Management of Pregnant Patients

• How long is normal pregnancy?

  40 weeks with 3 Trimesters
• What is considered a premature baby?

  born before 37 weeks
• Describe the first trimester of pregnancy

  1-12 weeks, labile emotion,s syncope, postural hypotension, fatigue, nausea, vomiting, hyperawareness of smell.
• Describe the 2nd trimerster during pregnancy?

  13 to 24 weeks, weight gain, change in body shape, feeling of well being.
• Describe the 3rd Trimester of pregnancy

  25 to 40 weeks, increases weight and size, mild depression, anxiety about labour and delivery.
• What are the Cardiovascular changes of pregnancy?

  Increased blood volume, tachycardia, heart murmur, blood pressure changes - rise in the third trimester, lowers in the second trimester.
• What are the respiratory changes with pregnancy?

  Upward displacement of diaphragm, Flaring out of ribs, Decrease in residual capacity, increased O2 consumption, Dyspnoea
• What is a functional heart murmur?

  Innocent heart murmur, not caused by heart disease and resolves after birth.
• What are the Gastrointestinal changes during pregnancy?

  Nausea and vomiting 8 – 12 weeks. Decreased gastric motility. Reduced competency gastro-oesophageal sphincter. Heartburn. Regurgitation. Risk of aspiration
• What are the renal changes during pregnancy?

  Smooth muscle dilation, urinary stasis, increased rick of urinary tract infection.
• What are the immunity changes during pregnancy?

  Suppresses normal immune system, free flu jab recommended
• What are the haematologial changes of pregnancy?

  Iron deficiency anemia, white blood cell count rise, clotting factors increased.
• What are the changes during pregnancy of the uterus?

  Increase in weight and size, supine hypotensive syndrome in late pregnancy. Foetus compresses inferior vena cava. Reduced venous return to the heart. Foetal hypoxia. Keep head above feet. Pillow under right hip
• What are the psychological changes during pregnancy?

  Stress, body image issues, worrying about labour and health of baby.
• Changes in oral cavity during pregnancy?

  • nausea/vomiting - erosion and sensitivity, increased appetite, pregnancy gingivitis as gums become more responsive to plaque and local irratation, increased gingival bleeding, non-surgical scaling and rsd okay to carry out, benign painless pregnancy tumors.
• Explain the pregnancy misconceptions?

  • Having baby does not ruin your teeth
  • Calcium and phosphorus are bound in tooth once formed, cannot be released into blood
  • Poor diet can lead to skeletal minerals passing to foetus.
  • Free care – seek treatment – found to need extractions.
  • Hormones don’t cause periodontitis, just gingivitis / increased gingival bleeding
• List some challenges of the Hygienist and Therapist and how its manages in the first trimester of pregnancy?

  nausea, vomiting, gagging, smell and taste exaggeration, fatigue, syncope, rinse mouth, non-cariogenic snacks, difficulty brushing, avoid strong odours, short appointments, appropriate emergency care.
• What are the challanges for the DHT in the second trimesters?

  food cravings, backache, new weight/shape, syncope, advise re cariogenic snacks, adjust chair, help pt in or out, lay pt on left hand side.
• What are the challanges of the DHT during the third trimester of pregnancy?

  fatigue, backache, frequent urinations, dyspnoea, syncope, supine hypotensive syndrome, short appointments, adjust chair, don't lie flat, support right hip.
• Describe the use of ionising radiation in pregnant women?

  High doses can cause birth defects. Dose for dental view is low. Foetus only sensitive to high radiation directed straight at uterus. Dental radiography therefore unlikely to cause damage. Weigh risk / benefit. ALARA. 0Consider parent’s worries
• Why do drugs pose a risk during pregnancy?

  Baby’s rapidly developing body is very sensitive to substances in the uterus. Greatest period of organogenesis is during first trimester. Foetal liver is not ready to deal with drugs. Consider prescription, over-the-counter, alternative and recreational drugs
• What are the issues with alcohol during pregnancy?

  Should avoid completely.

  Avoid in first trimester - miscarriage.

  2 units twice / week, “Have not been shown to be harmful”* Can lead to foetal alcohol syndrome from consuming more that 6 units a day.
• List safe drugs for pregnancy

  Lidiocaine with adrenaline, GA, Penicillin, Amoxycillin, Cephalosporins
• List Contraindicated drugs in pregnancy?

  Amalgam, tetracyclines, aspirins, codeine, ibuprofen, nitrous oxides, citanest in 3rd trimester.
• What are the opportunities for the DHT during pt pregnancy?

  • Patient present with significant disease.
  • Free NHS dental treatment.
  • Dispel myths.
  • Receptive to good preventive advice.
  • Advice for mother and child.
  • Smoking. Oral hygiene. Diet. Regular dental attendance
• What is a pregnancy epulis?

  • Benign, Painless Interproximal gingival margin problematic
  • normally resolves after pregnancy but can be removed
  • = Pregnancy Tumour
  • Red, magenta or blue flattened mushroom
  • can sometime cause bone loss