MANAGEMENT OF PREGNANT . AND POSTPARTUM PATIENTS
Although riot a disease state, pregnancy is still a situation in which. special considerations are necessary when oral surgery is required. The primary concern when providing care for a pregnant” patient is the ptevention of genetic damage to the fetus. Two areas of oral surgrcal management.
with potential for creating fetal damage are (1) dimtal radiography and (2) drug administration. It is virtually impossible to perform an oral surgical procedure properly with neither radiographs nor’ the administration’ of medications; therefore one option is to defer any elective oral surgery until after delivery to avoid fetal risk. Frequently, temporary measures can be used to delay surgery.
However, if surgery during pregnancy cannot be postponed efforts should be made to lessen fetal exposure to teratogenic-factors. In the case o’f irradiation, using protective aprons and taking periapical films of only the
areas ‘requiring surgery can accomplish. this (Fig. 1-5). The.list of drugs’ thought to pose little risk to the fetus is relatively short. For purposes of oral surgery, the following drugs are believed least likely to harm a fetus when used in moderate amounts:.Iidocaine, buplvacaine, acetaminophen,
codeine, penicillin cephalosporins, and erythromycin ..Although aspirin is otherwise safeto use, it shouldnot be given late ill the third trimester because of its anticoagulant property. All sedative drugs are best
avoided in pregnant patients. Nitrous oxide should not be used during the. first trimester butifnecessary can be used in the second and third trimesters as long as it is’ delivered with at least’ 50% Oxygen ‘(Boxes 1-25 and 1-26). The Food and Drug Administration (FDA) created . a system of drug categorization based on the known degree of risk to the human fetus posed by particular drugs. When required to give a medication to a pregnant patient, the clinician should check that the drug falls into an acceptable risk cate~ory before administering it to the patient (Box 1-27)
Pregnancy can be emotionally and physiologically stressful; therefore an anxiety reduction’ protocol is recommended. Patient vital signs should be obtained, with particular attention paid to any elevation in blood pressure
(a possible sign of preeclampsia). A patient nearing delivery may ·need special positioning of the chair during care, because if the patient is placed .in a nearly supine position, the uterine ‘contents may cause bothpression
of the inferior vena cava, compromising nI10US return to the heart and thereby cardiac output. The patient may need to be in a more upright position or with her torso turned slightly to one side during surgery. Frequent breaks to allow the patient -to void are commonly necessary late ill pregnancy because of fetal pressure on the urinary bladder. Before performing any oral surgery on a pregnant patient, her obstetrician
should be consulted.