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SM Endocrine > Endocrinology of Pregnancy > Flashcards

Endocrinology of Pregnancy Flashcards

(58 cards)

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1
Q

What days does follicular growth occur

A

1 -9

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2
Q

At what day in the ovarian cycle does LH spike

A

13-15

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3
Q

What days does occupation occur

A

usually 15

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4
Q

What is the fate of the ovum

A

Ovum to corpus luteum to placenta

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5
Q

What hormones does the placenta produce

A

Human placental lactogen
placental progesterone
palcental oestrogens

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6
Q

What does the corpus luteum produce

A

Progesterone

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7
Q

What does the ovium produce

A

Oestradiol

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8
Q

What hormone does the pituitary gland produce that is particularly important to pregnancy

A

Prolactin (lactogen)

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9
Q

Why does gestational diabetes occur

A

Hormones cause an increase in insulin resistance

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10
Q

What 2 hormones can cause an increase in insulin resistance in the mother

A

Progesterones and hPL

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11
Q

When does gestational diabetes occur in pregnancy

A

The 3rd trimester (28 weeks)

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12
Q

When does foetal organogenesis occur

A

5 weeks (around the time the mother realises she has missed a period and notices she might be pregnant)

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13
Q

What are 6 complications in pregnancy for mothers with either type 1 or type 2 diabetes

A 
congenital malformation
prematurity
intra-uterine growth retardation (IUGR) 
Macrosomia 
Polyhydramnios
Intrauterine death
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14
Q

What complications can occur in gestational diabetes

A

Macrosomia
Polyhydramnios
Intrauterine death

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15
Q

What is polyhydramnios

A

fluid around the baby resulting in premature death and early delivery

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16
Q

what are some of the complications in a neonate of a mother with diabetes

A

Respiratory distress - immature lungs
Hypoglycaemia
Hypocalcaemia

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17
Q

Why would a neonate end up hypoglycaemic rather than hyperglycaemic

A

The pancreas has had to secrete more insulin during development due to the mothers increased glucose level. Now there is a normal glucose level but still too much insulin..

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18
Q

What part of the spine is affected by caudal regression syndrome

A

Lumbar spine

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19
Q

What patients are affected by caudal regression syndrome

A

Babies to mothers with diabetes. Unusual outside diabetes

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20
Q

What is a major growth factor for a foetus

A

When it produces its own insulin in the 3rd trimester

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21
Q

How can we manage patients with diabetes

A

Pre-pregnancy counselling and ensuring good glycemic control
Folic acid 5mg
Regular eye checks
Avoid ACEI an statins

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22
Q

What does folic acid do

A

Reduces the risk of CNS congenital malformations

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23
Q

What is the dose for a non-diabetic pregnant woman and a diabetic pregnant woman

A

400micrograms for non-diabetic

5milligrams for diabetic

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24
Q

What drugs can be used to control blood pressure in pregnancy

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A

Labetalol
Nifedipine
Methyl dopa

25
How can we maintain good blood glucose during labour
IV insulin and IV dextrose
26
How often should blood sugars be monitored during pregnancy
pre-meal post-meal and pre bed some will do one during the night as well
27
What drugs can be used to control glucose levels during pregnancy
Insulin Metformin Glibenclamide
28
What type of diabetes is indicative of glibenclamide
MODY
29
When should a woman who has had gestational diabetes be tested again to ensure the blood glucose has returned to normal
6 weeks post natal
30
If the glucose levels have not returned to normal after 6 weeks, what does this indicate
Either type 1 or Type 2 diabetes
31
How can we prevent diabetes after gestational diabetes
Keep weight as low as possible Healthy diet Aerobic exercise Annual fasting glucose
32
Foetal hyperinsulinaemia causes increased foetal growth
True
33
What is the risk of type 2 diabetes in a mother who developed gestational diabetes within 10 years after the baby has been born
50%
34
What is maternal thyroxine particularly important for
Neonatal development
35
What is the usual increase in the dose of thyroxine in a pregnant lady already on thyroxine
25mcg
36
What are some normal findings of thyroid tests during pregnancy
Low TSH | increased fT4
37
How often should TFTs be checked during pregnancy
Monthly for first 20 weeks then 2 monthly until term
38
What is the optimum level of TSH in the first trimester
39
What is the optimum level of TSH in the second or third trimester
40
What are some of the risks of untreated hypothyroidism
Increased abortion, preeclampsia, abruption, postpartum, haemorrhage, preterm labour Increased risk of foetal neuropsychological development
41
What are some causes of thyrtoxicosis and pregnancy
Grave's disease TMNG, toxic adenoma Thyroiditis Gestational hCG associated Thyrotoxicosis
42
What hormones can increase thyroxine
TSH and hCG
43
What happen if there is an increase in thyroxine
Suppression of TSH
44
What can hyperthyroidism cause in pregnancy
``` Infertility Spontaneous miscarriage stillbirth thyroid crisis in labour Grave's disease Transient neonatal thyrotoxicosis ```
45
What are some signs that a baby may hyperthyroid
Not good at feeding, failing to put on weight, fidgety
46
What is transient neonatal thyrotoxicosis
When auto-antibodies from the mum have passed to the baby through the placenta and remain in the baby for 4-6 weeks until they are excreted from the baby's body
47
What is the main strategy applied for hyperthyroidism in pregnancy
conservative and supportive management
48
What can be used if hyperthyroidism is unmanageable
Beta blockers | Low dose anti-thyroid drugs
49
What antithyroid drug can be used in the 1st trimester
Propylthiouracil
50
What antithyroid drug can be used in the 2nd or 3rd trimester
Carbimazole
51
Why is carbimazole not used in the 1st trimester
Proven to cause foetal abnormalities
52
Why is propylthiouracil not used in the 2nd and 3rd trimester
Can cause liver damage
53
If TRAb antibodies cross the placenta, what can they cause
Neonatal transient hyperthyroidism
54
When should TRAb antibodies be tested
Ideally third trimester
55
What percentage of postpartum women have postpartum thyroiditis
5%
56
What do patients present with if they have postpartum thyroiditis
small diffuse, non-tender goitre
57
When is the classic time to develop hyperemesis
10th week of pregnancy
58
If a patient still needs thyroxine 1 year after delivery, how likely is it that she will require it life-long
Very likely

SM Endocrine (27 decks)

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