Pregnancy Flashcards
Normal pregnancy
40 weeks No baby for 1st 2 weeks 1st trimester 0-12/40 -organogenesis 2nd trimester 13-28/40 -maturation and growth 3rd trimester 28-42/40 -growth and maturation
Physiological changes in pregancy
Oestrogenic and progestogenic effects Metabolic demands of fetus Nutritional demands of fetus Mass effect of uterus All effects magnified in multiple pregnancy
Respiratory systen
PO2 rises PCO2 falls Tidal volume increases RR unchanged Exertional dyspnoea normal
CV system
Cardiac output increases 30-50% HR increases ~10bpm Dilutional anaemia > clotting factors Vasodiation Aorta-caval compression
GI system
< tone lower oesophagus
Delayed gastric emptying and bowel transit
> intra-abdo pressure
Haematological system
Iron deficiency anaemia
> risk of DVT
Implications for dental practice
Procedures <20-30 min
Defer procedures in 1st and 3rd trimester
Avoid supine posture >20/40
If unavoidable: 15 degrees left lateral tilt, oxygen, thromboprophylaxis
OH during pregnancy
Hyper salivation > vascularity Gingival tissue growth Altered immune response to bacteria Tooth mobility Effects of excessive vomiting
Pregnancy gingivitis
Aggravated pre-existing disease Plaque induced inflammation Histologically similar to non-pregnant disease Worsens through pregnancy Usually resolves after
Pregnancy epulis
Granulomatous/ fibrous hormonal response at pre-existing sit of gingivitis
Often at labial interdental papillary gingiva upper jaw
Usually pedunculated
Pregnancy epulis incidence
5%
Pregnancy epulis associated with
Plaque
Pregnancy epulis microscopy
Inflammatory cells, new capillaries and fibroblasts
Pregnancy epulis prognosis
Tends to regress but recur in subsequent pregnancies
Bone involvement rare
Periodontal disease and adverse perinatal outcome
Low birth weight
Pre-eclampsia
Prematurity and pregnancy loss
Unclear it treatment improves outcome
Implications for dental practice
Good oral hygiene & plaque control
Dietary advice
Routine dental checkups, scale and polish in 2nd trimester ideally
Give advice re infant dental care and diet
Persistent vomiting: see your Obstetrician, avoid brushing more than bd
Effect of pregnancy on dental care
Imaging Prescribing Amalgam Breast feeding Periodontal disease
Imaging
X-rays are teratogenic
Foetal exposure from 18 oral views = 800x CXR
Document pregnancy status prior to any X-ray
Strategies: shielding, restrict number of views, avoid
Prescribing
Almost all drugs cross placenta & enter breast milk
Highest risk during organogenesis
Dependence & Neonatal withdrawal >28/40
Antimicrobials
Penicillins, Cephalosporins, Erythromycin, Nystatin ok
Avoid Tetracyclines
Avoid Augmentin
Avoid Metronidazole before 28/40 in some patients
Avoid Ketoconazole, Miconazole, Amphotericin
Analgesics
Avoid NSAIDs especially >34/40
Use minimum dose of opioids for shortest time
Anaesthesia
Avoid sedatives and hypnotics, Entenox ok for 20-30 min
Lignocaine / Prilocaine +/- adrenaline ok
Avoid vasopressin (uterine stimulant)
Avoid GA, risks lowest in 2nd trimester
Specialist anaesthetic input advised
Amalgam
Exposure during pregnancy associated with low birth weight
DOH advises Mercury amalgam fillings should not be inserted or removed during pregnancy
Breast feeding mothers
Levels lower in breast milk compared to blood**
Advise taking after breast feeding
Avoid Tetracyclines, Aspirin
Key messages - general
Care is free
Document pregnancy status of all women 13-50yrs prior to X-rays and any treatment
Alter prescribing during pregnancy, remember Metronidazole, Augmentin
Key messages - treatment
Treatment is generally the same with specific exceptions
Reassure treatment is safe
Limit to essential treatment, in 1st & 3rd trimeters
Treat infection & pain
Limit procedures to 20-30 min until 3/12 postnatal
Avoid supine position >20/40
