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Endocrine > Endocrinology in pregnancy > Flashcards

Endocrinology in pregnancy Flashcards

(56 cards)

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1
Q

What hormone will a follicle release?

A

Oestradiol

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2
Q

What will the corpus luteum release?

A

Progesterone

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3
Q

When is hCG reelased?

A

When the ferilised follice (corpus lutem) is implaned

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4
Q

What hormones does the placenta release?

A

Human placental lactogen (hPL)
Placental progesterone
Placental oestrogens

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5
Q

What will the pituitary release during pregnancy?

A

Prolactin

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6
Q

When is the peak of LH in the menstrual cycle?

A

During ovulation - commonly day 14

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7
Q

When is the peak of FHS in the menstrual cycle?

A

Ovulation - day 14

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8
Q

How long does the luteal phase last?

A

14 days

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9
Q

How long does the follicular phase last?

A

14 days but can be very variable

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10
Q

When is the peak of progesterone in the menstrual cycle?

A

In the luteal phase around day 21

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11
Q

What are the 3 phases of the menstrual cycle?

A

Menses
Proliferative phase
Secretory phase

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12
Q

What hormones lead to increased insulin resistance in a pregnant woman?

A

Progesteron

hPL

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13
Q

What can increased insulin resistance lead to?

A

If predisposed then can lead to gestational diabetes

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14
Q

When does gestational diabetes tend to start?

A

In the 3rd trimester as the placental hormones are at their highest level

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15
Q

When does foetal organogenesis start?

A

At 5 weeks

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16
Q

What complications in pregnancy can happen due to gestational diabetes?

A

Macrosomia - >90th centile, over 4kg
Polyhydraminos
Intrauterine death

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17
Q

What complications in pregnancy can happen due to pre-existing diabetes in pregnancy?

A 
Congenital malformation
Prematurity 
Intra-uterine growth retardation 
Macrosommia
Polyhydraminos
Intrauterine death
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18
Q

What complications can occur in the neonate from a diabetic pregnancy?

A

Respiratory distress - immature lungs
Hypoglycaemia - fits
Hypocalcaemia - fits

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19
Q

What CNS defects are more common in diabetic pregnancies?

A

Anencephaly

Spina bifida

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20
Q

What skeletal abnormalities are more common in diabetic pregnancies?

A

Caudal regression syndrome

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21
Q

What genital and GI abnormalities are more common in diabetic pregnancies?

A

Urteric duplication

UTI

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22
Q

Why does maternal diabetes lead to macrosomia?

A

Maternal hyperglycaemia
Foetal hyperglycaemia
Foetal hyperinsulinaemia
Results in macrosomia and neonatal hypoglycaemia

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23
Q

Why does foetal hyperinsulinaemia lead to increased growth?

Study These Flashcards
A

In the 3rd trimester, the foetus produces its own insulin which is a major growth factor

24
Q

What pre-pregnancy advice would you give to diabetic mothers?

Study These Flashcards
A

Good sugar control 3 months pre-conception

Limit risk of congenital malformation

25
What is the advice surrounding folic acid in diabetic mothers?
Folic acid 5mg instead of the 400 micrograms for the geneal pop
26
What is the advice around eye checks in diabetic mothers?
Regular eye checks (10/20/30 weeks gestation) as there is accelerated retinopathy
27
What drugs should be stopped during pregnancy for diabetic mothers?
Avoid ACEI and statins Change tablets to insulin if T2DM If hypertensive - change to labetalol, nifedipine or methyldopa
28
What are the aims for blood sugar control in pregnant diabetics?
Pre-meal <4-5.5 mmol/l | 2h post meal <6.5-7 mmol/l
29
What is the management for pregnant diabetics?
``` Diabetic diet and lifestyle Good blood sugar control Monitor HbA1c Monitor BP Maintain good glucose levels during labour - IV insulin and IV dextrose ```
30
What drug treatments for diabetes are approved in pregnancy?
T1: insulin T2: metformin and insulin GDM: lifestyle, metformin, may need insulin
31
When should the blood sugars be checked in a women with diabetes with GDM?
6 weeks post natal fasting glucose or GGT to ensure they have resolution of DM and to ensure they dont have T2DM
32
What is the risk factor for developing T2DM ifi you have gestational diabetes?
50% after 10-15 years | 80% for those who are obese
33
How can diabetes be prevented after GDM?
Keep weight as low as poss Healthy diet - low refined surgar, predominant starch, low saturated fat, low energy foods Aerobic exercise Annual fasting glucose
34
What can hypo and hyperthyroidism do to the menstrual cycle?
Anvovulatory cyles - reduced fertility
35
What happens to the demand for thyroxine during pregnancy?
Maternal thyroxine important for neonatal development (esp CNS) Increased demand on the thyroid during pregnancy as the plasma protein binding increases
36
What will happen to the size of the thyroid gland during pregnancy?
Increase in size | Increased T4 production to maintain normal conc
37
What happens in pregnancy to a women with pre-existing hypothyrodism?
Unable to compensate for increased demand Increase thyroxin dose by 25 micograms as soon as pregnancy is suspected Check TFTs monthy for the first 20 weeks then 2 months until term Average dose is increased by 50% by 20 weeks
38
What is the target TSH in pregnancy?
<3 mU/I
39
What are the risks of untreated hypothyrodism in pregnancy?
``` Increased abortion Preeclamsia Abruption Postpartum haemorrhage Preterm labour Foetal neuropsychological development ```
40
What is the link between TSH and hCG?
hCG increases the need for thyroxine therefore supressing TSH
41
What will the thyroid function tests be like in hyperemesis gravidarum?
hGC HIGH, 50% have a low TSH and a high fT4
42
What is the hCG effect of thyroid tests in pregnancy?
fT4 increased in 14% of pregnancies Low TSH (0.1-0.4) of pregnancies Mimics hyperthyrodism biochemically
43
What are the signs and symptoms of gestational hCG-associated thyrotoxicosis?
Hyperemesis gravidarum - increased hCG and decreased TSH Not TRab antibody positive Resolves by 20 weeks Only treat if it persists beyond 20 weeks
44
What effects does hypertyrodism have on conception, pregnancy and labour?
Infertility due to anovulatory cycle Spontaneous miscarriage Stillbirth Thyroid crisis in labour
45
What effect will maternal hyperthyrodism have on the neonate?
Transient neonatal htyrotoxicosis - thyroid receptor antibodies cross the placenta causing an overactive thyroid in the foetus
46
What are the symptoms of hyperthyrodism in pregnancy?
N+V Tachycardia Warm and sweaty Lack of wt gain
47
How should hyperthyrodsim be managed in pregnancy?
Supportive - if hyperemesis it will settle. Graves may also settle during pregnancy Beta blockers if needed
48
What is the pharma management of hyperthyrodism in pregnancy?
Low soe anti-thyroid drugs Propylthiouracil in 1st trimester Carbimazole in 2/3rd trimester
49
Why should you never use carbimazole in pregnancy?
Teratogenic - scalp abnormalities, GI abnormalities, chanal and oesophageal atresia
50
What are the issues with propylthiouracil?
Risk of liver toxicity
51
When should TRAb antibodies be checked in pregnancy?
3rd trimester | If present should alert neonatologist
52
What is the treatment if the baby has hyperhyrosidm?
Low does carbimazole until settles - is transient
53
What is post-partum thyroditis?
Normal thyroid level at delivery but development of thyroditis 6/8 weeks post partum and then 4/6 months of hypothyrodism until it settles at around a year
54
Why shouldnt carbimazole be given in post-partum thyroditis?
Makes the hypo crash MUCH worse
55
What blood test should you do in post-natal depression?
Thyroid levels - hypothyrodism can cause depression
56
What will happen if the post partum mother still needs levothyroxine after 1 year post partum?
Persistent hypothyrodism - likley need levothyroxine lifelong

Endocrine (35 decks)

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