Pregnancy (Desai) Flashcards
What cardiovascular changes are seen in pregnancy?
Increased water resorption increasing plasma volume 30-40%, causing dilution anemia, increasing cardiac output by increasing stroke volume and rate
By how much will a pregnant woeman’s pulse rise?
10-15 bpm
What is a concern in the third trimester with a pregnant patient supine? Why?
Supine hypotension due to increased uterine size and baby pressing on IVC and aorta causing aortocaval compression
What is the management for aortocaval compression induced supine hypotension?
Slight elevation of right hip
What is decreased in pregnant respiration?
Functional residual capacity
What are pregnant patients at increased risk for with respect to airway?
Airway obstruction if they get a deep space infection
What is the likely cause of the difficulty nasal breathing, frequent epistaxis, decreased functional reserve, and increased risk for airway with deep space infection in pregnant women?
Increased uterine size superiorly
Increased oxygen demand on lungs for oxygen
Are pregnant women more likely or less likely to coagulate?
Hypercoagulable with predisposition to thrombosis and embolism?
What clotting factors are elevated in pregnant women?
5,7,9,10,12
Does a pregnant woman’s platelet count increase along with the clotting factors?
No
What are 2 types of anemia found in about 20% of pregnancies?
- Dilutional due to increased plasma volume
2. Secondary due to increased iron and folate demand
Will a pregnant mother be immunosuppressed even though she has increased number of circulating neutrophils?
Yes
Which T-cell dominates in pregnancy: Th1 or Th2?
Th2
Should an oral infection in a pregnant mother be treated aggressively or conservatively?
Treat aggressively
When is pre-eclampsia (BP >140/90) most common in pregnancy?
After 32nd week
What does “HELLP” stand for in pre-eclampsia?
Hemolysis
Elevated Liver enzymes
Low Platelets
Which trimester is the only one during pregnancy during which elective dental procedures can be performed?
Second trimester
What are considered essential procedures that can be performed on a pregnancy mother in 1st and 3rd trimester?
- Endo
- EXT
- Minor perio
- Restorative
Lidocaine, prilocaine, and etidocaine are what FDA drug schedule for pregnancy risk?
B (no demonstrated risk to baby in human trials)
Mepivicaine, bupivacaine, articaine are what FDA drug schedule for pregnancy risk?
C (adverse effect to baby in animals, but no human studies)
What is a consideration when giving local anesthesia?
Uterus will be sensitive to epinephrine
What is the safest analgesic to use in a pregnant mother?
Acetaminophen
What analgesic is to be avoided in pregnant mothers?
Aspirin
What analgesic is recommended to avoid in pregnant mothers?
Ibuprofen (can cause premature closing of the ductus ateriosus and derease amnitotic fluid volume)
What erythromycin preparation is to be avoided in pregnant women?
Erythromycin estolate
What is the only C schedule antibiotic?
Clarithromycin
What is an antibiotic to avoid giving pregnant mothers?
Tetracycline (D schedule)
Are sedatives contraindicated in pregnant mothers?
Yes. Avoid barbiturates, benzodiazepines. (Nitrous is supposedly okay but use with caution)
If nitrous is used on a pregnant mother, what are the trimesters and administration duration?
2nd and 3rd trimesters, <35 mins
What are some drugs to avoid prescribing to pregnant mothers?
- Aspirin
- Ibuprofen
- Tetracycline
- Erythromycin estolate
- Barbiturates
- Benzodiazepines
What amount of drug is secreted in breast milk versus the maternal dose?
1-2% maternal dose
What is a pedunculated growth from the gingiva with an erythematous border common in pregnant mothers?
Pyogenic granuloma / pregnancy tumor
Can pregnant mothers have increased caries risk during pregnancy even though they were low caries risk prior?
Yes. Oral flora can change and enamel can erode secondary to vomiting
What are 2 other mucosal changes beyond the pyogenic granuloma, seen in pregnant mothers?
- Pregnancy gingivitis (increased endocrine and hematologic factors)
- Increased periodontitis (due to decreased immunity)
