Question for OB's

[Noyac]

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20yo G1P0 38+weeks is being induced in order to deliver her baby so that she can have a root canal for a tooth abscess. She calls me, anesthesiologist on call, for an epidural. She is being managed by a CNM who failed to inform me of the tooth abscess, but thats another story. Her vitals are stable, afebrile (98.3), labs: WBc10 Hct 40 plt 276. She reports fever and chills earilier in the week when she saw her dentist but currently feel fine. She has not received any antibiotics to date.
So my question is, do yo start her on antibiotics? Why or why not? Do you induce for something like this? How would you manage this case?

 

[Noyac]

20yo G1P0 38+weeks is being induced in order to deliver her baby so that she can have a root canal for a tooth abscess. She calls me, anesthesiologist on call, for an epidural. She is being managed by a CNM who failed to inform me of the tooth abscess, but thats another story. Her vitals are stable, afebrile (98.3), labs: WBc10 Hct 40 plt 276. She reports fever and chills earilier in the week when she saw her dentist but currently feel fine. She has not received any antibiotics to date.
So my question is, do yo start her on antibiotics? Why or why not? Do you induce for something like this? How would you manage this case?

OK , so I guess nobody knows how to handle this case. Or you don't care. All I really want to know is, is it appropriate to induce for a tooth abscess and if so should she be on antibiotics?

 

[Noyac]

Thanks, you guys have been really helpful. No really! 👎

 

[fuzzyerin]

As a moderator, I figure you might know that this board is mostly dead to begin with. But I figured I'd answer your question this way:

I am not a dentist. I don't know about tooth abscesses. Would I induce a patient for that? I guess it depends on my conversation with the dentist. Is the patient in need of surgery? Most of the time, dental surgery can be done on a pregnant patient, but many many doctors/dentists are terrified of pregnant people. If she was term, understood the risks of being induced, etc, I might. Would I give her antibiotics? Again, it depends if the dentist feels it's necessary. Maybe I'd just give her penicillin - it's be easier if she was already gbs+, then she'd already be getting antibiotics.

The white count you report is normal in pregnant patients. We have people with fevers all the time (chorio, pyelo, etc). In my experience, that hasn't interfered with anesthesia putting in an epidural.

I hope that gives you somewhat of an answer. Sorry to have "taken so long" in response.

 

[ceg]

Not that I agree with it but I know a lot of people who are induced at "37+" weeks (as we all know LMP EDD are not exactly accurate) because their OB is going out of town, they have a baby-sitter that day, they want to go on vacation, their back hurts, whatever. So if you are following that train of thought, an induction for that is not at all outside the bounds of what it accepted. Elective c-sections are scheduled for 38/39 weeks and that doesn't seem to raise a whole lot of red flags.

As far as antibiotics go, if she is afebrile and her white count is normal for a preg woman I would say no. There's really no indication for them and I would try to avoid the other side effects if at all possible. Again, if she is GBS+ and chooses antibiotics in labor that would cover it.

 

[Noyac]

Thank you for the replies. I understand that antibiotics in preganancy is a topic of controversy but there are case reports of tooth abscesses causing serious morbidity in the obstretrics and perinatology. Here's one:

http://www.ncbi.nlm.nih.gov/entrez/...t_uids=7710571&query_hl=1&itool=pubmed_docsum

NOw with these cases popping up, would you say it would be prudent to treat these pts with drainage and antibiotics or just antibiotics if they are >37 weeks?

 

[tiredmom]

Yuck! Why do mouths really gross me out? I would still think if she looked sick or showed signs of infection, you'ld do antibiotics, but I don't know if she was afebrile and looked okay. But, isn't drainage the cure for abcesses? What would you use for antibiotics... something like Clindamycin to cover mouth anerobes? UTHSC San Antonio is currently doing research project on correlating bad dental health and preterm labor, bad outcomes, but I don't think its close to publication yet.

 

[fuzzyerin]

I would probably ask the dentist what antibiotic he would give in this situation to a non-pregnant patient and if it's one that works in pregnancy, give it. But again, I'm not planning on going out to treat teeth in my future. Just as I expect that a dentist would have the patient ask the ob what meds to use, I would ask them for advice on how to treat teeth abscesses.

 

[tiredmom]

Good call.

 

[Noyac]

Ok, so I take it that nobody is all that excited about starting this pt on antibx's until she is sick, febrile.

Do you put pts with chorio on antibx's?

 

[fuzzyerin]

OF COURSE people with chorio get antibiotics. I don't have any problem giving people antibiotics when they are pregnant. We treat GBS with Penicillin/Ampicillin or if allergic, Ancef, Clinda, or Vancomycin. We treat UTIs all the time with Macrobid, Keflex, Bactrim. Chorio gets antibiotics - Amp and Gent or Amp/Gent/Clinda. The thing about it is I wouldn't know what antibiotic to use to cover teeth, hence the reason I would ask the dentist.

 

[Noyac]

OF COURSE people with chorio get antibiotics. I don't have any problem giving people antibiotics when they are pregnant. We treat GBS with Penicillin/Ampicillin or if allergic, Ancef, Clinda, or Vancomycin. We treat UTIs all the time with Macrobid, Keflex, Bactrim. Chorio gets antibiotics - Amp and Gent or Amp/Gent/Clinda. The thing about it is I wouldn't know what antibiotic to use to cover teeth, hence the reason I would ask the dentist.

Good enough! 👍

 

[lgalvin]

test

 

[Noyac]

test

WHAT?