PHYSIOLOGY
During pregnancy, women may experience systemic disorders such as respiratory alterations: dyspnoea (in 60-70% of all the pregnant women), hyperventilation, snoring, an upper ribcage breathing pattern and chest widening andrhinitis; haemodynamic alterations: elevation of the coagulation factors V, VII, VIII, X and XII, and reduction of the factors XI and XIII, with an increased fibrinolytic activity to compensate for the increased clotting tendency; gastrointestinal alterations: an increased intragastric pressure and a reduction in the lower oesophageal sphincter tone which is secondary to inhibition of the production of the motilin peptide hormone due to a rise in progesterone concentrations which are observed in this period — which give rise to heartburn (acidity) in 30-70% of all the pregnant women and an almost two-fold prolongation of the gastric emptying time as compared to those in non-pregnant women [3,4]. Nausea and vomiting are experienced by 66% of all the pregnant women, starting approximately 5 weeks after the last menstrual period, and reaching a maximum prevalence after 8-12 weeks. In this context, the morning dental appointments are to be avoided by pregnant women with an increased vomiting tendency due to pregnancy; renal alterations: an increased renal perfusion, particularly during the second half of the pregnancy, which gives rise to an increased drug excretion in the urine. Drug dosing adjustments are thus commonly required in such patients. Endocrine alterations are also observed in pregnant women: gestational diabetes is observed in 45% of all the pregnant women. On the other hand, the decubitus hypotension syndrome or the vena cava syndrome is observed in the final stage of the pregnancy in approximately 8% of all the cases, as a result of a difficulty in the venous return to the heart, which is caused by compression of the inferior vena cava by the gravid uterus. This condition manifests as a sudden drop in the blood pressure, with nausea, dizziness and fainting, when the patient is in the horizontal position [5]. In order to prevent this problem, pregnant women should keep their right hips slightly raised (10-12 cm) or inclined to the left, while they are seated on the dental chair. At the oral level, there may be an increased risk of caries, periodontal disease and pyogenic granulomas [6].
สาขาสรีรวิทยาDuring pregnancy, women may experience systemic disorders such as respiratory alterations: dyspnoea (in 60-70% of all the pregnant women), hyperventilation, snoring, an upper ribcage breathing pattern and chest widening andrhinitis; haemodynamic alterations: elevation of the coagulation factors V, VII, VIII, X and XII, and reduction of the factors XI and XIII, with an increased fibrinolytic activity to compensate for the increased clotting tendency; gastrointestinal alterations: an increased intragastric pressure and a reduction in the lower oesophageal sphincter tone which is secondary to inhibition of the production of the motilin peptide hormone due to a rise in progesterone concentrations which are observed in this period — which give rise to heartburn (acidity) in 30-70% of all the pregnant women and an almost two-fold prolongation of the gastric emptying time as compared to those in non-pregnant women [3,4]. Nausea and vomiting are experienced by 66% of all the pregnant women, starting approximately 5 weeks after the last menstrual period, and reaching a maximum prevalence after 8-12 weeks. In this context, the morning dental appointments are to be avoided by pregnant women with an increased vomiting tendency due to pregnancy; renal alterations: an increased renal perfusion, particularly during the second half of the pregnancy, which gives rise to an increased drug excretion in the urine. Drug dosing adjustments are thus commonly required in such patients. Endocrine alterations are also observed in pregnant women: gestational diabetes is observed in 45% of all the pregnant women. On the other hand, the decubitus hypotension syndrome or the vena cava syndrome is observed in the final stage of the pregnancy in approximately 8% of all the cases, as a result of a difficulty in the venous return to the heart, which is caused by compression of the inferior vena cava by the gravid uterus. This condition manifests as a sudden drop in the blood pressure, with nausea, dizziness and fainting, when the patient is in the horizontal position [5]. In order to prevent this problem, pregnant women should keep their right hips slightly raised (10-12 cm) or inclined to the left, while they are seated on the dental chair. At the oral level, there may be an increased risk of caries, periodontal disease and pyogenic granulomas [6].
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