From the Guidelines
For a dental abscess in a 38-week pregnant patient who needs imaging but can't receive contrast, and with a potential repeat C-section today, I recommend managing the dental abscess with antibiotics and proceeding with the planned C-section, as the risks associated with contrast agents are outweighed by the need to prioritize maternal health and impending delivery. Given her term pregnancy and imminent delivery, the most practical approach would be to manage the dental abscess with antibiotics (amoxicillin-clavulanate 875/125 mg twice daily or clindamycin 300 mg four times daily if penicillin-allergic) and proceed with the planned C-section today 1. After delivery, you can obtain appropriate imaging with contrast if needed. For pain management, acetaminophen is safe, and limited use of opioids may be considered if necessary. Dental consultation should be obtained as soon as possible, as drainage of the abscess may be required. The concern with contrast agents during pregnancy is theoretical risk to the fetus, but at 38 weeks with delivery imminent, the maternal infection is the priority, as noted in recent guidelines on reproductive health and liver disease 1 and acute pelvic pain in the reproductive age group 1. Untreated dental abscesses can lead to serious complications including sepsis, so prompt treatment is essential while balancing the risks of imaging contrast against the benefits of proper diagnosis and treatment. Non-contrast MRI can be considered if imaging is absolutely necessary, as it is a useful secondary imaging modality for characterizing masses and assessing the extent of disease during pregnancy, without the need for gadolinium-based contrast 1. Key considerations include:
- Prioritizing maternal health and impending delivery
- Managing the dental abscess with antibiotics
- Proceeding with the planned C-section
- Obtaining dental consultation as soon as possible
- Considering non-contrast MRI if imaging is necessary.
From the Research
Dental Abscess in Pregnancy
- A dental abscess is a serious condition that requires prompt treatment, especially in pregnant women 2.
- According to a study published in The Journal of Emergency Medicine, dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct 2.
- However, the use of contrast agents in imaging studies may be a concern in pregnant women, particularly at 38 weeks of gestation.
Cesarean Section and Antibiotic Prophylaxis
- Cesarean delivery is a common procedure in pregnant women, and antibiotic prophylaxis is often used to reduce the risk of postpartum infection 3, 4, 5.
- A study published in The Cochrane Database of Systematic Reviews found that prophylactic antibiotic treatment substantially reduced the incidence of episodes of fever, endometritis, wound infection, and serious infection after cesarean section 3.
- However, another study published in The Journal of Maternal-Fetal & Neonatal Medicine found that routine use of prophylactic postoperative antibiotics after emergent cesarean delivery with povidone-iodine skin preparation did not appear to reduce the rate of postpartum infection or wound complication 4.
Management of Pregnancy at Advanced Maternal Age
- Pregnancy at advanced maternal age (age >35 years old) is considered a risk factor for adverse maternal and perinatal outcomes 6.
- A study published in the International Journal of Women's Health found that pregnancies of advanced maternal age have become more prevalent over the last few decades, and possible maternal complications include increased risk of spontaneous miscarriage, preterm labor, gestational diabetes mellitus, and cesarean delivery 6.