Shelly Abramowicz et al Figure 3: Patient postintervention. Note large number of drains. Each year it is estimated that about 50,000 women un- dergo anesthesia and a surgical intervention at some time during gestation for indications unrelated to the pregnancy [3]. In such situations, when medical and surgical treat- ments for pregnant women are considered, both the physi- ologic changes of pregnancy and the perinatal eﬀects of the treatment must be considered [4]. Pregnancy is accompa- nied by many physiological changes which place the mother at a higher risk of infection or of doing worse once in- fected. First, the immune response is greatly diminished dur- ing pregnancy, thus resulting in potential faster progression of an infection. In addition, there is decreased neutrophil chemotaxis, cell mediated immunity, and natural killer cell activity [5, 6]. Moreover, approximately 50% of pregnant women complain of dyspnea by 19 weeks gestation [5] and there is some depletion in the oxygen reserve of the gravid patient. This results in lower oxygen reserve which could in- crease fetal hypoxia during periods of hypoventilation [4]. From an oral perspective, as pregnancy associated hormonal changes begin to aﬀect a woman’s body, the gingival tissues are aﬀected as well. They become much more sensitive and thus susceptible to irritation from soft plaque. The plaque accumulates, becomes hard calculus deposits on the teeth, and harbors bacteria in large numbers resulting in a con- stant, low-grade intraoral infection. An exaggerated local in- ﬂammatory response can then begin and may result in ery- thematous and edematous swelling of the gingiva between the teeth, also known as pregnancy gingivitis. Approximately 70% of pregnant women have this condition, even with rou- tine oral care [7]. This condition may be slightly painful and also bleeds easily upon routine tooth brushing. Maternal in- fective processes sustained especially by gram negative anaer- obic bacteria, such as those leading to Ludwig’s angina, have been demonstrated to cause physiologic imbalance through inﬂammatory cytokine production, sometimes resulting in preterm labor, preterm premature rupture membranes, and low birth weight [8, 9]. During pregnancy, women tend to maintain frequent meals and snacks, which cause further plaque accumulation, as well as an increase in decay or rapid progression of previously present decay. Because a preg- nant patient has increased demands on her organs, there is 3 increased potential for poor oxygenation. On the other hand, poor oxygenation is compromising to the fetus. An infection in itself can at times infect the placenta, uterus, and possibly the fetus, causing fetal septicemia. Treatments such as pro- longed intubation and certain intravenous medications can also harm the fetus. During a life threatening infectious situ- ation such as the one described, the risk of maternal and fetal morbidity may overshadow potential teratogenic side eﬀects [10]. In order to prevent a similar life-threatening emergency, health care providers should not neglect even minimal com- plaints of dental pain. Often, if a problem is identiﬁed dur- ing the early stages of pregnancy, routine dental care can be planned to control active disease or eliminate potential prob- lems that could increase in severity later in the pregnancy. An appropriate time for dental care from a medical standpoint is the second trimester and pregnant women usually experience the greatest sense of well being during that time [6]. Dental treatments including routine cleanings, ﬁllings, crowns, ex- tractions, gum treatment, and continuation of orthodontic treatment can all be provided. Dental anesthetics such as li- docaine can penetrate the placenta but, in general, do not reach it because they are used locally and in small dosages during routine dental procedures [7]. Antibiotics that are acceptable include penicillin, amoxicillin, and clindamycin. Tetracycline should be avoided since it tends to cause per- manent discoloration of primary and temporary dentition of the unborn child [6]. To decrease dental pain, narcotics should be avoided as well as over the counter medications such as aspirin, ibuprofen, and related products because of the potential to aﬀect bleeding. Morphine appears to be a safe analgesic when administered for short periods of time [7]. Ludwig’s angina is life threatening because of both sep- ticemia and asphyxia. Furthermore, in pregnancy, the risks that both the condition and the possible therapies may cause the mother and her unborn child must be considered as well as the possible consequences of the condition and therapies to both. 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