Pregnancy (Desai)

Question 1

What cardiovascular changes are seen in pregnancy?

Answer 1

Increased water resorption increasing plasma volume 30-40%, causing dilution anemia, increasing cardiac output by increasing stroke volume and rate

Question 2

By how much will a pregnant woeman’s pulse rise?

Answer 2

10-15 bpm

Question 3

What is a concern in the third trimester with a pregnant patient supine? Why?

Answer 3

Supine hypotension due to increased uterine size and baby pressing on IVC and aorta causing aortocaval compression

Question 4

What is the management for aortocaval compression induced supine hypotension?

Answer 4

Slight elevation of right hip

Question 5

What is decreased in pregnant respiration?

Answer 5

Functional residual capacity

Question 6

What are pregnant patients at increased risk for with respect to airway?

Answer 6

Airway obstruction if they get a deep space infection

Question 7

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?

Answer 7

Increased uterine size superiorly

Increased oxygen demand on lungs for oxygen

Question 8

Are pregnant women more likely or less likely to coagulate?

Answer 8

Hypercoagulable with predisposition to thrombosis and embolism?

Question 9

What clotting factors are elevated in pregnant women?

Answer 9

5,7,9,10,12

Question 10

Does a pregnant woman’s platelet count increase along with the clotting factors?

Answer 10

No

Question 11

What are 2 types of anemia found in about 20% of pregnancies?

Answer 11

1. Dilutional due to increased plasma volume

2. Secondary due to increased iron and folate demand

Question 12

Will a pregnant mother be immunosuppressed even though she has increased number of circulating neutrophils?

Answer 12

Yes

Question 13

Which T-cell dominates in pregnancy: Th1 or Th2?

Answer 13

Th2

Question 14

Should an oral infection in a pregnant mother be treated aggressively or conservatively?

Answer 14

Treat aggressively

Question 15

When is pre-eclampsia (BP >140/90) most common in pregnancy?

Answer 15

After 32nd week

Question 16

What does “HELLP” stand for in pre-eclampsia?

Answer 16

Hemolysis
Elevated Liver enzymes
Low Platelets

Question 17

Which trimester is the only one during pregnancy during which elective dental procedures can be performed?

Answer 17

Second trimester

Question 18

What are considered essential procedures that can be performed on a pregnancy mother in 1st and 3rd trimester?

Answer 18

1. Endo
2. EXT
3. Minor perio
4. Restorative

Question 19

Lidocaine, prilocaine, and etidocaine are what FDA drug schedule for pregnancy risk?

Answer 19

B (no demonstrated risk to baby in human trials)

Question 20

Mepivicaine, bupivacaine, articaine are what FDA drug schedule for pregnancy risk?

Answer 20

C (adverse effect to baby in animals, but no human studies)

Question 21

What is a consideration when giving local anesthesia?

Answer 21

Uterus will be sensitive to epinephrine

Question 22

What is the safest analgesic to use in a pregnant mother?

Answer 22

Acetaminophen

Question 23

What analgesic is to be avoided in pregnant mothers?

Answer 23

Aspirin

Question 24

What analgesic is recommended to avoid in pregnant mothers?

Answer 24

Ibuprofen (can cause premature closing of the ductus ateriosus and derease amnitotic fluid volume)

Question 25

What erythromycin preparation is to be avoided in pregnant women?

Answer 25

Erythromycin estolate

Question 26

What is the only C schedule antibiotic?

Answer 26

Clarithromycin

Question 27

What is an antibiotic to avoid giving pregnant mothers?

Answer 27

Tetracycline (D schedule)

Question 28

Are sedatives contraindicated in pregnant mothers?

Answer 28

Yes. Avoid barbiturates, benzodiazepines. (Nitrous is supposedly okay but use with caution)

Question 29

If nitrous is used on a pregnant mother, what are the trimesters and administration duration?

Answer 29

2nd and 3rd trimesters, <35 mins

Question 30

What are some drugs to avoid prescribing to pregnant mothers?

Answer 30

1. Aspirin
2. Ibuprofen
3. Tetracycline
4. Erythromycin estolate
5. Barbiturates
6. Benzodiazepines

Question 31

What amount of drug is secreted in breast milk versus the maternal dose?

Answer 31

1-2% maternal dose

Question 32

What is a pedunculated growth from the gingiva with an erythematous border common in pregnant mothers?

Answer 32

Pyogenic granuloma / pregnancy tumor

Question 33

Can pregnant mothers have increased caries risk during pregnancy even though they were low caries risk prior?

Answer 33

Yes. Oral flora can change and enamel can erode secondary to vomiting

Question 34

What are 2 other mucosal changes beyond the pyogenic granuloma, seen in pregnant mothers?

Answer 34

1. Pregnancy gingivitis (increased endocrine and hematologic factors)
2. Increased periodontitis (due to decreased immunity)