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Oral Surgery I > EXAM I Pregnancy > Flashcards

EXAM I Pregnancy Flashcards

1
Q

in the treatment of the pregnant patient, is the maternal health sacrificed for the benefit of the fetus?

A

no

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2
Q

in the treatment of the pregnant patient, what types of circumstances will predicate decisions?

A

trimester, dental abscess, airway compromise, elective choices

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3
Q

during pregnancy, blood volume increases by ___%, which can cause ___

A
  • 50%
  • secondary anemia
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4
Q

during pregnancy, cardiac output increases or decreases? and during which trimester?

A

increases during 3rd trimester

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5
Q

during pregnancy, a ___ murmur develops; a sudden deceleration of blood flow from ___ to ___; ___ during pregnancy

A
  • S3 (third sound)
  • left ventricle to left atrium
  • mitral valve prolapse
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6
Q

what happens to BP during pregnancy?

A

decreases and then increases

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7
Q

what is preeclampsia?

A
  • a condition that only occurs during pregnancy
  • characterized by hypertension, proteinuria, blurred vision, and edema
  • eclampsia can occur - seizures/coma
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8
Q

describe the changes in respiration during pregnancy

A
  • increased oxygen demands
    • tidal volume and ventilation rate (per minute) due to displacement of diaphragm
    • rise in intrathoracic pressure
    • anterior-posterior diameter of chest and increase in oxygen demand
    • hypoxia/hypercapnea/dyspnea; 50% 2nd trimester and 75% at the 3rd trimester
    • hyperventilation - accounts for change in volume due to diaphragm displacement
    • increase of mucus in airways; severe rhinitis, URI: due to increase levels of estrogen
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9
Q
A
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10
Q

what are the hematological alterations that occur during pregnancy?

A
  • increase in number of erythrocytes, leukocytes, erythrocyte sedimentation rate (ESR)
  • clotting factors increased: VII, VIII, IX, X; fibrin split products increase hypercoagulopathic
  • plasma volume increases
  • increase leukocytes, cortisol, catecholamines
  • leukocytosis seen: 12-15,000
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11
Q

what are gastrointestinal considerations of pregnant patients?

A
  • increase in intragastric pressure; nausea, vomiting; <1% excessive; and pyrosis (heartburn)
  • hormonal effects: taste altered, gag
  • increased insulin resistance: gestational diabetes
  • alteration in hepatic function: decrease albumin, increase AlkP, cholesterol, bilirubin, AST and ALT (liver enzymes): 3% have abnormal liver function
  • loss of lower esophageal sphincter tone
  • slower gastric emptying time (if this pt is NPO, you still have to be careful because they may still have contents in their stomach)
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12
Q

what are the renal considerations of the pregnant patient?

A
  • increased renal plasma/ GFR
  • decrease in creatinine levels/ BUN
  • urinate more and increased risk of UTI
  • increase filtration of urea and so a decline in serum creatinine and BUN
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13
Q

what are the treatment considerations of the pregnant patient with respect to cardiovascular system?

A
  • increase compression of IVC, venous return impaired and so pt must be on left side 5-15 degrees to prevent hypotension, bradycardia and syncope
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14
Q

what are the treatment considerations of the pregnant patient with respect to respiratory system?

A
  • hyperventilation: respiratory alkalosis
  • ventilation must be adjusted to avoid hypoxemia when supine due to abnormal alveolar/arterial/oxygen gradient
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15
Q

what are the treatment considerations of the pregnant patient with respect to hematologic alterations?

A
  • risk for thromboembolic events; hypercoag and venous stasis leading to PE
  • anticoagulant therapy in some cases LMW heparin does not cross placenta
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16
Q

what are the treatment considerations of the pregnant patient with respect to the gastrointestinal system?

A
  • morning sickness (increase B-HCG): early appointments, recommend gatorade for electrolyte loss
  • decrease albumin
  • increase edema
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17
Q

what are the treatment considerations of the pregnant patient with respect to renal system?

A
  • pt should void before treatment secondary to increase urination
  • meds need to be adjusted due to GFR and clearance rates of drugs
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18
Q

what is the FDA criteria for a category A medication?

A

human studies - no risk to fetus

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19
Q

what is the FDA criteria for a category B medication?

A

studies in animals - no risk

no human studies

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20
Q

what is the FDA criteria for a category C medication?

A

animal studies - toxic

no human studies

benefit may outweigh risk

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21
Q

what is the FDA criteria for a category D medication?

A

human toxic

benefit to mother may exceed risk to fetus

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22
Q

what is the FDA criteria for a category X medication?

A

fetal abnormalities

risk outweighs all

23
Q

how is alcohol teratogenic?

A

fetal alcohol syndrome

24
Q

how is tobacco teratogenic?

A

toxic with decreased oxygen

25
Q

how is cocaine teratogenic?

A

placenta / hypertension / cardiac death

26
Q

how is thalidomide teratogenic?

A

embryology - appendages

27
Q

how are anticonvulsants teratogenic?

A

orofacial clefting

28
Q

how is dilantin teratogenic?

A

fetal hydantoid syndrome

29
Q

how are retinoids teratogenic?

A

neural tube defect

30
Q

how are antimicrobials teratogenic?

A

ototoxic/neurotoxic

31
Q

how are ACE inhibitors teratogenic?

A

renal ischemia

32
Q

how do local anesthetics affect the pregnant patient?

A

not harmful to fetus but can affect vascular volume, toxicity and drug dosing, epi based on blood pressure

B and C categories

33
Q

how are general anesthetics affect the pregnant patient?

A

in most studies, meds are safe, but nitrous oxide causes decreased fertility and spontaneous abortions; scavengers have improved safety

B and C categories

34
Q

how do analgesic agents affect the pregnant patient?

A
  • acetaminophen is safe (B), salicylates cause spontaneous abortions, fetal abnormalities, low dose ASA prevent pre-eclampsia, NSAIDS increase cardiac septal defects in first trimester
  • narcotics: neonatal narcotic withdrawal
35
Q

which antibiotic has no adverse reaction with the pregnant patient?

A

penicillin

36
Q

what antibiotics have unlikely reactions with the pregnant patient?

A

amoxicillin, chloramphenicol, rifampin, doxycycline

37
Q

what antibiotics have undetermined affects on the pregnant patient?

A

clindamycin, gentamycin, vancomycin

38
Q

what antibiotic has adverse reactions with the pregnant patient and therefore should not be used?

A

fluoroquinolones

39
Q

which antibiotics may or may not cross the placenta?

A

macrolides: erythromycin, clarithromycin, azithromycin

40
Q

should tetracyclines be given to pregnant patients? what about metronidazole?

A

tetracyclines should be avoided, metronidazole is questionable

41
Q

which antivirals can be given to pregnant patients?

A

nystatin and clotrimazole

42
Q

are systemic antifungals appropriate for the pregnant patient?

A

generally no because they cause fetal malformations, except for amphotericin B

43
Q

which antivirals can be given to pregnant patients?

A

acyclovir and valacyclovir

no effects seen

44
Q

what steroids are ok to give pregnant patients?

A

prednisone and prednisolone

45
Q

which steroids are teratogenic in animals?

A

triamcinolone/beclomethasone

46
Q

what are some intraoperative medical emergency complications that can arise in the pregnant patient with given local anesthesia?

A
  • local infiltration
  • regional nerve blocks
    • cardiovascular, neurologic, CNS/fatal
    • remember carpule count
47
Q

what are the category B local anesthetics?

A

lidocaine, prilocaine, etidocaine

48
Q

what are the category C local anesthetics?

A

bupivicaine, articaine, mepivicaine

49
Q

describe OMFS dentoalveolar/elective procedures of the pregnant patient

A
  • emergent situations
  • elective delayed until post partum
  • pain relief, elimination of infections
50
Q

describe OMFS trauma scenarios of the pregnant patient

A
  • 5% of pregnancies; 82% fetal death
  • domestic violence
  • OB consult
  • minimize MMF for fractures
51
Q

how are infections treated for the pregnant patient?

A
  • early incise and drainage of odontogenic infections
  • airway considerations as well as antibiotics
52
Q

describe common intraoral pathologies in pregnant patients

A
  • increased pigmentation: melasma
  • pyogenic granulomas: pregnancy tumors
  • gingival hyperplasia
  • salivary changes with a lower pH
  • desquamation of mucosa and increase in bacteria
  • periodontal disease
  • growth of certain osseous lesions: ossifying fibromas
53
Q

in pregnant patients, maternal death is rare, but what are some of the causes?

A
  • trauma
  • bleeding
  • embolism
  • hypertension: eclampsia/preeclampsia
  • infection
  • cardiomyopathy
  • anesthesia

Oral Surgery I (13 decks)

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