Pregnancy Flashcards
When does pregnancy begin?
first day of last menstrual cycle
fetal age at first missed menses?
3 weeks
gestational age at first missed menses?
5 weeks
pregnancy urine test
2 weeks after conception
serum pregnancy test
9 days after conception
how many weeks is an average pregnancy?
40 weeks (38-42 weeks normal)
first trimester
until 14 weeks
second trimester
until 28 weeks
third trimester
until delivery
What does compression of the IVC in supine position cause?
supine hypotention
supine
lying facing upwards
hypotention
abnormally low blood pressure
symptoms of supine hypotension
- feeling faint/dizzy
- vision “going grey”
- palor
- nausea
- drop in blood pressure from decreased venous return to heart
- decreased blood flow to uterus
What position helps with supine hypotention
left lateral tilt position
-sit patient up, fully recline chair and roll patient to left side
positioning of pregnant patient
- use semi-reclining position as tolerated
- encourage frequent position changes
- place small pillow under right side to tilt patient to the left
What is the total weight gain in pregnancy?
27.6 lbs
What is the ideal weight gain in in pregancy?
25-35 lbs
What are some significant cardiovascular changes with pregnant women?
increase in plasma volume and cardiac output (HR + SV)
or decrease in peripheral vascular resistance and BP
what are some respiratory changes in pregnant women?
increase in minute ventilation and tidal volume
-in 3rd trimester, supine position can impair respiratory function
in what trimester can supine position impair respiratory function?
3rd
Gastrointestinal changes in pregnant women
- gums can become hyperemic
- decreased motility of GI tract (constipation, reflux, heartburn)
- relaxed esophageal spincter (GERD and increased risk of aspiration esp in surgery (spinals/epidurals during cesareans help avoid)
hyperemia
increase of blood flow to different tissues in the body
gastrointestinal changes
nausea/vomiting (hyperemesis Gravidarum)
- 70% experience in 1st trimester
- 2% w/ hyperemesis
hyperemesis
surface enamel loss through acid-induced erosion
-1 tsp baking soda in 1 cup water- rinse after vomitting
Why should you avoid brushing right after vomiting?
can worsen already demineralized teeth
pregnancy periodontal disease
- affects 15% childbearing age
- up to 40% of pregnant women
- more common in low income women
- older age, smoking, diabetes increases risk
pregnancy gingivitis
- common (50-70%)
- hormones cause increased growth of gum capillaries -hypertrophy of gums
- inflammation: erythema and edema
- range from redder looking gums that bleed when brushing teeth to severe swelling and bleeding
- hormonal changes may cause shift in bacterial flora and increase susceptibility
pregnancy tumor
- pyogenic granuloma (not purulent)
- lobular capillary hemangioma
where can pregnancy tumors be found?
hands, arm, face
what percentage of pregnant women have pregnancy tumors
10%
What is pregnancy tumors often seen with
inflammatory gingivitis or area of local trauma/ irritation
pyogenic granuloma (pregnancy tumor)
- pedunculated outgrowth from interproximal gingiva
- anterior + maxillary
- smooth or lobulated red-purple mass
- early- vascular and bleeds easily
- later-less vascular, more collagenous and pink
pyogenic granuloma
mm to cm
-painless and soft
treatment of pregnancy tumor
most resolve after pregnancy, surgical excision if very bothersome?
periodontal disease
15% childbearing age women and 40% pregnant women
periodontal disease and preterm birth
- pathogen and proinflammatory cytokines spread via hematogenous transport
periodontal disease and preterm birth is associated with
CV disease, DM, respiratory function
2.8 fold increase risk of preterm birth with
maternal periodontal infection, intervention may not help
periodontal care in pregnancy
- VERY IMPORTANT
- GENERAL MATERNAL HEALTH MAINTENANCE
- STUDIES SHOW IT IS SAFE
no adverse serious medical events of adverse pregnancy outcomes for
- routine, essential dental care,
- nonsurgical periodontal care
- use of topical/ local anesthesia
is dental caries increased by pregnancy?
NO, pre-existing dental disease may become exacerbated due to pregnancy influences
teratogen
any agent or factor to which fetal exposure produces a permanent alteration in form or function of offspring
pre-implantation period
2 weeks from fertilization to implantation
-“all or none” period - death vs. injury w/ complete compensation
emybryonic period
- 2nd through 8th week following conception
- organogenesis- structural malformations
fetal period
- 9 weeks and beyond
- some organs still vulnerable (e.g. brain, heart)
determining teratogenicity
- timing of exposure
- duration of exposure
- route of administration
- concurrent exposure to other agents
- individual maternal + fetal metabolism
- placental transport
FDA category A
well controlled human studies show no fetal risk
FDA category B
animal studies show no risk but no human studies OR animal studies show risk but human studies show NO risk
FDA category C
animal studies show averse effects but no studies in women - benefits may warrant use
FDA category D
positive evidence of human risks but benefits may outweigh the risks
FDA category X
risks demonstrated and outweigh benefits
drugs contraindicated in pregnancy
alcohol anticonvulsants warfarin ACE inhibitors retinoids androgens + DES antineoplastic agents antimicrobials
antimicrobials contraindicated in preganncy
tetracycline + sulfonamides
anticonvulsants contraindicated in pregnancy
phenytoin carbamezepine valproate trimethadione phenobarbitol
tetracyclines (doxy + monocycline)
yellow-brown discoloration of deciduous teeth
antibiotics with potential toxicity
sulfonamides (Bactrim)
nitrofurantoin (Macrodantin, macrobid)
tetracyclines
sulfonamides (bactrim)
- mixed data about teratogenicity
- displace bilirubin from protein binding sites
- theoretical concern hyperbilirubinemia near delivery
nitrofurantoin (macrodantin, macrobid)
mixed data about teratogenicity
ACOG says sulfonamides and nitrofurantoins safe in
2nd/3rd trimester but avoid in 1st unless it’s the only option
antibiotics that are safe to use
penicillin
cephalosporins
erythromycin
clindamycin
analgesics in pregnancy
salicylates (aspirin)
indomethacin
salicylates (aspirin)
- potent PG inhibitor
- theoretical concern premature closure of ductus arteriosus
- no cases found when studied for preeclampsia prevention
indomethacin
- constriction of ductus arteriosus & pulmonary HTN
- decreased fetal urine output
analgesics in pregnancy
- acetaminophen safe to use
- narcotics safe to use (oxycodone, codeine)
- avoid aspirin use
- ibuprofen and naproxen (fair evidence of safety, avoid 1st and 3rd trimesters
when should you avoid ibuprofen and naproxen?
1st + 3rd trimesters
are local anesthetics safe to use in pregnancy?
yes!
general anesthesia
- non are teratogens
- if crosses CNS of mother, it will cross the placenta + depress CNS of fetus
- GI transit time is prolonged so risk of aspiration increased
nitrous oxide
- safe for pregnant women but
- chronic exposure (occupational) w/out proper scavenging of exhaleed gases assos with: reduced fertility + increased in miscarriages
X-rays in pregnancy
no single diagnostic X-ray procedure results in radiation exposure to a degree that would threaten the well-being of the developing pre-embryo, embryo or fetus
which radiologic tests are very safe in pregnancy?
-those that don’t involve ionizing radiation like ultrasound and MRI
what radiation exposure is safe?
fetal exposures of CXR (2 views)
.02-.07
fetal exposures of skull film
.004
fetal exposures of CT scan head or chest
fetal exposures of CT abdomen
1-2
fetal exposures of daily background
.036
radiologic tests that are NOT SAFE in pregnancy
radioactive iodine for therapeutic purposes: 1 crosses placenta 2 affects fetal thyroid 3 especially if used after 10-12 wks 4 contraindicated in pregnancy 5 treat patients AFTER delivery
nuclear medicine tests to use cautiously
1 radiopaque contrast agents for CT/X-rays
-no problems in nursing babies
2 paramagnetic contrast agents for MRI
3 radionucleotide testing for V/Q, thyroid, bone and renal scans
fetal risks of high dose radiation exposure
- embryonic death
- teratogenic effects
- carcinogenesis
- genetic effect or germ cell mutations
- ?? adverse genetic effects on future generations
- intrauterine growth restriction
embryonic death
- high-dose radiation before implantation
- most likely lethal to embryo
- animal studies
- “all or none” phenomenon in early embryonic development
teratogenic effects
- data from atomic bomb survivors
- growth restriction
- microcephaly
- mental retardation
- CNS effects greatest if exposed 8-15 wks
- threshold may be 20-40 rad
fetal risks of high dose radiation exposure- carcinogenesis
-unclear risk but probably small
-estimated 1-2 rad fetal exposure may increase incidence leukemia by 1.5-2
-estimated 1 in 1000 cases per rad
-background risk is 1 in 3000
nonirridiated sibs also have higher incidence
principles for radiographic testing in pregnancy
- no radiologic test performed unless medically necessary
- if testing indicated, shield the fetus and limit exposure
- do not put patient at risk by avoiding indicated test
- highest risk for fetus during organogenesis (3-10 weeks)
dental care in 1st trimester
evaluate dentition, perform established dentistry regimen
dental care in 2nd trimester
any routine or major necessary procedures
dental care in 3rd trimester
continue established maintenance programs; perform major procedures as required
all essential dental treatments can be maintained
routine extractions, periodontal treatment, restorations, continuation of orthodontic treatment, placement of movable and fixed prosthesis, placement of crowns
what is best left till postpartum period
elective surgery
how long should infants be breasted?
6 mos
how long should breasfeeding continue
until 1 yrs of age with supplementation of solid foods after 6 mos.
benefits of breastfeeding
- colostrum helps digestive system
- antibodies help immune system
- lower risk of asthma, obesity, allergies
- protein/fat better used than those in formula
- less gas, feeding problems, constipation
- less SIDS- sudden infant death
breastfeeding contraindicated
taking antineoplastic, thyrotoxic and immunosuppressive agents
- receiving radioactive isotopes
- undergoing chemotherapy or radiation therapy
safe meds for breastfeeding
antibiotics, antihistamines, nasal decongestants , analgesics, IV contrast agents
which antibiotics are safe for breastfeeders
penicillins, cephalosporins, macrolides, aminoglycosides
nasal decongestants
may reduce milk supply
analgesics safe for breastfeeders
tylenol, NSAIDS (no ASA), opiates (may cause sedation)
primary contraceptive methods
female sterilization, male sterilization, oral contraception, injectables/implant/patch, condom, others
hormonal contraceptives
supresses midcycle surge of LH from pituitary so ovulation does not occur
-supresses FSH secretion during folicular phase
