Jorge Francisco Kuhn dos Santos

Obstetric and perinatal effects of active and/or passive smoking during pregnancy

CONTEXT Cigarette smoke, whether inhaled voluntarily or not, causes damage to the mother-infant pair. The antenatal period may present the best opportunity for performing effective anti-smoking campaigns. OBJECTIVE To study the obstetric and perinatal effects of smoking on pregnancy and the infant. TYPE OF STUDY Prospective study, interviewing pregnant women who were randomly selected at the maternity hospital as they were being discharged after giving birth. SETTING Hospital Municipal Vereador José Storópolli, São Paulo, Brazil. METHODS 758 patients were interviewed regarding smoke inhalation before being discharged from the maternity hospital. The groups were formed by 42 active smokers, 272 passive smokers, 108 who inhaled smoke both actively and passively, and 336 non-smokers. The groups were compared regarding age, parity, school education, incidence of spontaneous abortion, rate of caesarian births, average gestational age at birth, rate of low birth weight and adequacy of weight in relation to the gestational age of newborn infants. For all variables we considered p < 0.05 as statistically significant. RESULTS There was a high rate (55.7%) of pregnant smokers, including 5.5% active, 35.9% passive and 14.3% active-passive smokers. Active and active-passive smokers were older and had higher parity. Active smokers had lower education levels and higher rates of previous spontaneous abortion. The weights of newborn babies were lower for smoking mothers. DISCUSSION The study was performed among patients that were mostly of low economic, social and cultural levels, thus possibly explaining the high incidence of smokers. Worse still was that 35.9% of the non-smokers were actually passive smokers. These rates we report were similar to those from the literature. The typical receptiveness of teenage girls to unrestricted advertising in the media contributes towards an early start to acquiring the habit of smoking, including during pregnancy in our country. We emphasize the difficulties in quantifying exposure to cigarettes even among active smokers. CONCLUSIONS Cigarette smoke, whether inhaled voluntarily or not, has an unfavorable effect on the mother-infant pair.

Maternal-fetal monitoring during dental procedure in patients with heart valve disease

BACKGROUND The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.FUNDAMENTO: Los efectos de la anestesia local en odontologia con lidocaina y epinefrina, sobre los parametros cardiovasculares de gestantes portadoras de valvulopatias y sus conceptos, no son claros. OBJETIVO: Evaluar y analizar parametros de la cardiotocografia, de la presion arterial y electrocardiograficos de la gestante portadora de enfermedad valvular reumatica, al someterse a anestesia local con 1,8 ml de lidocaina 2% sin vasoconstrictor y con epinefrina 1:100.000, durante procedimiento odontologico restaurador. METODOS: Realizamos monitoreo ambulatorio de la presion arterial, electrocardiografia ambulatoria materna y cardiotocografia de 31 portadoras de cardiopatia reumatica, entre la 28a y la 37a semana de gestacion, divididas en dos grupos segun la presencia o no del vasoconstrictor. RESULTADOS: Se observo reduccion significativa de los valores de frecuencia cardiaca materna en los dos grupos, durante el procedimiento, al compararlo con los demas periodos (p 0,05). Lo mismo ocurrio (p > 0,05) con el numero de contracciones uterinas, nivel de variabilidad de la linea de base y numero de aceleraciones de la frecuencia cardiaca fetal. CONCLUSION: El uso de 1,8 ml de lidocaina 2% asociado a la adrenalina se mostro seguro y eficaz en procedimiento odontologico restaurador durante la gestacion de mujeres con cardiopatia valvular reumatica.

Monitorização materno-fetal durante procedimento odontológico em portadora de cardiopatia valvar

BACKGROUND The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.FUNDAMENTO: Los efectos de la anestesia local en odontologia con lidocaina y epinefrina, sobre los parametros cardiovasculares de gestantes portadoras de valvulopatias y sus conceptos, no son claros. OBJETIVO: Evaluar y analizar parametros de la cardiotocografia, de la presion arterial y electrocardiograficos de la gestante portadora de enfermedad valvular reumatica, al someterse a anestesia local con 1,8 ml de lidocaina 2% sin vasoconstrictor y con epinefrina 1:100.000, durante procedimiento odontologico restaurador. METODOS: Realizamos monitoreo ambulatorio de la presion arterial, electrocardiografia ambulatoria materna y cardiotocografia de 31 portadoras de cardiopatia reumatica, entre la 28a y la 37a semana de gestacion, divididas en dos grupos segun la presencia o no del vasoconstrictor. RESULTADOS: Se observo reduccion significativa de los valores de frecuencia cardiaca materna en los dos grupos, durante el procedimiento, al compararlo con los demas periodos (p 0,05). Lo mismo ocurrio (p > 0,05) con el numero de contracciones uterinas, nivel de variabilidad de la linea de base y numero de aceleraciones de la frecuencia cardiaca fetal. CONCLUSION: El uso de 1,8 ml de lidocaina 2% asociado a la adrenalina se mostro seguro y eficaz en procedimiento odontologico restaurador durante la gestacion de mujeres con cardiopatia valvular reumatica.

Monitoreo maternofetal durante procedimiento odontológico en portadora de cardiopatía valvular

BACKGROUND The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.FUNDAMENTO: Los efectos de la anestesia local en odontologia con lidocaina y epinefrina, sobre los parametros cardiovasculares de gestantes portadoras de valvulopatias y sus conceptos, no son claros. OBJETIVO: Evaluar y analizar parametros de la cardiotocografia, de la presion arterial y electrocardiograficos de la gestante portadora de enfermedad valvular reumatica, al someterse a anestesia local con 1,8 ml de lidocaina 2% sin vasoconstrictor y con epinefrina 1:100.000, durante procedimiento odontologico restaurador. METODOS: Realizamos monitoreo ambulatorio de la presion arterial, electrocardiografia ambulatoria materna y cardiotocografia de 31 portadoras de cardiopatia reumatica, entre la 28a y la 37a semana de gestacion, divididas en dos grupos segun la presencia o no del vasoconstrictor. RESULTADOS: Se observo reduccion significativa de los valores de frecuencia cardiaca materna en los dos grupos, durante el procedimiento, al compararlo con los demas periodos (p 0,05). Lo mismo ocurrio (p > 0,05) con el numero de contracciones uterinas, nivel de variabilidad de la linea de base y numero de aceleraciones de la frecuencia cardiaca fetal. CONCLUSION: El uso de 1,8 ml de lidocaina 2% asociado a la adrenalina se mostro seguro y eficaz en procedimiento odontologico restaurador durante la gestacion de mujeres con cardiopatia valvular reumatica.

Reanimação fetal: um relato de caso

Os autores descrevem caso de desaceleracao prolongada da frequencia cardiaca fetal, diagnosticada atraves da cardiotocografia, tratada com sucesso mediante tocolise aguda com terbutalina intravenosa.