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Dentistry Module 4 > Pregnant and Nursing Patients > Flashcards

Pregnant and Nursing Patients Flashcards

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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
Where is human chorionic gonadotropin (hCG) eliminated?
In the urine
26
What happens to oestrogen and progesterone level as the placenta grows?
They rise
27
Why does the placenta not secrete oestrogen during the first trimester?
It does not have all the enzymes needed for oestrogen synthesis
28
When can the placenta secrete progesterone?
Soon after implantation occurs
29
Define what structures secrete oestrogen and progesterone through all 3 trimesters of pregnancy
1st trimester: corpus luteum 2nd trimester: placenta 3rd trimester: placenta
30
What are the two physiological roles of oestrogen?
1. Stimulates growth of myometrium 2. Promotes development of mammary gland ducts, through which milk will be ejected during lactation
31
What is the myometrium?
Uterine musculature
32
what are the three physiological roles of progesterone during pregnancy?
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
33
what are the two main functions of human chorionic gonadotropin during pregnancy?
1. Maintains the corpus luteum 2. Stimulates secretion of testosterone by the developing testes in XY embryos
34
What happens to the uterus during gestation?
It expands and increases in weight by more than 20x
35
What is parturition?
Labour, delivery or birth
36
what two factors are required for parturition?
1. Dilation of the cervical canal 2. Contractions of the uterine myometrium
37
What are Braxton-hicks contractions and when do they occur?
Mild contractions that are experienced with increasing strength and frequency, sometimes mistaken for onset of labour. They occur in the third trimester.
38
What peptide hormone, produced by corpus luteum and placenta, causes cervical softening during late gestation to prepare for parturition?
Relaxin
39
What three changes occur in the late stages of gestation to prepare for parturition?
1. Braxton-Hicks contractions 2. Softening of the cervix 3. The foetus shifts downwards so that head is in contact with cervix
40
what is a breech birth?
Where any part of the body other than the head approaches the birth canal first
41
Once parturition has begun, what hormone has a positive feedback cycle which acts to increase uterine contractions?
Oxytocin
42
What happens during the first stage of labour?
Cervical dilation
43
What happens during the second stage of labour?
Delivery of the baby
44
What happens during the third stage of labour?
Delivery of the placenta
45
In the second stage of labour, what do stretch receptors in the vagina do?
Activate a neural reflex that triggers contraction of the abdominal wall in synchrony with the uterine contractions
46
How is the baby freed from the placenta after birth?
Cutting of the umbilical cord
47
After the third stage of labour, what happens in order to prevent haemorrhage?
Continued contractions of the myometrium constrict the uterine blood vessels at site of placental attachment
48
what is involution?
shrinking of the uterus back to it’s pregestational size
49
How long does involution take?
4-6 weeks
50
What two processes induce involution?
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
What milk producing glands are lobules in breasts made up of?
Alveoli
52
How is milk ejected through the mammary ducts?
Contraction of surrounding myoepithelial cells
53
What hormones trigger development of the breast during pregnancy?
Oestrogen progesterone Prolactin Human chorionic somatomammotropin (hCS)
54
What is the role of oestrogen in breast development?
Promotes extensive mammary duct development
55
What is the role of progesterone in breast development?
Stimulates abundant alveolar-lobular formation
56
What is the role of prolactin and human chorionic somatomammotrpin in breast development?
Induce the synthesis of enzymes needed for milk production
57
What hormones are produced when suckling triggers a neuroendocrine reflex?
- prolactin - oxytocin
58
Upon suckling, what does prolactin stimulate?
Milk production
59
Upon suckling, what does oxytocin stimulate?
Milk ejection
60
What hormone causes contraction of myoepithelial cells?
Oxytocin
61
what is the milk produced in the first 5 days after delivery referred to as?
Colostrum
62
What is the importance of breastfeeding in the first 5 days after brith?
Colostrum contains concentrations of immunoprotective agents, important for the baby to receive.
63
What are the made nutrients that make up breast milk?
- water - triglyceride - lactose - proteins - vitamins - calcium - phosphate
64
What effect does lactation have on ovulation?
Tends to prevent it, decreasing the likelihood of another pregnancy
65
What three dental complications are pregnancy women at a higher risk of?
- increased caries and erosion risk - increased periodontal disease risk - increased tooth mobility due to disturbances in PDL attachment
66
What are teratogenic effects?
Effects of drugs on the formation of foetus
67
during what trimester is the foetus more prone to teratogenic effects?
First trimester
68
what position must pregnant patients NOT be placed in when receiving treatment in the 3rd trimester? And why?
Supine, because this would compress the maternal vena cava and aorta
69
What position should pregnant women in the 3rd trimester be placed in when receiving treatment?
On their left hand side, with their right hip slightly elevated
70
What is hypotension syndrome?
When the uterus compresses the inferior vena cava when a pregnant women is in supine position, leading to decreased venous return centrally
71
What two ways can mercury in amalgam cross the placenta?
Mercury vapour- passive diffusion Methyl mercury- active transport by amino acid carriers
72
Should pregnant women receive an amalgam restoration upon treatment? Yes or no?
No
73
what are the concerns that have been raised about use of resin composites in pregnant women?
Concerns regarding elation of bisphenol A [BPA] in resin composites which may cross placental barrier
74
What is the first line antibiotic used to treat dental infections?
Pen V
75
What weeks does the first trimester cover?
Start of week 1 to end of week 12
76
Why does pregnancy gingivitis occur?
Hormonal changes make gums more susceptible to plaque, leading to inflammation and bleeding
77
What are the main hormones that arise and circulate during the first trimester?
Oestrogen, progesterone, hCG
78
Which weeks does the second trimester cover?
Start of week 13 to end of week 27
79
which trimester of pregnancy is the safest to treat the patient in?
Second trimester
80
What is the risk of performing sub-gingival PMPR on a pregnant patient?
There can be an ingress of bacteria into the bloodstream, increasing the likelihood of inflammatory response
81
Why does a pregnancy epulis occur?
Due to the high levels of progesterone that affects local vasculature, resulting in increased gingival exudate and swelling
82
If a pregnant patient has “pregnancy epulis” what would be your treatment plan going forward?
1. Increase OH instruction 2. Inform the patient not to worry as the epulis should regress post partum
83
What weeks does the third trimester cover?
Start of week 28 to week 40 (end of pregnancy)
84
In what trimester is ensuring the correct positioning of a pregnant patient in the dental chair most important?
Third trimester
85
Why should a new mother still be mindful of having amalgam fillings placed or removed?
Mercury in amalgam could still pass into breast milk if they are breastfeeding
86
How does pregnancy epulis appear clinically?
- red-purple swelling - readily bleeds/ulcerates
87
What hormones reduce the thickness of the keratin in the gingival epithelium during pregnancy, rendering it a less effective barrier to bacteria?
Progesterone and oestrogen
88
If a pregnant patient presents with mild pregnancy gingivitis/epulis, what would your treatment plan be?
- OHI using TIPPS - smoking cessation if applicable
89
If a pregnant patient presents with severe pregnancy gingivitis/epulis, what would your treatment plan be?
- OHI and smoking cessation - debridement - highlight to patient where supra-gingival deposits found - may require more frequent recalls
90
What is pre-eclampsia?
Maternal high blood pressure
91
What are the three main adverse pregnancy outcomes of periodontal disease?
1. Miscarriage 2. Pre-eclampsia 3. Preterm low birthweight
92
How could periodontal disease lead to pre-term labour?
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
what medications should you never prescribe to a pregnant patient and why?
- 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
Which medication should specifically not be prescribed in the first trimester and why?
Clarithromycin, as it has been shown to cause fetal loss in animals

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