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Maxillary jewelry in a parturient: a new cause for concern

San Diego, California

To the Editor:

A new fashion of self-expression through body piercing in unconventional sites among young adults (including pregnant women) appears to continue to increase in our society. We previously described the anesthetic implications of oral (tongue piercing),¹ and nasal (alar piercing),² jewelry in parturients requiring anesthesia in the peripartum period, and made a recommendation that oral/nasal jewelry should be removed prior to the administration of anesthesia (of any kind). However, we recently administered an uneventful epidural anesthesia to a 22-yr-old parturient with a non-reassuring fetal heart tracing for forceps assisted vaginal delivery. The patient had a piece of jewelry attached to her maxillary gumline with through and through fixation (Figure). Removal of the maxillary jewelry would have required special tools. We elected to not try and remove the maxillary jewelry because of the urgent nature of the case. We would welcome comments from colleagues from other institutions on their guidelines for the management of labour analgesia in parturients presenting with oral/nasal jewelry in situ.

View larger version (121K): [in this window] [in a new window]   FIGURE Gingival jewelry (anterior view).

References

1 Kuczkowski KM, Benumof JL. Tongue piercing and obstetric anesthesia: is there cause for concern? J Clin Anesth 2002; 14: 447–8.[Medline]

2 Kuczkowski KM, Benumof JL, Moeller-Bertram T, Kotzur A. An initially unnoticed piece of nasal jewelry in a parturient: implications for intraoperative airway management. J Clin Anesth 2003; 15: 359–62.[Medline]

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