what are gastrointestinal considerations of pregnant patients?
- increase in intragastric pressure; nausea, vomiting; <1% excessive; and pyrosis (heartburn)
- hormonal effects: taste altered, gag
- increased insulin resistance: gestational diabetes
- alteration in hepatic function: decrease albumin, increase AlkP, cholesterol, bilirubin, AST and ALT (liver enzymes): 3% have abnormal liver function
- loss of lower esophageal sphincter tone
- slower gastric emptying time (if this pt is NPO, you still have to be careful because they may still have contents in their stomach)
what are the renal considerations of the pregnant patient?
- increased renal plasma/ GFR
- decrease in creatinine levels/ BUN
- urinate more and increased risk of UTI
- increase filtration of urea and so a decline in serum creatinine and BUN
what are the treatment considerations of the pregnant patient with respect to cardiovascular system?
- increase compression of IVC, venous return impaired and so pt must be on left side 5-15 degrees to prevent hypotension, bradycardia and syncope
what are the treatment considerations of the pregnant patient with respect to respiratory system?
- hyperventilation: respiratory alkalosis
- ventilation must be adjusted to avoid hypoxemia when supine due to abnormal alveolar/arterial/oxygen gradient
what are the treatment considerations of the pregnant patient with respect to hematologic alterations?
- risk for thromboembolic events; hypercoag and venous stasis leading to PE
- anticoagulant therapy in some cases LMW heparin does not cross placenta
what are the treatment considerations of the pregnant patient with respect to the gastrointestinal system?
- morning sickness (increase B-HCG): early appointments, recommend gatorade for electrolyte loss
- decrease albumin
- increase edema
what are the treatment considerations of the pregnant patient with respect to renal system?
- pt should void before treatment secondary to increase urination
- meds need to be adjusted due to GFR and clearance rates of drugs
what is the FDA criteria for a category A medication?
human studies - no risk to fetus
what is the FDA criteria for a category B medication?
studies in animals - no risk
no human studies
what is the FDA criteria for a category C medication?
animal studies - toxic
no human studies
benefit may outweigh risk
what is the FDA criteria for a category D medication?
human toxic
benefit to mother may exceed risk to fetus
what is the FDA criteria for a category X medication?
fetal abnormalities
risk outweighs all
how is alcohol teratogenic?
fetal alcohol syndrome
how is tobacco teratogenic?
toxic with decreased oxygen
how is cocaine teratogenic?
placenta / hypertension / cardiac death
how is thalidomide teratogenic?
embryology - appendages
how are anticonvulsants teratogenic?
orofacial clefting
how is dilantin teratogenic?
fetal hydantoid syndrome
how are retinoids teratogenic?
neural tube defect
how are antimicrobials teratogenic?
ototoxic/neurotoxic
how are ACE inhibitors teratogenic?
renal ischemia
how do local anesthetics affect the pregnant patient?
not harmful to fetus but can affect vascular volume, toxicity and drug dosing, epi based on blood pressure
B and C categories
how are general anesthetics affect the pregnant patient?
in most studies, meds are safe, but nitrous oxide causes decreased fertility and spontaneous abortions; scavengers have improved safety
B and C categories
how do analgesic agents affect the pregnant patient?
- acetaminophen is safe (B), salicylates cause spontaneous abortions, fetal abnormalities, low dose ASA prevent pre-eclampsia, NSAIDS increase cardiac septal defects in first trimester
- narcotics: neonatal narcotic withdrawal
which antibiotic has no adverse reaction with the pregnant patient?
penicillin
what antibiotics have unlikely reactions with the pregnant patient?
amoxicillin, chloramphenicol, rifampin, doxycycline
what antibiotics have undetermined affects on the pregnant patient?
clindamycin, gentamycin, vancomycin
what antibiotic has adverse reactions with the pregnant patient and therefore should not be used?
fluoroquinolones
which antibiotics may or may not cross the placenta?
macrolides: erythromycin, clarithromycin, azithromycin
should tetracyclines be given to pregnant patients? what about metronidazole?
tetracyclines should be avoided, metronidazole is questionable
which antivirals can be given to pregnant patients?
nystatin and clotrimazole
are systemic antifungals appropriate for the pregnant patient?
generally no because they cause fetal malformations, except for amphotericin B
which antivirals can be given to pregnant patients?
acyclovir and valacyclovir
no effects seen
what steroids are ok to give pregnant patients?
prednisone and prednisolone
which steroids are teratogenic in animals?
triamcinolone/beclomethasone
what are some intraoperative medical emergency complications that can arise in the pregnant patient with given local anesthesia?
- local infiltration
- regional nerve blocks
- cardiovascular, neurologic, CNS/fatal
- remember carpule count
what are the category B local anesthetics?
lidocaine, prilocaine, etidocaine
what are the category C local anesthetics?
bupivicaine, articaine, mepivicaine
describe OMFS dentoalveolar/elective procedures of the pregnant patient
- emergent situations
- elective delayed until post partum
- pain relief, elimination of infections
describe OMFS trauma scenarios of the pregnant patient
- 5% of pregnancies; 82% fetal death
- domestic violence
- OB consult
- minimize MMF for fractures
how are infections treated for the pregnant patient?
- early incise and drainage of odontogenic infections
- airway considerations as well as antibiotics
describe common intraoral pathologies in pregnant patients
- increased pigmentation: melasma
- pyogenic granulomas: pregnancy tumors
- gingival hyperplasia
- salivary changes with a lower pH
- desquamation of mucosa and increase in bacteria
- periodontal disease
- growth of certain osseous lesions: ossifying fibromas
in pregnant patients, maternal death is rare, but what are some of the causes?
- trauma
- bleeding
- embolism
- hypertension: eclampsia/preeclampsia
- infection
- cardiomyopathy
- anesthesia
