Pregnancy

Question 1

What is the corpus luteum?

Answer 1

Bundle of cells in the ovary

Question 2

What does the corpus luteum secrete?

Answer 2

Progesterone

Question 3

If implantation of a fertilised egg occurs what is produced?

Answer 3

HcG

Question 4

What hormone does the Ovum produce?

Answer 4

Oestradiol

Question 5

What hormones does the placenta produce?

Answer 5

Human placental lactogen
Placental progesterone
Placental oestrogen

Question 6

What does human placental lactogen do?

Answer 6

Increases the breast size

Development of ducts within breast tissue

Question 7

Which to hormones trigger increased insulin resistance in pregnancy?

Answer 7

Progesterone

HPL Human placental lactogen

Question 8

What is the functional benefit of an increased insulin resistance in pregnancy?

Answer 8

It diverts nutrients away from the mother towards the child was glucose isn’t taken up by the mothers tissues.

Question 9

Why is an increased insulin resistance an issue in pregnancy in developed nation?

Answer 9

It was beneficial when there wasn’t an excess

Raised blood glucose prior to pregnancy leads to gestational diabetes.

Question 10

In which trimester does gestational diabetes usually occur?

Answer 10

3rd trimester

Question 11

Why does gestational diabetes usually occur in the third trimester?

Answer 11

Placenta undergoes rapid growth

• increased HPL and progesterone secretion
• increased resistance

Question 12

At what stage do foetal organs start to develop?

Answer 12

Around 5 weeks

Question 13

What hormone is used in pregnancy tests?

Answer 13

HCG

Question 14

What does diabetes increase the risk of in pregnancy?

Answer 14

Congenital malformations
Prematuritiy
Intrauterine growth retardation
Macrosomia - large babies in 90th gentile
Intrauterine death

Question 15

Why does an increased insulin level lead to larger babies?

Answer 15

Insulin is a major growth factor in the foetus

Question 16

What does gestational diabetes increase the risk off in neonates?

Answer 16

Respiratory failure - immature lungs
Hypoglycaemia
Hypocalcaemia

Question 17

Why are neonates of mothers with gestational diabetes more likely to develop hypoglycaemia?

Answer 17

They are exposed to consistent high blood glucose levels, as a result they over produce insulin.
After birth they continue to produce same levels of insulin but blood glucose is massively reduced.

Question 18

What CNS risk factors do mothers with gestational diabetes expose their child to?

Answer 18

5x risk of spina bifida

Question 19

What other risk factors do mothers with gestational diabetes expose their child to?

Answer 19

200x risk of caudal regression syndrome

20x risk of uterine duplication

Question 20

In type I and II what is most important things to do prior to pregnancy?

Answer 20

Counselling on good sugar control and diabetic diet

Folic acid

Question 21

What is the dose of folic given in diabetes in contrast to non diabetics?

Answer 21

5mg

400μg

Question 22

What other medication should be given in diabetics?

Answer 22

Aspirin 150mg at 12 weeks

Question 23

What medication should pregnant diabetics be taken off?

Answer 23

ACE and statins

Question 24

What medication can be used in the place of ACE and statins in pregnant diabetes?

Answer 24

Labetalol - beta blocker

Nifedipine - Calcium channel blocker

Question 25

Why should pregnant diabetics undergo frequent eye reviews?

Answer 25

10/20/30 weeks | Pregnancy accelerates retinopathy

Question 26

What should be considered in a type I and II diabetics during pregnancy?

Answer 26

Switch to insulin | Metformin is okay for type 2

Question 27

What is the pre meal glucose target for pregnancy?

Answer 27

4-5.5

Question 28

What is the 2 hour post meal blood glucose target in pregnancy?

Answer 28

<6.5-7

Question 29

What should be monitored regularly throughout pregnancy in diabetics?

Answer 29

HB1Ac | Blood pressure

Question 30

During labour what is a common practise in diabetics?

Answer 30

IV infusion of insulin and dextrose | Allows close control of blood glucose levels

Question 31

Why is it important to have good control of glucose during pregnancy?

Answer 31

Due to stress adrenaline cortisol and growth hormones are released all of which lead to massive fluctuations in blood glucose levels.

Question 32

When is fasting blood glucose measured after pregnancy?

Answer 32

6 weeks

Question 33

If fasting glucose at 6 weeks is high what is diagnosis?

Answer 33

Undiagnosed type II diabetic

Question 34

What percentage of patients with gestational diabetes go onto have type II?

Answer 34

50% | 80% if BMI over 30

Question 35

If a patient is thin and had gestational diabetes what is could it be?

Answer 35

Type I diabetes | 5% of GDM are acutely type 1

Question 36

What is maternal thyroxine important in?

Answer 36

Development of foetal brain

Question 37

Why do mothers thyroid glands grow?

Answer 37

Increased demand means increased T4 production | Increase in size to meet the demand

Question 38

What is the target for TSH blood levels in pregnancy?

Answer 38

<3 mU/1

Question 39

What is the risk of hypothyroidism in pregnancy?

Answer 39

Increased abortions and post partum haemorrhage | Average reduction in child IQ by 7

Question 40

As soon as pregnancy is suspected how should the dose of thyroxine be altered?

Answer 40

increased by 25mg

Question 41

Hyperemesis

Answer 41

Morning sickness

Question 42

Why does hyperemesis occur?

Answer 42

hCG causes an increase in thyroxine | Suppress TSH

Question 43

What should be looked for if suspecting hyperemesis?

Answer 43

Low TSH | -ve TRab

Question 44

Why should you wait for as long as possible before treating hyperthyroidism in pregnancy?

Answer 44

Hyperemesis and hyperthyroidism present very similarly | After 20 weeks hCG levels decrease so symptoms would resolve in hyperemesis

Question 45

What pregnancy risks are associated with hyperthyroidism?

Answer 45

Still birth Thyroid crisis Spontaneous miscarriage

Question 46

If TRab antibodies are positive what is the issue?

Answer 46

Transient Neonatal Thyrotoxicosis TRab are able to cross the placenta Alert paeds

Question 47

What is initial treatment for first 20 weeks in suspected hyperthyroidism?

Answer 47

Symptomatic Anti-emetic B-Blockers

Question 48

If hyperthyroidism is confirmed what is 1st line drug?

Answer 48

Propylthiouracil 1 trimester | Carbimazole 2 and 3 trimester

Question 49

Post partum what is the risk with hypothyroidism?

Answer 49

Linked to postnatal depression