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Anesthesia during pregnancy: possible risks and problems. Surgical Interventions During Pregnancy: An Anesthesiologist's View

Can teeth be anesthetized during pregnancy? Every expectant mother asks this question when she is in the chair to the dentist.

As you know, any drug, especially injected into the body, brings not only benefits, but also some harm. And for a pregnant woman, the danger is higher due to the possible adverse effects of medications on the child's body. This article discusses the issues of local anesthesia during pregnancy, the choice of anesthetics and methods of pain relief.

As you know, the main indication for pain relief is pain or discomfort during medical procedures. However, it is better for pregnant women not to carry out local anesthesia unnecessarily.

In addition, the stage of pregnancy must be considered. It is believed that the least harm to the body of the expectant mother and child is caused by drugs in the second trimester (4-6 months). In the first trimester, the laying of organs and systems takes place, in the second - their planned development, in the third - formation.

Therefore, the introduction of local anesthetics in the first and third trimester is not recommended (with the exception of emergencies, such as inflammatory diseases that require surgery). In addition to the toxic effect, anesthetics with a large amount of adrenaline used in the last months of pregnancy can cause premature birth.

When sanitizing the oral cavity in the first months of pregnancy and the need to remove individual teeth in a planned manner, the intervention is postponed for several months until the second trimester.

Choice of drugs

If it is necessary to carry out local anesthesia for a pregnant woman, you need to competently approach the choice of anesthetic. Thus, the use of drugs with a high concentration of vasoconstrictors is not recommended.

The best option is 3% Scandonest (mepivacaine) or articaine varieties with a minimal adrenaline content (for example, Ultracaine D-S or Ubistezin D-S, vasoconstrictor concentration 1: 200,000).

Anesthesia techniques

Pregnant women can receive both infiltration and conduction anesthesia, but dentists prefer the first option. Conductive anesthesia is not used unless urgently needed.

conclusions

  • It is possible to carry out anesthesia for teeth for pregnant women, the best time for this is the second trimester. However, in conditions requiring urgent surgical interventions (opening up abscesses, removing sharpened teeth), anesthesia is performed in any month of pregnancy.
  • The drugs of choice are Scandonest, Ultracaine D-S and Ubistezin D-S.
  • Infiltration anesthesia is preferred.

About 5% of women require emergency dental treatment under anesthesia during pregnancy. The safest period for such manipulations is 14-28 weeks of the period, when all the organs of the child have already been formed. When conducting anesthesia, not only the choice of a safe drug is important, but also the method of its administration.

Can anesthesia be done during pregnancy?

You can't stand the pain. This is stressful for both the expectant mother and the baby. Anesthesia is simply indispensable when carrying out such procedures:

  • dental treatment, including endodontic treatment - the dental nerve reacts to the slightest mechanical effect, causing acute pain;
  • tooth extraction - when a tooth is extracted from the alveolus, the nerve endings are damaged, and, of course, unbearable pain occurs. And if you do not use an anesthetic, painful shock may occur;
  • prosthetics - the installation of a prosthesis requires the preparation (grinding) of the enamel, this is a rather unpleasant and painful procedure.

However, any kind of anesthesia is potentially dangerous while carrying a baby. The use of various medications, including anesthetics, can negatively affect the development of the fetus.

Therefore, at the dentist's appointment, the patient is obliged to warn the doctor about her pregnancy, and also to name the exact date. Then the doctor will be able to pick up special anesthetics, the active substances of which do not overcome the placental barrier and do not harm the baby.

Features of anesthesia in dentistry for pregnant women

Safe local anesthetic drugs

Local (local) anesthesia is the safest form of pain relief. It is he who is used for women during pregnancy. As a rule, Lidocaine solution is used for injection. This drug in small doses can penetrate the placenta in early pregnancy, but it is quickly excreted from the baby's body and is not harmful.

Also during pregnancy, Novocaine can be used, but the dosage is usually reduced.

Anesthetics Ultracaine and Primacaine, which contain adrenaline, are very popular in dentistry. However, they cannot be used during the period of bearing a child. Accidental release of adrenaline into the bloodstream can cause severe vasoconstriction and disrupt blood flow to the placenta.

The dosage of the drug depends on the patient's weight, her pain threshold and the complexity of the planned procedure. As a rule, women are injected with 1 ampoule or half, and if overweight - 2 ampoules. The duration of the anesthetic is from 40 minutes to 2 hours.

The main contraindications for local anesthesia are:

The third trimester is also a dangerous period for dental procedures. It is especially not recommended to carry out any operations at 9 months, since there is a high risk of increased uterine tone and premature birth.

Is anesthesia harmful during pregnancy? Doctors say yes. This type of pain relief can lead to a sharp decrease in blood pressure in a pregnant woman, while blood oxygen saturation worsens.

Dangerous consequences of general anesthesia:

Operations under anesthesia are performed in extreme cases when there is a threat to the mother's life. Superficial sedation (inhalation of nitrous oxide) is also contraindicated. Therefore, only local anesthesia is used for dental treatment.

If a woman is afraid of injections, then you can first anesthetize the area of ​​the mucous membrane with an anesthetic gel, and only then do an injection into the gum.

Private dental clinics have a large selection of anesthetic drugs indicated during pregnancy. If you are looking for reliable dentistry, we suggest using the convenient search engine of our website.

None of us is immune from health problems; often, expectant mothers are also worried about such troubles. Especially serious diseases sometimes require urgent surgical intervention, which raises a lot of questions and concerns, since treatment, especially anesthesia, during pregnancy is not particularly desirable. But there is no need to delay the operation, if it is urgent and urgent. Here's a double-edged sword for you, as they say.

During pregnancy, the mother's body works in a special mode, the composition of the blood changes, and the load on all organ systems increases. Chronic diseases can worsen and go to the stage when urgent surgery is required. Also, the help of a surgeon may be needed in the event of an unexpected injury or dental problem. Therefore, doctors should be extremely careful not to harm either the mother or the child, their work is equated only to jewelry.

At what stage of pregnancy is anesthesia safest for the unborn child?

During the operation, the responsibility lies not only with the surgeon, but also with the anesthesiologist, he needs to calculate the dose of anesthesia very accurately, taking into account the gestational age, the sensitivity of the fetus, the permeability of the placenta, and the possible consequences. An incorrectly selected dose of anesthesia during pregnancy can cause developmental disorders of the child, his metabolism, in especially severe cases, provoke deformity or death of the baby. A particularly dangerous period for the introduction of anesthesia is considered 2-8 weeks inclusive. Starting from the 28th week and until the end of the gestation period for the baby, the threat is also increased. If surgical intervention is necessary and there is an opportunity to stall for time, then doctors recommend the period from 14 to 28 weeks for operations, at which time the uterus does not react so strongly to external influences, and the main organs of the baby are already formed.

What types of anesthesia are acceptable for pregnant women

The most suitable for safety is the method of regional anesthesia. In this case, anesthesia is administered over the lining of the spinal cord, while the mother remains conscious, the lower part of the body becomes anesthetized. But options are not excluded when there are contraindications to this method, for example, neurological diseases, or it cannot be applied due to the duration of the operation. Therefore, doctors have to use multicomponent balanced anesthesia, while artificial ventilation of the lungs is needed. Before the operation, be sure to prescribe drugs that help reduce the acidity of gastric juice so that vomiting does not occur.

The drugs used for anesthesia will depend on your duration, condition and complexity of the operation. For small operations, Lidocaine is usually used, which provides local anesthesia, it breaks down rather quickly and does not have time to harm the fetus. Ketamine is prescribed for intravenous anesthesia, but it is used in small doses and with caution, since it can increase the tone of the uterus, but in the third trimester its negative effect becomes weaker. Nitrous oxide is used for combined anesthesia, but very rarely and for a short time, this drug is harmful to a small organism. If the expectant mother suffers from severe pain, then Morphine or Promedol can be used for injections, they are the least dangerous and almost do not cause malformations in the child. Of course, you must be extremely careful not to allow such health situations to arise. If the inevitable happened, then you should trust only experienced and qualified specialists.

The safety of use in the treatment of pregnant women remains currently an unresolved issue. The range of doctors' opinions is as wide as possible: from “it can be used for any period of time, it is absolutely harmless” to “it is absolutely impossible for any week, the risk of complications for the mother and child does not justify the benefits of dental treatment”. The reason for this amplitude of judgments is the almost complete absence of an evidence base for the toxicity / harmlessness of a local anesthetic during pregnancy. Pharmaceutical companies out of harm's way are in no hurry to test their drugs for pregnant women. Scientific research on this topic is disastrously small. Therefore, significant filtering of information is required. It is not possible to rely on expert opinion, since there are no experts on this problem in the world. Not only in Russia, but also in countries with developed medicine, the question of using anesthesia (and even the possibility of dental treatment in general) during pregnancy is decided by each doctor independently. There are no strict standards of care for pregnant women.

Fears of doctors and patients

A survey of 702 private dentists in Germany showed that only 61% of them treat pregnant patients, 35.5% postpone treatment until the postpartum period, 3.5% are referred to other clinics. Only 10% of dentists perform all the necessary types of treatment, 14% refuse local anesthesia. Almost half of dentists indicated that they would not be treated in the first trimester, and 8.5% in the second. 1

In a survey of 116 dentists in Connecticut, USA, 97% of dentists said they treated pregnant women, but only 45% felt comfortable doing so. 2

Seeking advice from a gynecologist does not clarify the situation much. A survey of 138 obstetricians in North Carolina, USA, found that 49% rarely or never recommend dental examinations to their patients. 3

Women themselves have little idea of ​​the risks of refusing treatment during pregnancy. In a 2012 survey, 2/3 of Australian women said they did not seek dental care during pregnancy, even if they had problems. 4

Is dental treatment really necessary during pregnancy?

Changes in the mouth and food intake during pregnancy can increase the incidence. 5 Lack of treatment leads to and. Periodontitis can cause periostitis and more serious complications.

Hormonal changes in pregnant women increase the incidence of and. 6 Untreated periodontitis has been shown by some studies to increase the risk of low birth weight, 7 premature birth, miscarriage and preeclampsia. eight

Timely elimination of periodontal problems improves the health of not only the mother, but also the newborn. 9 Therefore, proper monitoring of oral health during pregnancy and treatment, if necessary, is recommended. ten

Major misconceptions about local anesthesia

There is a special anesthesia for pregnant women

No, expectant mothers are given the same anesthesia as everyone else. The same articaine, mepivacaine, lidocaine and novocaine.

Anesthesia during pregnancy can lead to a lower IQ in the baby and other cognitive abnormalities.

This fact was really mentioned in the medical literature, only it has nothing to do with local anesthesia used in dentistry. A decrease in IQ was observed in children whose mothers received general anesthesia. eleven

Previously used anesthetics were dangerous, while modern ones do not penetrate (or hardly penetrate) through the placental barrier, and therefore are completely harmless. This is most often said about articaine (ultracaine).

In fact, articaine also penetrates, like all other anesthetics. But the percentage of it in the blood of the fetus is really lower - 32% of the content in the mother's bloodstream. Lidocaine has a similar indicator - 52-58%, mepivacaine - 64%. 12 Adrenaline also crosses the placenta and affects the fetus. 13

Anesthesia for pregnant women can be done, but only without adrenaline.

For this reason, many dentists use mepivacaine, an anesthetic that does not have a vasodilator effect, and therefore is used without a vasoconstrictor. However, its analgesic effect lasts on average only 25-40 minutes. 14 This is not enough for most dental procedures. Mepivacaine penetrates the placenta to a greater extent, and even at a higher rate (in comparison with lidocaine and adrenaline). And has a category C according to the FDA classification. This is not the best choice for most women. It is indicated for patients with arterial hypertension, paroxysmal ventricular tachycardia, atrial fibrillation, bronchial asthma and allergy to sulfites (added to the carpula to stabilize adrenaline).

Adrenaline itself also has a category C. But experimental animals were injected with astronomical doses of this drug, at which serious teratogenic effects were revealed. For example, in 1981, adrenaline at a dosage of 500 mg per kilogram of body weight caused a decrease in reproductive capacity in hamsters. 15 Such a horse dose (in terms of weight) is not used in humans even for anaphylactic shock or cardiac arrest. The dental carpool contains 0.009 mg or 0.018 mg of adrenaline, more than 7-8 carpool cannot be done at one time, and the weight of even the most graceful lady is many times greater than the weight of a hamster.

It has been theoretically suggested that a vasoconstrictor can cause fetal hypoxia by reducing uteroplacental blood flow. In an experiment on sheep, a decrease in fetal blood flow was noted for several minutes. 16 But not a single proof of the negative effect of this on the human fetus has been received to date.

In addition, it should be recalled that adrenaline is the body's own hormone, it is present in the bloodstream, regardless of whether it was exogenous or not. And the endogenous hormone is vigorously released just in case of pain, fear, panic. That is, when weak adrenaline-free anesthesia does not provide enough pain relief.

Adrenaline increases the tone of the uterus and can lead to miscarriage or premature birth.

This is such a common misconception that the situation should be explained in detail. Epinephrine activates both the alpha receptors of the uterus (increasing tone) and beta receptors (decreasing tone). So its effect on β 2 -adrenergic receptors is prevalent. Adrenaline reduces the tone of the uterus. 17 Moreover, with epidural anesthesia during labor itself, adrenaline is contraindicated because it induces atony and inhibits the second stage. Miscarriages during dental treatment under local anesthesia have not yet occurred anywhere in the world (or at least there is not a single mention of this in the professional literature).

Previously, not only adrenaline, but also norepinephrine was added to the anesthetic solution. Now it has been completely abandoned. So norepinephrine just more activated α-adrenergic receptors and increased the tone of the uterus. Perhaps this is where such a delusion was born.

Local anesthesia during pregnancy is completely harmless (if done correctly).

For a long time, indeed, no convincing evidence of a particular teratogenic or toxic effect on the child and mother was found. Studies on this issue were sporadic and with a small sample. But in 2015, the results of an observation carried out in 1999-2005 in Israel of 210 pregnant women, whose dental treatment was using local anesthesia, were published. They were compared with 794 pregnant women who did not undergo this procedure. The frequency of anomalies in children of the first group was 4.8%, the second - 3.3%. The authors considered the difference to be insignificant and concluded that the use of dental local anesthetics, as well as dental treatment during pregnancy, did not pose a significant teratogenic risk. 18 Subsequent authors in articles devoted to this problem began to use this conclusion as further evidence of the safety of local anesthesia.

However, among other experts, this conclusion has caused objections. 19 The 1.5% difference did not seem insignificant to everyone. After all, if the percentage of anomalies crossed the 5% barrier, and according to a statistical analysis, the conclusion would have to be changed to the exact opposite - local anesthesia significantly increases teratogenic risks.

In my opinion, 1.5% is still a significant increase in risk. But every expectant mother has the right to decide this for herself, the dentist should not impose her own opinion on her.

How to choose the optimal anesthetic?

1. To begin with, it is worth deciding: is it really necessary to have anesthesia. Many dental procedures are painless or not painful. Professional cleaning of teeth, treatment and prosthetics of depulped teeth, in some cases, treatment of caries or living teeth are unpleasant, but often it is quite possible to endure them without experiencing unbearable suffering. Therefore, it is recommended that you try this safest approach. If there is serious pain, you do not need to torture yourself - it is wiser to agree to local anesthesia.

Cosmetic procedures (teeth whitening, veneering) are completely inappropriate during pregnancy - they can and should be postponed.

2. From the whole spectrum of anesthetics, in the absence of contraindications, it is preferable to choose 4% articaine with adrenaline 1: 200,000. Articaine, although it has category C according to the FDA classification, is safer than other anesthetics. Its teratogenic effect was found when laboratory rabbits and rats were injected with loading doses of 4% articaine in combination with adrenaline 1: 100,000 (2-4 times higher than the maximum permissible concentration for humans). When using drugs at the level of maximum permissible concentration for humans in experimental animals, no teratogenic effect was found. 20 Moreover, the concentration of 1: 200,000 is twice as low, and no one will use 7 carpool at one time (maximum allowable volume) in pregnant women.

3. If such anesthesia was ineffective, then it is better to use the second cartridge with a ratio of 1: 100,000 articaine and adrenaline. The chances of achieving deep pain relief are greatly increased.

4. If adrenaline is completely contraindicated or significantly increases the risk of complications (arterial hypertension, paroxysmal ventricular tachycardia, atrial tachyarrhythmia, bronchial asthma, hyperthyroidism, pheochromocytoma, etc.), then you need to use 3% mepivacaine without adrenaline.

5. It is permissible to use lidocaine for pregnant women with an adrenaline concentration of 1: 200,000 or 1: 100,000. Lidocaine has a category B. However, the effectiveness of its anesthesia is 1.5 times less than that of articaine. 21 And the risk of allergic reactions is higher (up to anaphylactic shock).

conclusions

  1. Pregnant women can be anesthetized. And it is necessary (if required).
  2. There is no specific anesthetic for pregnant women.
  3. Some stories about the harm of anesthesia refer to general anesthesia, not local anesthesia (and there is still a lot of uncertainty).
  4. Modern anesthetics are better than the old ones, but not completely harmless.
  5. Anesthesia with adrenaline can be done, and in most cases it is even desirable.
  6. Adrenaline lowers the tone of the uterus; miscarriages from local anesthesia have not been reported.
  7. Local anesthesia is not completely safe in dentistry. You need to balance between expected benefits and possible risks.
  8. Of the drugs, 4% articaine with an adrenaline concentration of 1: 200,000 is preferable.
  9. You can also use articaine with an adrenaline concentration of 1: 100,000, mepivacaine without adrenaline, lidocaine with adrenaline.

Literature

  1. Pistorius J, Kraft J, Willershausen B. Dental treatment concepts for pregnant patients - results of a survey. Eur J Med Res. 2003 Jun 30; 8 (6): 241-6.
  2. Pina PM, Douglass J. Practices and opinions of Connecticut general dentists regarding dental treatment during pregnancy. Gen Dent. 2011 Jan-Feb; 59 (1): e25-31.
  3. Wilder R, Robinson C, Jared HL, Lieff S, Boggess K. Obstetricians "knowledge and practice behaviors concerning periodontal health and preterm delivery and low birth weight. J Dent Hyg. 2007 Fall; 81 (4): 81.
  4. George A, Shamim S, Johnson M, Dahlen H, Ajwani S, Bhole S, Yeo AE. How do dental and prenatal care practitioners perceive dental care during pregnancy? Current evidence and implications. Birth. 2012 Sep; 39 (3): 238-47
  5. Kidd E, Fejerskov O. Essentials of dental caries. 3rd ed. Oxford: Oxford University Press; 2005. pp. 88-108.
  6. Amini H, Casimassimo PS. Prenatal dental care: A review. Gen Dent. 2010; 58: 176-18
  7. Vergnes JN, Sixou M. Preterm low birth weight and maternal periodontal status: A meta-analysis. Am J Obstet Gynecol. 2007; 196: 135.e1-135.e7.
  8. Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG. 2006 Feb; 113 (2): 135-43.
  9. López NJ, Da Silva I, Ipinza J, Gutiérrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol. 2005; 76 (11 Suppl): 2144-53.
  10. Lee JM, Shin TJ. Use of local anesthetics for dental treatment during pregnancy; safety for parturient. J Dent Anesth Pain Med. 2017 Jun; 17 (2): 81-90. Translation of this article into Russian:.
  11. Yu CK, Yuen VM, Wong GT, Irwin MG. The effects of anesthesia on the developing brain: a summary of the clinical evidence. F1000Res. 2013 Aug 2; 2: 166.
  12. Strasser K, Huch A, Huch R, Uihein M. Placental transfer of carticaine (Ultracain) a new local anesthetic agent. Z Geburtshilfe Perinatol. 1977 Apr; 181 (2): 118-20.
  13. Morgan CD, Sandler M, Panigel M. Placental transfer of catecholamines in vitro and in vivo. Am J Obstet Gynecol 1972; 112: 1068-75.
  14. Haas A. An update on local anesthetics in dentistry. J Can Dent Assoc. 2002 Oct; 68 (9): 546-51.
  15. Hirsch KS, Fritz HI. Teratogenic effects of mescaline, epinephrine, and norepinephrine in the hamster. Teratology. 1981 Jun; 23 (3): 287-91.
  16. Hood DD, Dewan DM, James FM., 3rd Maternal and fetal effects of epinephrine in gravid ewes. Anesthesiology. 1986; 64: 610-613.
  17. Mike Samuels, Nancy Samuels. New Well Pregnancy Book: Completely Revised and Updated. 1996
  18. Hagai A, Diav-Citrin O, Shechtman S, Ornoy A. Pregnancy outcome after in utero exposure to local anesthetics as part of dental treatment: A prospective comparative cohort study. J Am Dent Assoc. 2015 Aug; 146 (8): 572-580.
  19. Best AM. More on local anesthetics in pregnancy. J Am Dent Assoc. 2015 Dec; 146 (12): 868-9.
  20. Malamed SF. Handbook of local anesthesia. 4th ed. St. Louis, Mosby; 1997.

During pregnancy, a woman should take any medications as responsibly and with great care. The more responsible is surgical intervention, if there is an urgent need for it, and the choice of anesthetic drugs.

Any operation poses a certain risk for any person. What then can we say about the expectant mother, whose body during pregnancy works in a completely different way! During pregnancy in a woman, almost all body systems are rebuilt to a different mode of operation: she breathes differently; , the kidneys and heart work in an enhanced mode; the composition of the blood changes ... But even realizing that it is necessary to avoid cases in which surgery is required, sometimes it happens that you still have to take risks.

Most often, pregnant women end up on the operating table due to injuries, acute organ diseases (for example), exacerbation of surgical diseases. Also, dental problems can serve as a reason for surgical intervention. If it turns out that the operation cannot be avoided, not only the surgeon, but the anesthesiologist, in the first place, must do everything possible so as not to harm the mother and the unborn baby.

So, the anesthesiologist, like a jeweler, will have to calculate the dose in this particular case, and also take into account the permeability of the placenta, the sensitivity or insensitivity of the fetus to the anesthetic and its subsequent effect on the growing small organism.

Anesthesia, in principle, is a certain danger at any stage of pregnancy, because it can damage the developing fetus. Anesthetic drugs can disrupt the development of the baby's cells, disrupt the biochemical reactions of metabolism, disrupt the development of the fetus as a whole, or lead to severe deformities or even the death of the child.

Anesthesiology is most dangerous for pregnant women in the periods between the 2nd and 8th weeks of pregnancy, when the main organs of the baby are formed, as well as from the 28th week until the end of pregnancy. It is then that the risk of abortion and major complications for a woman is very high. This is due to the fact that at this stage the organs of the abdominal cavity of the pregnant woman are "clamped" by the uterus, it presses on the main blood vessels in the abdomen, disrupting the blood flow. In turn, the pressure in the abdominal cavity is transferred to the chest cavity, while the volume of respiratory movements decreases. Thus, the mother also breathes for the child. In this regard, doctors, if an operation is necessary, try, if possible, to carry out an operation between 14 and 28 weeks: at this time, the child's organs are already formed, and the uterus reacts minimally to external influences.

The specialists responsible for the operation of the pregnant woman choose the tactics of pain relief depending on the timing of pregnancy, the complexity and duration of the operation, as well as on the basis of the individual characteristics of the woman's body. Their main tasks are the maximum protection of the child and the preservation of pregnancy.

The safest method of anesthesia for the expectant mother and fetus today is epidural (or regional) anesthesia. With this type of anesthesia, the anesthetic is injected into the space above the dura mater of the spinal cord: nerve roots pass here, which deliver pain impulses from the uterus. For painlessness of the procedure, the skin is preliminarily anesthetized before injection. With this type of anesthesia, the woman remains conscious - only the lower half of the body and legs are anesthetized. Provided that this method of anesthesia is carried out correctly, the risk for the baby and mother is minimal. Contraindications for epidural anesthesia are as follows: sepsis, neurological disease, bleeding disorder, skin infection at the injection site. If the use of this method of anesthesia is impossible (for example, during a long and serious operation), they resort to multicomponent balanced anesthesia with mechanical ventilation.

If, nevertheless, the operation could not be avoided, the pregnant woman, depending on the situation, can be prescribed all sorts of drugs. For example, immediately before the operation, as a rule, Ranitidine is prescribed: it is designed to lower the acidity of gastric juice in order to avoid vomiting.

During operations using combined anesthesia, nitrous oxide is sometimes used, but rarely, for a short time and in small doses. In the early stages of using this drug, they try to avoid it as much as possible: it is toxic to young cells.

The anesthetic Ketamine (Calypsol) is commonly used for intravenous anesthesia. In the first and second trimester - only in small doses for special indications and in combination with other drugs, because it has the ability to increase. In the third trimester, the negative effect of ketamine decreases.

If the pain is severe, the doctor can give the pregnant woman an injection of Morphine or Promedol. These drugs are considered the safest for expectant mothers, because they practically do not provoke the appearance in the fetus.

For small operations, local anesthesia is usually used: in such cases, Lidocaine is used. This drug can penetrate the placenta in the early stages, but its beauty is that the baby's body destroys this drug even faster than the adult's body.

It happens that sometimes expectant mothers still have to take risks and go under a scalpel. In this case, the most important thing is to find real good specialists who, with the necessary skill and skill, can help a pregnant woman. In this case, you will have to strictly adhere to the recommendations of doctors, follow all their instructions and take prescribed medications. The main thing for expectant mothers is to remember: very often our health depends only on ourselves. And therefore, during pregnancy, you will have to be as careful as possible and avoid traumatic situations.

Specially for- Elena Kichak