Treatment Of Pregnant Patients Research Articles

Challenging cases in rheumatic disease pregnancy: management perspectives from reproductive rheumatologists

Pregnant women with rheumatic and musculoskeletal diseases (RMDs) have a higher risk of adverse pregnancy and perinatal outcomes compared to those without RMDs. Although evidence-based guidelines have been developed for the reproductive health care and management of these individuals, multiple areas of uncertainty exist around the diagnosis and treatment of pregnant patients with confirmed or suspected RMDs. We present a series of outpatient cases that address areas of uncertainty in the field of reproductive rheumatology. Expert opinions were elicited from rheumatologists who have expertise in the reproductive health of individuals with RMDs to build new understanding around diagnosis or treatment approaches. The cases focused on the interpretation of antiphospholipid antibodies in various clinical scenarios, diagnosis and management of nephrotic-range proteinuria during pregnancy, and the use of tumor necrosis factor inhibitors during pregnancy. Our objective was not to replace existing guidelines and classification criteria but rather to provide a range of expert opinions that rheumatologists might consider when tailoring treatment and care for patients, particularly in challenging situations with limited data.

Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners.

Diagnostic and therapeutic decision-making in pregnancy with suspected pulmonary embolism (PE) is challenging. European and other international professional societies have proposed various recommendations that are ambiguous, probably due to the unavailability of randomized controlled trials. In the following sections, we discuss the supporting diagnostic steps and treatments. We suggest a standardized diagnostic work-up in pregnant patients presenting with symptoms of PE to make evidence-based diagnostic and therapeutic decisions. We strongly recommend that clinical decisions on treatment in pregnant patients with intermediate- or high-risk pulmonary embolism should include a multidisciplinary team approach involving emergency physicians, pulmonologists, angiologist, cardiologists, thoracic and/or cardiovascular surgeons, radiologists, and obstetricians to choose a tailored management option including an interventional treatment. It is important to be aware of the differences among guidelines and to assess each case individually, considering the specific views of the different specialties. This review summarizes key concepts of the diagnostics and acute management of pregnant women with suspected PE that are supportive for the clinician on duty.

Review Paper: Optimized Drug Therapy in Dental Care of Pregnant Women

Pregnancy is a critical stage in oral health of women. The storm of hormones in pregnancy usually cause gingival problems and tooth decay. On the other hand, poor oral health during pregnancy may lead to complications such as premature delivery and preeclampsia. However, while a routine dental care is necessary during pregnancy, drug therapy may be required in some cases such as pain control or management of dental procedures or oral infections. In a pregnant patient requiring dental care, the agents routinely prescribed should be evaluated for potential risks to the mother and/or fetus. On the other hand, many physiological changes occur dur­ing pregnancy to support the needs of the developing fetus and these changes can affect the efficacy and pharmacokinetics of drugs as well. This article aims to provide a comprehensive review of dental drug therapy in pregnancy, including safety and recommendations for commonly used medications in dental practice. The physiological changes during pregnancy and their impact on oral health and drug therapy are discussed with an emphasize on dental therapeutic agents which can be selected in treatment of pregnant patients.

Management for Acute Uncomplicated Appendicitis During Pregnancy: National Trends and Patient Outcomes.

This study analyzes national trends in the management of uncomplicated appendicitis during pregnancy, comparing outcomes for nonoperative management (NOM) and appendectomy. In the nonpregnant population, several randomized controlled trials demonstrated noninferiority of NOM compared with appendectomy for acute uncomplicated appendicitis. However, it remains unclear whether these findings are generalizable to pregnant patients. The National Inpatient Sample was queried for pregnant women diagnosed with acute uncomplicated appendicitis from January 2003 to September 2015. Patients were categorized by treatment: NOM, laparoscopic appendectomy (LA), and open appendectomy. A quasi-experimental analysis with interrupted time series examined the relationship between the year of admission and the likelihood of receiving NOM. Multivariable logistic regression analyses were used to evaluate the association between treatment strategy and patient outcomes. A total of 33,120 women satisfied the inclusion criteria. Respectively, 1070 (3.2%), 18,736 (56.6%), and 13,314 (40.2%) underwent NOM, LA, and open appendectomy. The NOM rate significantly increased between 2006 and 2015, with an annual increase of 13.9% (95% CI, 8.5-19.4, P <0.001). Compared with LA, NOM was significantly associated with higher rates of preterm abortion (odds ratio [OR]: 3.057, 95% CI, 2.210-4.229, P <0.001) and preterm labor/delivery (OR: 3.186, 95% CI, 2.326-4.365, P <0.001). Each day of delay to appendectomy was associated with significantly greater rates of preterm abortion (OR: 1.210, 95% CI, 1.123-1.303, P <0.001). Although NOM has been increasing as a treatment for pregnant patients with uncomplicated appendicitis, compared with LA, it is associated with worse clinical outcomes.

The impact of antihypertensive treatment of mild to moderate hypertension during pregnancy on maternal and neonatal outcomes: An updated meta-analysis of randomized controlled trials.

Currently, there is controversy regarding the treatment of pregnant patients with mild hypertension (blood pressure 140-159/90-109 mm Hg). While guidelines do not recommend this treatment, results from recent clinical trials are supportive of the treatment. This meta-analysis aimed to clarify if active treatment of mild hypertension during pregnancy results in better maternal and fetal outcomes. All of the potentially eligible randomized controlled trials were retrieved through a systematic database search investigating the impact of pharmacological treatment in mild hypertensive patients on maternal, fetal, and neonatal outcomes. Relative risk (RR) and 95% confidence interval (CI) were calculated using a random-effects model. Data from 12 trials comprising 4461 pregnant women diagnosed with mild to moderate hypertension (2395 in the intervention group and 2066 in the control group) were extracted for quantitative synthesis. Antihypertensive treatment was associated with better outcomes in seven out of the 19 analyzed outcomes: Severe hypertension (RR = 0.53; 95% CI = [0.38;0.75]), preeclampsia (RR = 0.71; 95% CI = [0.54; 0.93]), placental abruption (RR = 0.48; 95% CI = [0.26; 0.87]), changes in electrocardiogram (RR = 0.43; 95% CI = [0.25; 0.72]), renal impairment (RR = 0.42; 95% CI = [0.34; 0.51]), pulmonary edema (RR = 0.46; 95% CI = [0.25; 0.84]), and neonatal mortality (RR = 0.72; 95% CI = [0.57; 0.92]). The primary safety outcome of small for gestational age was not different between the treatment group and the control group (RR = 1.12; 95% CI = [0.80; 1.57]). The results of this meta-analysis are in favor of the beneficial impact of pharmacological treatment of mild hypertension on both maternal and neonatal outcomes and without significant adverse events for the fetus.

ODP331 Management and Long Term Outcomes in a Patient with Pituitary Apoplexy in Pregnancy

Abstract Background Pituitary apoplexy is caused by hemorrhage or infarction of the pituitary gland. This diagnosis is rare in pregnancy, with little data to guide management in this population. Case A 30-year-old previously healthy pregnant female G4P3002 at 31 weeks gestation, presented with three days of severe headaches, dizziness, polyuria, polydipsia, and photophobia without vision loss. Her last pregnancy two years prior was uncomplicated. Pituitary MRI showed a 1.5 cm lesion with internal blood products, possibly indicating recent hemorrhage within an adenoma or cyst. The pituitary gland extended into the suprasellar cistern without compressing the optic chiasm. She was empirically started on stress dose steroids. Labs showed an ACTH of 32.9 pg/mL [9. 0-50. 0], cortisol 27.13 mcg/dL [3. 09-22.40], TSH 1.404 uIU/mL [0.550-4.780], with free T4 0.94 ng/dL [0.93-1.76] and total T4 of 11. 0 mcg/dL [4.5-10.9]. Glucocorticoids were continued given the inability to verify adrenal insufficiency after steroid initiation. Central hypothyroidism was diagnosed based on total T4 being less than 1.5 times the upper limit of the pre-pregnancy normal range, and she was started on levothyroxine. Prolactin was 93. 0 ng/mL [9.7-208.5] without hook effect on dilutional testing; this value was considered lower than expected for the third trimester. IGF-1 was normal at 296 ng/mL [117-329]. FSH was &amp;lt;0.3 mIU/mL [&amp;lt;0.3], LH &amp;lt;0.7 mIU/mL [&amp;lt;0.1-1.5], and estradiol &amp;gt;4000 pg/mL [reference range unavailable], all normal values for pregnancy. She had a normal serum sodium, however had polyuria at 266 mL/hour during a six hour water restriction test, with persistently dilute urine studies. Urine output and concentration improved after giving desmopressin. She was diagnosed with partial central diabetes insipidus and started on maintenance desmopressin. Per her obstetric team's recommendation, she underwent an uncomplicated Caesarean section at 38 weeks and was able to breastfeed shortly after delivery . Due to refractory headaches, 8 weeks after delivery she underwent transsphenoidal resection of an intrasellar cystic lesion with old blood products. No adenoma was identified. She was able to taper off hydrocortisone, desmopressin, and levothyroxine over one year after surgery. Follow up FSH, LH, estradiol, and prolactin levels normalized, and she resumed regular menses. Annual MRI's over five years have shown no evidence of lesion recurrence. Conclusion Studies have shown successful treatment of pituitary apoplexy with both surgical and non-surgical management, with surgery favored in patients with severe and/or progressive neuro-ophthalmologic deficits (1). However, there is a lack of data to guide treatment in pregnant patients. We present a case of pituitary apoplexy in pregnancy in which symptoms and hormonal function fully recovered after surgery, and imaging has been stable. Further research is needed to compare surgical and non-surgical treatment in this population, as well as the risk of tumor recurrence. (1) Marx et al. Endocrine, 2021. Presentation: No date and time listed

Efficacy evaluation of probiotics combined with prebiotics in patients with clinical hypothyroidism complicated with small intestinal bacterial overgrowth during the second trimester of pregnancy.

ObjectiveTo explore the effect of probiotics combined with prebiotics on clinical hypothyroidism during pregnancy combined with small intestinal bacterial overgrowth.Methods(1) In total, 441 pregnant women were included in this study. A total of 231 patients with clinical hypothyroidism during the second trimester of pregnancy and 210 normal pregnant women were enrolled in the lactulose methane-hydrogen breath test. The positive rate of intestinal bacterial overgrowth (SIBO), gastrointestinal symptoms, thyroid function and inflammatory factors were compared between the two groups by chi-square test and two independent sample t-test. (2) SIBO-positive patients in the clinical hypothyroidism group during pregnancy (n=112) were treated with probiotics combined with prebiotics based on conventional levothyroxine sodium tablets treatment. The changes in the methane-hydrogen breath test, gastrointestinal symptoms, thyroid function and inflammatory factors were compared before treatment (G0) and 21 days after treatment (G21) by chi-square test and paired sample t test.Results(1) The positive rates of SIBO in pregnant women in the clinical hypothyroidism group and control group were 48.5% and 24.8%, respectively. (2) The incidence of abdominal distention and constipation in the clinical hypothyroidism group was significantly higher than that in the control group, and the risk of abdominal distention and constipation in SIBO-positive pregnant women was higher than that in SIBO-negative pregnant women. (3) The serum levels of hypersensitive C-reactive protein (hsCRP), IL-10, IL-6, TNF-α, low-density lipoprotein (LDL), total cholesterol (TC), free fatty acids (FFAs) and apolipoprotein B (ApoB) in the hypothyroidism group during pregnancy were higher than those in the control group. (4) After 21 days of probiotics combined with prebiotics, the incidence of pure methane positivity in the methane-hydrogen breath test in the G21 group was significantly reduced, and the average abundance of hydrogen and methane at each time point in the G21 group was lower than that in the G0 group. (5) The incidence of constipation in the G21 group was significantly lower than before treatment. (6) The levels of serum TSH, hsCRP, IL-6, TNF-α, TC and LDL in pregnant women after probiotics combined with prebiotics were lower than those before treatment.ConclusionProbiotics combined with prebiotics are effective in the treatment of pregnant patients with clinical hypothyroidism complicated with SIBO, providing a new idea to treat pregnant patients with clinical hypothyroidism complicated with SIBO.

343EMF Identifying and Addressing Barriers to Emergency Department Buprenorphine Use Across a Health Care System

343EMF Identifying and Addressing Barriers to Emergency Department Buprenorphine Use Across a Health Care System

Breast cancer during pregnancy: epidemiology, phenotypes, presentation during pregnancy and therapeutic modalities.

Although it is uncommon in general, breast cancer is the most commonly diagnosed cancer during pregnancy. While treatment for pregnant patients should adhere to treatment guidelines for non-pregnant patients, there exist specific considerations concerning diagnosis, staging, oncological treatment, and obstetrical care. Imaging and staging are preferably performed using breast ultrasound and mammography. Other ionizing radiation imaging modalities, including computed tomography (CT) and Positron Emission Tomography/ Computed Tomography (PET/CT), can be selectively performed when the estimated benefit for the mother outweighs the risks to the foetus, e.g., when the results will change clinical management. MRI is appropriate to stage for distant disease on the indication. Breast cancer during pregnancy is less often hormone receptor-positive and more frequently triple-negative breast cancer compared to age-matched controls. The basic principle is that women should receive state-of-the-art oncological treatment without delay if possible and that the pregnancy should be maintained as long as possible. Treatment strategy should be multidisciplinary defined, carefully weighing the selection, sequence, and timing of treatment modalities depending on patient-, tumour-, and pregnancy-related characteristics, as well as patient preferences. Initiating cancer treatment during pregnancy often decreases the risks of early delivery and prematurity. Breast cancer surgery is possible during all trimesters. Radiotherapy is possible during pregnancy in the first half of pregnancy. Chemotherapy can be safely administered starting from 12 weeks of gestational age, but endocrine and HER2 targeted therapy are contraindicated throughout the whole pregnancy. Importantly, foetal growth should be monitored and long-term follow-up of the children is encouraged in dedicated centres.

PRINCIPLES OF TREATMENT OF PREGNANCY-ASSOCIATED MALIGNANT DISEASES: A LITERATURE REVIEW

Relevance: Cancer during pregnancy is uncommon and found in 1/1000 pregnant women. An increasing number of women worldwide&#x0D; plan childbearing at 30 years when the risk of malignant diseases increases. During pregnancy, cancers inherent with the reproductive&#x0D; period in women are more likely. These cancers include breast cancer and cervix cancer. This article reviews the principles of treating&#x0D; pregnant women with these cancers.&#x0D; The study aimed to systematize relevant literature reviews for the past decade to efficiently choose diagnostic and treatment tactics for&#x0D; pregnant women with breast cancer and cervix cancer without harming the fetus and gravid.&#x0D; Methods: We analyzed the literature sources from different authors on the frequency of cancer of such localizations as breast cancer&#x0D; and cervical cancer associated with pregnancy in patients of reproductive age. When selecting literary sources, attention was paid to the&#x0D; history of the disease, complaints, features of diagnostic methods, and the choice of optimal treatment methods. The analysis was based on&#x0D; comparative data from the studied literary sources for the past ten years.&#x0D; Results: The value and the adequacy of different diagnostic methods of research that have no threat to gravid and fetus and are recommended for pregnant patients were established. Considering a patient’s condition, gestation, and stage of the disease, the best treatment&#x0D; options for those cancer types were identified. Possibilities were studied on preserving patients’ fertility after treatment of these cancers.&#x0D; Conclusion: Malignant tumors of the reproductive system alternating with pregnancy are statistically rare. However, medical oncologists have to solve the problem of the diagnosis and treatment of pregnant patients. The choice of the diagnostic methods and the type of&#x0D; treatment must be individual. Having appropriate examinations and the staging done, Multidisciplinary Tumor Board approves the patient&#x0D; management plan. Practitioners face the problematic issue of choosing optimal diagnostic and treatment measures, and this situation requires further investigations and methodological developments in pregnancy management complicated with oncological diseases

PRINCIPLES OF TREATMENT OF PREGNANCY-ASSOCIATED MALIGNANT DISEASES :&#x0D; A LITERATURE REVIEW

Relevance: Cancer during pregnancy is uncommon and found in 1/1000 pregnant women. An increasing number of women worldwide plan childbearing at 30 years when the risk of malignant diseases increases. During pregnancy, cancers inherent with the reproductive period in women are&#x0D; more likely. These cancers include breast cancer and cervix cancer. This article reviews the principles of treating pregnant women with these cancers.&#x0D; ОБЗОР ЛИТЕРАТУРЫ&#x0D; Онкология и радиология Казахстана, №1 (63) 2022 69&#x0D; The study aimed to systematize relevant literature reviews for the past decade to efficiently choose diagnostic and treatment tactics for pregnant women with breast cancer and cervix cancer without harming the fetus and gravid.&#x0D; Results: The value and the adequacy of different diagnostic methods of research that have no threat to gravid and fetus and are recommended&#x0D; for pregnant patients were established. Considering a patient’s condition, gestation, and stage of the disease, the best treatment options for those&#x0D; cancer types were identified. Possibilities were studied on preserving patients’ fertility after treatment of these cancers.&#x0D; Conclusion: Malignant tumors of the reproductive system alternating with pregnancy are statistically rare. However, medical oncologists have&#x0D; to solve the problem of the diagnosis and treatment of pregnant patients. The choice of the diagnostic methods and the type of treatment must be&#x0D; individual. Having appropriate examinations and the staging done, Multidisciplinary Tumor Board approves the patient management plan. Practitioners face the problematic issue of choosing optimal diagnostic and treatment measures, and this situation requires further investigations and&#x0D; methodological developments in pregnancy management complicated with oncological disease.

Does the Fetus Limit Antibiotic Treatment in Pregnant Patients with COVID-19?

During pregnancy, there is a state of immune tolerance that predisposes them to viral infection, causing maternal-fetal vulnerability to the adverse effects of COVID-19. Bacterial coinfections significantly increase the mortality rate for COVID-19. However, it is known that all drugs, including antibiotics, will enter the fetal circulation in a variable degree despite the role of the placenta as a protective barrier and can cause teratogenesis or other malformations depending on the timing of exposure to the drug. Also, it is important to consider the impact of the indiscriminate use of antibiotics during pregnancy can alter both the maternal and fetal-neonatal microbiota, generating future repercussions in both. In the present study, the literature for treating bacterial coinfections in pregnant women with COVID-19 is reviewed. In turn, we present the findings in 50 pregnant women hospitalized diagnosed with SARS-CoV-2 without previous treatment with antibiotics; moreover, a bacteriological culture of sample types was performed. Seven pregnant women had coinfection with Staphylococcus haemolyticus, Staphylococcus epidermidis, Streptococcus agalactiae, Escherichia coli ESBL +, biotype 1 and 2, Acinetobacter jahnsonii, Enterococcus faecium, and Clostridium difficile. When performing the antibiogram, resistance to multiple drugs was found, such as macrolides, aminoglycosides, sulfa, dihydrofolate reductase inhibitors, beta-lactams, etc. The purpose of this study was to generate more scientific evidence on the better use of antibiotics in these patients. Because of this, it is important to perform an antibiogram to prevent abuse of empirical antibiotic treatment with antibiotics in pregnant women diagnosed with SARS-CoV-2.

Efficacy and safety of combination of nifuratel tablets with Baofukang suppository on treatment and recurrence of vaginitis in pregnancy

&#x0D; &#x0D; &#x0D; &#x0D; Purpose: To investigate the effect and safety of a combination of Nifuratel tablets and Baofukang suppository in the treatment and recurrence of vaginitis in pregnant patients.&#x0D; Methods: A retrospective analysis was carried out on 100 in-patients admitted between February 2019 and April 2020. They were randomly assigned to control and study groups, with 50 in each group. The control group received Baofukang suppository treatment, whilst the study group was treated with Nifuratel tablets in addition to Baofukang suppository. The two groups were compared with regard to treatment effectiveness, incidence of adverse reactions, recurrence at 1, 2 and 3 months post-treatment; time taken for disappearance of clinical symptoms, and levels of inflammatory factors 1 week after treatment. Moreover, Mental Status Scale in Non-Psychiatric Settings (MSSNS) score, and Quality of Life Index (QLI) score were compared between the groups.&#x0D; Results: The study group out-performed the control group with respect to treatment effectiveness and QLI score (p &lt; 0.05). Patients in the study group had significantly lower incidence of adverse reactions, degree of recurrence at 1, 2 and 3 months post-treatment, time taken for disappearance of clinical symptoms, expression levels of inflammatory factors, and MSSNS score, when compared to those in control group (p &lt; 0.05).&#x0D; Conclusion: Combined use of Nifuratel tablets and Baofukang suppository in the treatment of pregnant patients with vaginitis leads to significant treatment efficacy and safety, and reduced recurrence and expression levels of inflammatory factors in patients.&#x0D; &#x0D; &#x0D; &#x0D;

Endodontic treatment during pregnancy: case series and literature review

ABSTRACT The aim of this paper is to provide a scientific basis for conducting safe root canal treatment in pregnant women, illustrating with case reports treated in the extension project Maternal-Child Dental Care at the Federal University of Pelotas. The scientific bases address the main doubts of professionals when performing prenatal dental care: use of radiographic examination, local anesthetics, prescription of medications, among other essential factors in the care of pregnant women. The assisted pregnant women sought care with dental pain. In two cases symptomatic irreversible pulpitis was diagnosed, while a third was experiencing acute apical periodontitis. Endodontic procedures were performed under controlled and standardized conditions. The root canals were prepared in a single session, using mechanical instrumentation with reciprocating kinematics (Wave One® Gold Primary - Dentsply Sirona), and the root canal length was determined by an electronic apex locator FinePex (Schuster). Root canal filling was performed by the single cone technique with Wave One® gutta-percha points. After endodontic treatment, coronal sealing was performed with composite resin A2 Z350 XT (3M ESPE). The care related to the gestational condition is highlighted, and the patients remain under monitoring. It is concluded that the use of apical locators and mechanical instrumentation, using reciprocating files associated with the single cone obturation technique with a standardized cone for each system, represents advances for the accomplishment of endodontic treatment in pregnant patients due to the shorter clinical time and greater comfort of the procedure.

Effect and Pregnancy Outcome of Levothyroxine Tablets in the Clinical Treatment of Pregnant Patients with Hypothyroidism

Effect and Pregnancy Outcome of Levothyroxine Tablets in the Clinical Treatment of Pregnant Patients with Hypothyroidism

Treatment of COVID-19 disease in pregnancy and breastfeeding

The physiological and anatomical clinical characteristics of pregnant women make them susceptible to complications caused by coronavirus disease (COVID-19). Increased coagulation and risk of thromboembolic phenomena are common during pregnancy; they are further enhanced when associated with a thrombogenic pathology such as in COVID-19. The treatment of COVID-19 is controversial and limited, even for non-pregnant patients. During pregnancy, the options are even more restricted due to the teratogenicity of some drugs and anatomical and physiological difficulties, especially in advanced pregnancy in patients with respiratory failure. Therefore, the focus of treatment for pregnant patients should be centered on isolation, monitoring fetal and maternal vital signs, uterine activity, and general maternal-fetal well-being. The prescription of drugs and management orientation should be based on gestational age and maternal clinical conditions. The optimal type of delivery is guided by obstetric indications and COVID-19 disease severity. Breastfeeding should be encouraged with the use of masks and hand hygiene. The treatment of pregnant women with COVID-19 brings important peculiarities that should be considered in order to make better decisions for preserving the health of the mother and fetus.

Country-based report: the safety of omalizumab treatment in pregnant patients with asthma

Background/aimWe aimed to report outcomes of pregnant patients with asthma under omalizumab treatment and their infants in our country.Materials and methodsPatients with asthma who received omalizumab for at least 6 months and at least one dose during their pregnancy were retrospectively evaluated using a questionnaire regarding their disease and therapy and the health of their infants.Results Twenty pregnant patients and their 23 infant’s data were analyzed. The mean delivery age was 31.8 ± 7.4 years. They received omalizumab for 28.9 ± 21.8 months. Eight (36.4%) patients showed exacerbation of the disease during pregnancy. Forced expiratory volume in 1 s (FEV1) and asthma control test (ACT) scores at the starting time of omalizumab administration, first month of the pregnancy, and after delivery were 71 ± 18%, 83.4 ± 10.5%, and 80.5 ± 13% (FEV1), and 11.9 ± 4.9, 20.2 ± 2.6, and 20.4 ± 2.2 (ACT), respectively. One patient gave birth to twin infants, two patients to two infants each in different years, and 17 to one infant each. Three (13%) infants had low birth weight and five (21.7%) were born prematurely. No congenital anomalies were detected. Seven (30.4%) infants presented atopic diseases during their life.Conclusion Omalizumab treatment during pregnancy seems to be safe for both patients and their infants.

What Factors Influence Dental Faculty's Willingness to Treat Pregnant Women?

Despite evidence-based guidelines advocating for the provision of oral health care throughout pregnancy, dentists remain hesitant to provide dental treatment for pregnant women. However, little is known about attitudes toward treating pregnant women among dental school faculty, who may transmit their attitudes and treatment preferences to their students. We collected cross-sectional survey data at the New York University College of Dentistry, which produces 10% of all US dentists and is the largest US dental school, to understand faculty attitudes and knowledge regarding providing dental treatment to pregnant women. This study was part of an educational effort to improve dental care access by pregnant women and to examine what factors influence willingness to treat pregnant patients among dental faculty members. We found that concerns about professional liability outweighed inadequate knowledge regarding treatment of pregnant patients in determining dental faculty's willingness to treat pregnant women. Educational interventions delivered to dental faculty regarding current dental treatment guidelines for pregnant women may not be sufficient to increase faculty's provision of dental care to women during pregnancy. Future work to design effective interventions to increase dental treatment of pregnant women among dental faculty should address liability concerns. Interventions addressing dental clinician and faculty knowledge about dental treatment for pregnant women may be insufficient to increase dental treatment among pregnant women. Instead, policy makers should consider designing, implementing, and evaluating interventions addressing malpractice and liability concerns.

Pregnancy screening practices and treatment of pregnant patients among radiation oncologists: results of an international survey.

BackgroundThe human embryo or foetus is susceptible to harmful effects of radiation, which include growth delay, malformations, impaired cognitive function, cancer and foetal demise. The purpose of this study is to describe pregnancy screening practices in radiation oncology, so that potential health effects may be avoided and areas of prevention may be identified.MethodsAn electronic survey was delivered to 6,304 members of the American Society for Radiation Oncology. The survey subjects were radiation oncologists who are currently practicing in the world. Chi-square tests and a multiple logistic regression model were used to analyse the data. All tests were two-sided and the statistical significance level used was 0.05. This study (STUDY00009765) was approved by an Institutional Review Board.ResultsA total of 434 responses from practicing radiation oncologists were received. Of these respondents, 69.1% were practicing in the United States. Of all respondents, 19.8% reported treating paediatric patients and 93.6% reported treating premenopausal patients. Despite 84.8% of radiation oncologists saying they would ‘strongly agree’ or ‘agree’ that one should screen for pregnancy prior to radiation therapy, 29.7% of respondents reported their department has no screening policy and 7.1% of respondents reported they do not screen for pregnancy. Having a departmental policy was associated with screening for pregnancy (p-value = 0.0005).Of all respondents, 93 reported treating a known pregnant patient. Of these 93 respondents, 76 reported intentionally treating and 17 reported accidentally treating a pregnant patient. Respondents who did not screen at time of simulation were significantly more likely to treat a pregnant patient than those who screened at time of simulation (p-value = 0.0459).ConclusionsHeterogeneity exists among practicing radiation oncologists regarding pregnancy screening. Institutional policies should be clear and consistent. All members of the radiation oncology team should make every effort to minimise unintended radiation exposure to the embryo or foetus.

Anaesthetic management for electroconvulsive therapy during the second trimester pregnancy

Electroconvulsive therapy (ECT) is a highly effective treatment for patients with psychotic disorders that do not respond to medication. Usually, many psychotropic drugs have a teratogenic effect on the foetus. ECT seems to be a relatively safe and effective choice of treatment in pregnant patients. Adverse events such as foetal heart rate reduction, uterine contractions and premature labour do occur during ECT. We report our experience with ECT in the treatment of first episode of mania with psychosis in a patient in second trimester of pregnancy.