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Dentistry Module 4 > Pregnant and Nursing Patients > Flashcards

Pregnant and Nursing Patients Flashcards

1
Q

Some precursors for secretion of hormones by the placenta come from the fetal adrenal cortex.
True or false?

A

True

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2
Q

Where is the site of fertilisation?

A

The oviduct in the fallopian tubes

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3
Q

How soon after ovulation must fertilisation occur? If this does not happen what are the consequences?

A

24 hours, if not, the ovum starts to disintegrate

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4
Q

What does the fertilised ovum differentiate into as it moves from site of fertilisation in oviduct to site of implantation in the uterus?

A

A blastocyst

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5
Q

What is the dense of mast cells grouped to one side of the wall of a blastocyst known as?

A

Inner cell mass

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6
Q

What is the thinner, outermost layer of the blastocyst known as?

A

Trophoblast

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7
Q

What is the function of the trophoblast?

A

Accomplishes implantation and develops into fetal portions of placenta

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8
Q

What group of cells is destined to develop into foetus?

A

Inner cell mass

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9
Q

What happens to the blastocyst when implantation is finished?

A

It completely buries into the endometrium

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10
Q

What three systems does the placenta perform all functions for the foetus?

A

Digestion, respiration, kidneys

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11
Q

What hormone is the basis of pregnancy diagnosis tests?

A

Human chorionic gonadotropin (hCG)

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12
Q

What is the source if oestrogen and progesterone during the first 10 weeks of pregnancy?

A

Corpus luteum

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13
Q

What peptide hormone causes contraction of the myoepithelial cells surrounding the alveoli of the breast?

A

Oxytocin

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14
Q

what happens to the uterus during involution?

A

Shrinks to its pregestational stage

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15
Q

Where is oxytocin formed and secreted from?

A

Formed in the hypothalamus and secreted from the posterior pituitary gland

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16
Q

By what process do substances such as oxygen, carbon dioxide, water and electrolytes cross the placenta?

A

Simple diffusion

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17
Q

By what process does a substance, for example, glucose, cross the placenta?

A

Facilitated diffusion

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18
Q

By what process does a substance, for example, amino acids, cross the placenta?

A

Secondary active transport

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19
Q

By what process does a substance, for example, cholesterol, cross the placenta?

A

Receptor mediated endocytosis

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20
Q

What organ does the placenta temporarily become during pregnancy?

A

Endocrine organ

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21
Q

what are the three endocrine systems during pregnancy that interact to support and enhance the growth/development of the foetus, coordinate timing of parturition, and prepare mammary glands for nourishing baby after birth?

A
  • placental hormones
  • maternal hormones
  • fetal hormones
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22
Q

What are the most important hormones secreted by the placenta?

A
  1. Human chorionic gonadotropin (hCG)
  2. Oestrogen
  3. Progesterone
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23
Q

During pregnancy, what tissue would be described as transient?

A

Placenta

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24
Q

What is the function of human chorionic gonadotropin (hCG)?

A

To prolong the life-span if the corpus luteum

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25
Q

Where is human chorionic gonadotropin (hCG) eliminated?

A

In the urine

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26
Q

What happens to oestrogen and progesterone level as the placenta grows?

A

They rise

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27
Q

Why does the placenta not secrete oestrogen during the first trimester?

A

It does not have all the enzymes needed for oestrogen synthesis

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28
Q

When can the placenta secrete progesterone?

A

Soon after implantation occurs

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29
Q

Define what structures secrete oestrogen and progesterone through all 3 trimesters of pregnancy

A

1st trimester: corpus luteum
2nd trimester: placenta
3rd trimester: placenta

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30
Q

What are the two physiological roles of oestrogen?

A
  1. Stimulates growth of myometrium
  2. Promotes development of mammary gland ducts, through which milk will be ejected during lactation
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31
Q

What is the myometrium?

A

Uterine musculature

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32
Q

what are the three physiological roles of progesterone during pregnancy?

A
  1. Prevent miscarriage by suppressing contractions of the uterine myometrium
  2. Promotes formation of a mucus plug to prevent contaminants reaching foetus
  3. Stimulates development of milk glands in breasts
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33
Q

what are the two main functions of human chorionic gonadotropin during pregnancy?

A
  1. Maintains the corpus luteum
  2. Stimulates secretion of testosterone by the developing testes in XY embryos
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34
Q

What happens to the uterus during gestation?

A

It expands and increases in weight by more than 20x

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35
Q

What is parturition?

A

Labour, delivery or birth

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36
Q

what two factors are required for parturition?

A
  1. Dilation of the cervical canal
  2. Contractions of the uterine myometrium
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37
Q

What are Braxton-hicks contractions and when do they occur?

A

Mild contractions that are experienced with increasing strength and frequency, sometimes mistaken for onset of labour. They occur in the third trimester.

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38
Q

What peptide hormone, produced by corpus luteum and placenta, causes cervical softening during late gestation to prepare for parturition?

A

Relaxin

39
Q

What three changes occur in the late stages of gestation to prepare for parturition?

A
  1. Braxton-Hicks contractions
  2. Softening of the cervix
  3. The foetus shifts downwards so that head is in contact with cervix
40
Q

what is a breech birth?

A

Where any part of the body other than the head approaches the birth canal first

41
Q

Once parturition has begun, what hormone has a positive feedback cycle which acts to increase uterine contractions?

A

Oxytocin

42
Q

What happens during the first stage of labour?

A

Cervical dilation

43
Q

What happens during the second stage of labour?

A

Delivery of the baby

44
Q

What happens during the third stage of labour?

A

Delivery of the placenta

45
Q

In the second stage of labour, what do stretch receptors in the vagina do?

A

Activate a neural reflex that triggers contraction of the abdominal wall in synchrony with the uterine contractions

46
Q

How is the baby freed from the placenta after birth?

A

Cutting of the umbilical cord

47
Q

After the third stage of labour, what happens in order to prevent haemorrhage?

A

Continued contractions of the myometrium constrict the uterine blood vessels at site of placental attachment

48
Q

what is involution?

A

shrinking of the uterus back to it’s pregestational size

49
Q

How long does involution take?

A

4-6 weeks

50
Q

What two processes induce involution?

A
  1. A fall in oestrogen and progesterone when the placenta is lost at delivery
  2. By breastfeeding, Oxytocin promotes myometrium contractions that help maintain uterine muscle tone
51
Q

What milk producing glands are lobules in breasts made up of?

A

Alveoli

52
Q

How is milk ejected through the mammary ducts?

A

Contraction of surrounding myoepithelial cells

53
Q

What hormones trigger development of the breast during pregnancy?

A

Oestrogen
progesterone
Prolactin
Human chorionic somatomammotropin (hCS)

54
Q

What is the role of oestrogen in breast development?

A

Promotes extensive mammary duct development

55
Q

What is the role of progesterone in breast development?

A

Stimulates abundant alveolar-lobular formation

56
Q

What is the role of prolactin and human chorionic somatomammotrpin in breast development?

A

Induce the synthesis of enzymes needed for milk production

57
Q

What hormones are produced when suckling triggers a neuroendocrine reflex?

A
  • prolactin
  • oxytocin
58
Q

Upon suckling, what does prolactin stimulate?

A

Milk production

59
Q

Upon suckling, what does oxytocin stimulate?

A

Milk ejection

60
Q

What hormone causes contraction of myoepithelial cells?

A

Oxytocin

61
Q

what is the milk produced in the first 5 days after delivery referred to as?

A

Colostrum

62
Q

What is the importance of breastfeeding in the first 5 days after brith?

A

Colostrum contains concentrations of immunoprotective agents, important for the baby to receive.

63
Q

What are the made nutrients that make up breast milk?

A
  • water
  • triglyceride
  • lactose
  • proteins
  • vitamins
  • calcium
  • phosphate
64
Q

What effect does lactation have on ovulation?

A

Tends to prevent it, decreasing the likelihood of another pregnancy

65
Q

What three dental complications are pregnancy women at a higher risk of?

A
  • increased caries and erosion risk
  • increased periodontal disease risk
  • increased tooth mobility due to disturbances in PDL attachment
66
Q

What are teratogenic effects?

A

Effects of drugs on the formation of foetus

67
Q

during what trimester is the foetus more prone to teratogenic effects?

A

First trimester

68
Q

what position must pregnant patients NOT be placed in when receiving treatment in the 3rd trimester? And why?

A

Supine, because this would compress the maternal vena cava and aorta

69
Q

What position should pregnant women in the 3rd trimester be placed in when receiving treatment?

A

On their left hand side, with their right hip slightly elevated

70
Q

What is hypotension syndrome?

A

When the uterus compresses the inferior vena cava when a pregnant women is in supine position, leading to decreased venous return centrally

71
Q

What two ways can mercury in amalgam cross the placenta?

A

Mercury vapour- passive diffusion
Methyl mercury- active transport by amino acid carriers

72
Q

Should pregnant women receive an amalgam restoration upon treatment? Yes or no?

A

No

73
Q

what are the concerns that have been raised about use of resin composites in pregnant women?

A

Concerns regarding elation of bisphenol A [BPA] in resin composites which may cross placental barrier

74
Q

What is the first line antibiotic used to treat dental infections?

A

Pen V

75
Q

What weeks does the first trimester cover?

A

Start of week 1 to end of week 12

76
Q

Why does pregnancy gingivitis occur?

A

Hormonal changes make gums more susceptible to plaque, leading to inflammation and bleeding

77
Q

What are the main hormones that arise and circulate during the first trimester?

A

Oestrogen, progesterone, hCG

78
Q

Which weeks does the second trimester cover?

A

Start of week 13 to end of week 27

79
Q

which trimester of pregnancy is the safest to treat the patient in?

A

Second trimester

80
Q

What is the risk of performing sub-gingival PMPR on a pregnant patient?

A

There can be an ingress of bacteria into the bloodstream, increasing the likelihood of inflammatory response

81
Q

Why does a pregnancy epulis occur?

A

Due to the high levels of progesterone that affects local vasculature, resulting in increased gingival exudate and swelling

82
Q

If a pregnant patient has “pregnancy epulis” what would be your treatment plan going forward?

A
  1. Increase OH instruction
  2. Inform the patient not to worry as the epulis should regress post partum
83
Q

What weeks does the third trimester cover?

A

Start of week 28 to week 40 (end of pregnancy)

84
Q

In what trimester is ensuring the correct positioning of a pregnant patient in the dental chair most important?

A

Third trimester

85
Q

Why should a new mother still be mindful of having amalgam fillings placed or removed?

A

Mercury in amalgam could still pass into breast milk if they are breastfeeding

86
Q

How does pregnancy epulis appear clinically?

A
  • red-purple swelling
  • readily bleeds/ulcerates
87
Q

What hormones reduce the thickness of the keratin in the gingival epithelium during pregnancy, rendering it a less effective barrier to bacteria?

A

Progesterone and oestrogen

88
Q

If a pregnant patient presents with mild pregnancy gingivitis/epulis, what would your treatment plan be?

A
  • OHI using TIPPS
  • smoking cessation if applicable
89
Q

If a pregnant patient presents with severe pregnancy gingivitis/epulis, what would your treatment plan be?

A
  • OHI and smoking cessation
  • debridement
  • highlight to patient where supra-gingival deposits found
  • may require more frequent recalls
90
Q

What is pre-eclampsia?

A

Maternal high blood pressure

91
Q

What are the three main adverse pregnancy outcomes of periodontal disease?

A
  1. Miscarriage
  2. Pre-eclampsia
  3. Preterm low birthweight
92
Q

How could periodontal disease lead to pre-term labour?

A

Can cause the systemic levels of cytokines to rise (due to bacteraemia &/or by releasing pro-inflammatory cytokines into bloodstream), which could cause a premature increase in cytokine levels, reaching a threshold where labour is initiated early.

93
Q

what medications should you never prescribe to a pregnant patient and why?

A
  • aspirin (haemorrhage risk)
  • tetracyclines (dental defects)
  • prilocaine with fellypressin ( oxytocin effect)
  • fluconazole (causes malformation of embryo)
  • Miconazole (causes malformation of embryo)
  • clarithromycin ( associated with fetal loss)
94
Q

Which medication should specifically not be prescribed in the first trimester and why?

A

Clarithromycin, as it has been shown to cause fetal loss in animals

Dentistry Module 4 (20 decks)

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