Placental Abruption With Delayed Fetal Compromise in Maternal Acetaminophen Toxicity

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The article by Taney et al regarding placental abruption in acetaminophen toxicity1 should be interesting to all obstetricians, not only because of the unique presentation of the case but also the cause behind the patient's overdose: dental pain. In 2001, a similar situation arose in New York involving a patient with acetaminophen-induced hepatic failure who presented with fetal death in utero at 29 weeks of gestation, eventually requiring liver transplantation (personal communication, New York State Department of Health, 2001). She also suffered from pain from dental caries that no local dentist would treat. These two similar cases are separated by more than a decade, emphasizing how little progress we have made in this arena, despite statements from the American College of Obstetricians and Gynecologists and the American Dental Association regarding the importance of perinatal oral health.2,3 Although this report provides excellent management guidance, a key teaching point would be how to prevent potential harmful use of acetaminophen. Oral health is important for overall health, as these two cases demonstrate in devastating terms.
Maternal oral hygiene status is well-known to influence early childhood caries—the most common chronic disease of early childhood.3 Given the preventable nature of this disease, we should capitalize on the teachable moment of pregnancy and improve both maternal and child health. Maternal education on oral health and dental hygiene as well as early referrals to dentists can make a critical difference. Equally important is health care provider education on the safety of virtually all dental procedures during pregnancy. Identifying dentists willing to care for women insured by government-sponsored programs is also critical, because lack of health care providers is another stumbling block to care.
In summary, oral health evaluation in the first trimester is recommended by both the American College of Obstetricians and Gynecologists and the American Dental Association. Given the consequences of acetaminophen toxicity, these cases emphasize the importance of incorporating oral health assessment into prenatal care with timely referrals to prevent poor maternal and fetal outcomes.
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