Obstetrics Flashcards
Changes during pregnancy
Cardiovascular:
- 40% increase in plasma volume
- reduced BP (1st and 3rd is higher)
- increased pulse
-fainting, palpitations
Respiratory:
-decreased total lung capacity
-increased tidal volume
- SOB
Urinary:
- increase urinary stasis
-increased urinary frequency
- UTI can increase risk of preterm birth
Haematological:
-thrombophilic state
- fall in haemoglobin
-increased risk of DVT
-anaemia
GI:
- delayed gastric emptying
- nausea and vomiting
-decreased GI motility
Musculoskeletal:
-change in posture
- relaxation of pelvic joints
Common dental conditions in pregnancy
Pregnancy gingivitis/periodontitis
- increased inflammatory response to dental plaque
- increased bleeding
- most likely Gram - bacteria
- Worse in 3 rd trimester
Benign oral gingival lesions(pyrogenic granuloma, granuloma gravidarum, epulis)
- 5% of pregnancy
- rarely need excision, only if too large
Tooth erosion
- due to increased acidity in mouth
-secondary to reflux, vomiting, increased sugar intake
Increased tooth mobility
Consideration for pregnancy and dental procedures
Inferior Vena Cava compression- always lay on left side!
Airway oedema
Breast enlargement
Medication
X ray
Teratogens
Valproate
( Used for epilepsy- associated with neural tube defects)
Tetracycline
( Discolouration of teeth)
Warfarin
( Fetal warfarin syndrome-low birth weight, developmental/mental delay, deafness, hypoplastic nose, skeletal abnormalities)
Alcohol
( No safe dose, fetal alcohol syndrome - developmental delay, behaviour issues, tin upper lip, decreased eye width)
What drugs do not cross placenta?
Low molecular weight heparin
Insulin
Large dose of LA may cause:
Neonatal respiratory depression, hypotonia, bradycardia
Antibiotics in pregnancy
Contraindicated: tetracycline, ciproflexacin, gentamycin
Safe: penicillins, erythromycin, metronidazole
Analgesics in pregnancy
Paracetamol - safe
NSAIDs- to avoid especially 3rd trimester
Dihyhrocodeine- safe but can cause neonatal respiratory depression if used during the labour;
Common drugs used in pregnancy and why
Aspirin- reduces risk of a small baby and hypertensive risk factors
Heprain- reduces the risk of DVT, PE
Antifungal medication in pregnancy
Contraindicated - miconazole, fluconazole ( risk of malformations)
Indicated: Nystatin, amphotericin
Antiviral medication
Aciclovir- okay for pregnancy (minimal transfer to the foetus)
Sedation and GA in pregnancy
All contraindicated
Key consideration for pregnancy in dentistry
PT positioning
PT should have left lateral tilt (15°) as weight of the baby and expanding uterus can partially occlude inferior Vena Cava. That can cause reduced venous return and reduced cardiac output- causing reduced blood flow to the foetus. Also can cause syncope due to hypotension secondary to decreased venous return in addition to dental anxiety
What is the dose from PA and OPT
PA- 0.001 mGy
OPT- 0.1 mGy (milligray)
Both still carry a risk of 1:1000 000 of childhood cancer
Things to consider when treating pregnant pt
Blood pressure - 1st lowest, 3rd highest
Emotional changes
Urinary frequency
Vomiting
Anaemia
Amalgam- rubber dam, high volume aspiration
Duraphat- not advised due to alcohol content
No 5000 ppm Fluoride toothpaste but 2800 ppm is safe
Fluoride mouthwash is okay (225 or 900 ppm)
Gingivitis - increase in oestrogen and progesterone causes increased inflammatory response to plaque (hormones act as growth factors for bacteria present) /gingival inflammation ( peak at 8months)
Also, supression of immuno system helps inflammation ( to prevent rejection of the foetus)
Hyperplasia of gingivae- due to marked proliferation of capillaries and minimal proliferation of fibroblasts
