Obstetrics: Patient Positioning and Supine Hypotensive Syndrome

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Questions and Answers

During which stage of pregnancy is it safest to provide dental care?

Second Trimester (correct)

First Trimester

Throughout the entire pregnancy

Third Trimester

What is the primary concern during the third trimester of pregnancy?

Elective dental care

Upcoming birth process and safety of the pregnant woman (correct)

Fetal organ formation

Fetal growth and maturation

What is the effect of hormonal secretions on the body during pregnancy?

Decreased blood volume

Unchanged insulin sensitivity

No significant changes

Increased cardiac output (correct)

What is a significant risk factor for thromboembolism during pregnancy?

Increased blood coagulation factors Signup and view all the answers

Which of the following is NOT a consideration for high-risk pregnancy?

Elective dental care Signup and view all the answers

What is the primary reason to avoid taking x-rays in the 2nd and 6th weeks of gestation?

The fetus is most susceptible to radiation during this period. Signup and view all the answers

During which week of pregnancy is the risk of cleft lip and palate highest?

5-7 weeks Signup and view all the answers

What is the main complication of the supine position in pregnant patients?

Supine hypotensive syndrome Signup and view all the answers

What is the estimated risk of malignant disease from 1 rad of utero radiation exposure?

0.1% Signup and view all the answers

What is the primary purpose of using a lead apron during dental radiography?

To reduce radiation exposure to the fetus Signup and view all the answers

What is the FDA classification of antibiotics that are safe to be taken in all trimesters of pregnancy?

Class B Signup and view all the answers

What is the adverse effect of tetracycline on the fetus?

Inhibition of bone growth and discoloration of teeth Signup and view all the answers

What is the primary concern with the use of aspirin during pregnancy?

Risk of maternal and fetal hemorrhage Signup and view all the answers

Why should NSAIDs be avoided in the last trimester of pregnancy?

Due to risk of circulatory effects and persistent pulmonary hypertension Signup and view all the answers

Which of the following analgesics is rated Category D?

Diazepam Signup and view all the answers

What is the concern with the use of corticosteroids during pregnancy?

They can inhibit brain growth Signup and view all the answers

Why is nitrous oxide not recommended in the first trimester of pregnancy?

No specific reason mentioned in the text Signup and view all the answers

What is the recommended analgesic of choice for short-term usage during pregnancy?

Paracetamol Signup and view all the answers

Who is authorized to prescribe treatments for a pregnant lady?

Her treating doctor Signup and view all the answers

Which of the following local anesthetics is categorized as Category B?

Lidocaine Signup and view all the answers

What is the effect of a large dose of prilocaine?

Maternal and fetal hypoxia Signup and view all the answers

What is the purpose of vasoconstrictors in local anesthesia?

To increase the effectiveness and duration of anesthesia Signup and view all the answers

Is there a specific contraindication to the use of vasoconstrictors in pregnant patients?

No, but it is prudent to use the minimal effective dose Signup and view all the answers

What is the most common emergency in a dental office?

Syncope Signup and view all the answers

What is the primary concern in managing a seizure in a pregnant woman?

Control of airway Signup and view all the answers

What is the mortality rate for seizures in pregnant women?

17% Signup and view all the answers

What is the main risk factor for seizures in pregnant women?

All of the above Signup and view all the answers

What is the recommended management for a pregnant woman experiencing morning sickness in a dental office?

Monitor and manage as needed Signup and view all the answers

What is the recommended positioning for a pregnant woman to avoid supine hypotensive syndrome?

Rolling to her left side Signup and view all the answers

Study Notes

Stages of Pregnancy

First Trimester (1-12 weeks): fetal organ formation and differentiation, most susceptible to teratogens, avoid elective care but provide emergency care as needed, 50% of abortion
Second Trimester (13-24 weeks): fetal growth and maturation, safest period to provide dental care
Third Trimester (25-40 weeks): fetal growth and maturation continues, concern is upcoming birth process and safety of the pregnant woman
High-risk pregnancy: extra precautions should be considered, recent cramping, light or intermittent bleeding or frank bleeding, diabetes, hypertension, multiple spontaneous abortion, ask about history of pregnancy

Physiologic Changes in Pregnancy

Increased hormonal secretions (estrogen 10 folds and progesterone 30 folds) and fetal growth causes several systemic and physical changes
Cardiovascular: increased blood volume (45%), decreased pulse (10-15 beats/min), increased cardiac output
Respiratory: diaphragm rises 4 cm, decreased residual volume, upper respiratory infection
GIT and Endocrine: heartburn/reflux, nausea and vomiting, gastric emptying delayed, insulin resistance (gestational diabetes)
Hematological: decreased RBC, increased WBC, increased ESR
Coagulation factors and risk of thromboembolism increased

Dental Considerations

Patient position: elevate the right hip 10-12 cm, semi-supine or sit-up position to avoid hypotension or hypoxia
Supine hypotensive syndrome: compression of inferior vena cava and aorta by the uterus, decrease venous return to heart, decrease uteroplacental perfusion, and fetal distress
Symptoms of supine hypotensive syndrome: sweating, nausea, weakness, sense of air lack, bradycardia, decrease blood pressure, loss of consciousness
Treatment: roll patient to her left side to decrease pressure on the inferior vena cava

Radiography in Pregnancy

Avoid taking x-rays in the 2nd and 6th weeks of gestation
Fetal dose from a single periapical radiograph is about 0.1 mrad
High dose (over 250 rads) prior to 16 weeks: microcephaly, mental retardation, cataracts, microphthalmia, growth retardation, spontaneous abortion
High dose after 20 weeks: hair loss, skin lesions, bone marrow suppression
Precautions: use lead shielding, long cone, proper collimation, limited to affected tooth, extra care should be used while taking essential films to eliminate the need for repeated exposure

Medications in Pregnancy

FDA classification system:
- Category B: penicillin, amoxicillin, clindamycin, paracetamol (short-term usage)
- Category C: chloramphenicol, ketoconazole, fluconazole, codeine (short-term usage)
- Category D: tetracycline, doxycycline, aminoglycoside, aspirin (non-teratogenic but may cause maternal and fetal hemorrhage and oral clefts)
Analgesics: NSAIDs should be avoided in the last trimester, sedatives (eg, diazepam) are rated D and can cause clefts with prolonged exposure
Nitrous oxide: avoid in the first trimester, use with caution in the second and third trimesters, do not use less than 50% oxygen

Emergencies in the Dental Office

Syncope: management by rolling the patient to her left side, supine hypotensive syndrome, dehydration, anemia, hypoglycemia, and neurogenic disorder
Morning sickness: enhanced gag reflex and delayed gastric emptying, aspiration of vomiting matter (real emergency), manage by oropharyngeal suction, recumbent position, chest compression
Seizure: mortality rate 17%, management by controlling airway, oxygen, transfer to hospital immediately
Bleeding and cramping: precedes miscarriage, active bleeding or painful contraction, manage by rolling the patient to her left side, oxygen, transfer to hospital

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Description

Learn about the importance of patient positioning in obstetrics, specifically elevating the right hip, and understand the risks of supine hypotensive syndrome, including symptoms and treatment.