Pregnancy

Question 1

How is pregnancy split into trimesters?

Answer 1

0-12 weeks = organogenesis = 1st trimester
13-28 weeks = maturation and growth = 2nd trimester
28-42 weeks = maturation and growth = 3rd trimester

Question 2

What physiological changes occur and why?

Answer 2

Increase oestrogen and progesterone

Progesterone - smooth muscle relaxation of bowel and dilate blood vessel

Question 3

What is Mendelson’s syndrome?

Answer 3

Relaxation upper abdominal sphincter - dangerous when giving GA

Question 4

What respiratory changes occur?

Answer 4

Increased tidal vol, RR unchanged
Increase PO2, decreased PCO2
Exertional dysponea normal

Question 5

What CV changes occur?

Answer 5

Increase HR, CO increases 30-50%, vasodilation and aora-caval compression

Question 6

What changes occur GI?

Answer 6

Delayed gastric emptying and bowel transit

Question 7

What changes occur haematological?

Answer 7

Iron deficiency anaemia, increased clotting factor - risk DVT

Question 8

How does pregnancy affect oral health?

Answer 8

Increased salivation, vascularity and gingival tissue growth

Altered immune response

Question 9

What is pregnancy gingivitis?

Answer 9

Aggravation of pre-exisiting disease - plaque induced

Question 10

What is pregnancy epulis?

Answer 10

Granulomatous/ fibrous response to pre-existing disease

Often at maxillary labial interdental papilla

Question 11

Does perio affect baby?

Answer 11

Can cause low birth weight, pre-eclampsia

Question 12

Give examples of how care might be affected in pregnancy?

Answer 12

1. Imaging - x-rays teratogenic

2. Prescribing - drugs cross placental barrier - increased risk during organogenesis

Question 13

Antimicrobials and prescribing?

Answer 13

PENC - Penicillin, cephalosporin, erythromycin, nystatin - all ok
Avoid: tetracycline, augmentin, miconhzole, aphortericin
Avoid: metronidazole before 28 weeks

Question 14

Advice for procedures?

Answer 14

Tx generally safe - limit to 20-30 mins

Avoid supine position after 20 weeks