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Administration of drugs to pregnant patient is of significant Concern.Two main concerns must be addressed when considering whether to give a drug to pregnant patient.
The first is that the drug may be teratogenic. The second is that drug may affect the near term fetus.
Pregnancy trimesters
It involves three trimesters: First trimester in this different body organs in the fetus are forming .it is the most critical time for teratogenicity. Dental prophylaxis with detailed instructions and visual examination of oral cavitywithout xrays should be performed if the patient is pregnant. Second trimester- it is an excellent time for dental prophylaxis if needed. The patients periodontal status should be carefully
Evaluated during this period. Third trimester the women begin to feel uncomfortable and it is difficult for her to lie in prone position for long time . Drugs that may affect the newborn should not be given during this trimester. Positioning of patient on dental chair can cause hypotension due to the compression of gravid uterus on inferior vena cava.
Pharmacokinetics in pregnancy
Drug absorption level of progesterone
gastric emptying
Drug metabolism- hepatic drug metabolizing enzymes are induced during pregnancy probably by high concentration of circulating progestrone.this can lead to more rapid metabolic degradation especially of highly lipid soluble drugs. Drug excretion during pregnancy renal plasma flow increases by 100% and glomerular filtration rate by 70%.Hence drugs which depend for their elimination mainly on kidney are eliminated more rapidly than in non pregnant stage .e.g Ampicillin ,cephalosporin.
Increase total blood volume there is increased total blood volume because increased fluid retention ,which leads to change in cardiac output , blood pressure and glomerular filtration rate resulting in changes in the metabolism,absorption and excretion of drug as well as their passage through placenta. Teratogenicity It refers to the capacity of drug to cause fetal abnormalities when administered to pregnant mother.
Tetracycline
phenytoin
Carbamazepine Retinoids Alcohol
Abnormalities Phocomelia. Multiple defects,fetal death. Discoloured &deformed tooth,retarded bone growth. Craniofacial and limb defect,cleft lip and palate. CNS defect Various abnormalities Fetal alcohol embryopathy
Potential benefit must be greater than the risk to the fetus if these are used.
D E
Analgesi cs
Paraceta B mol Aspirin C
Yes Yes Yes Yes Yes No Limited dose No
Codeine C Morphin e B
Yes Yes
Yes
Yes
No
Hepatot oxicity during pregnan cy . No
No
tetracycl ine
Yes
Yes
Same
Yes
No
Yes
Yes Yes
No
No
Adrener
treatment is to eliminate the source of pain . Thus for removal of caries ,an infected pulp or tooth surgical procedure should be done under small doses of local anaesthesia to minimize the use of systemic drugs . First trimester- it is roughly of 12-13 weeks ,in the 1st 12 days exposure to harmful drugs can kill the embryo,from the 13th day the period of organogenesis starts and the fetus is susceptible to injury and insult resulting in malformation. 2nd and 3rd trimester- there is considerable development of structures like teeth , bone,cns,endocrine ,etc. so, malformation is less but drugs like streptomycin can still be harmful causing retardation of physical and mental growth and premature labor .
Preventive dental prophylaxis Radiographs Reduce chair time Position Fainting Severe complications
Guidelines for prescribed drugs Dont use drug unless it is absolutely necessary. Ruling out possibility of pregnancy. Risk and benefit ratio . Lower doses.
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