Pregnancy Flashcards Preview

Y2 - Endocrine > Pregnancy > Flashcards

Flashcards in Pregnancy Deck (20)
Loading flashcards...
1
Q

What is the sequence of events in the menstrual cycle?

A

Hypothalamus releases GnRH which stimulates the pituitary to secrete LH and FSH
FSH stimulates growth of follicles in the ovary
The growing follicle secretes oestrogen
LH levels rise sharply, stimulating ovulation
The remnant of the follicle becomes the corpus luteum, which secretes progesterone
If fertilisation does not occur the ovum is expelled with uterine lining in menstruation

2
Q

How does blood glucose and insulin resistance change in pregnancy?

A

Placental progesterones cause increase in insulin resistance in the mother so that blood sugar increases and can be transferred to the foetus instead of the mother

3
Q

What causes gestational diabetes?

A

If the mother is predisposed to diabetes, the increased blood glucose levels that physiologically occurs can result in gestational diabetes

4
Q

When does foetal organogenesis start?

A

5 weeks - possibly earlier

5
Q

What are the complications associated with T1 and T2 diabetes in pregnancy?

A

Congenital malformation
Prematurity
Intra-uterine growth retardation

6
Q

What are the complications associated with GDM?

A

Macrosomia (baby in 90th percentile for size)
Polyhydraminos (increased fluid around the baby)
Intrauterine death

7
Q

What complications associated with diabetes in pregnancy can occur in the neonate?

A
Respiratory distress due to immature lungs
Hypoglycdaemia
Hypocalcaemia
CNS defects (anencephaly, spina bifida)
Skeletal abnormalities
Genital and GI abnormalities
8
Q

How can maternal hyperglycaemia lead to neonatal hypoglycaemia?

A

Maternal hyperglycaemia lead to foetal hyperglycaemia and hyperinsulinaemia, which puts the baby at risk of hypoglycaemia when it is cut off from the mother’s glucose supply

9
Q

How can maternal hyperglycaemia lead to macrosomia?

A

Maternal hyperglycaemia lead to foetal hyperglycaemia and hyperinsulinaemia. The foetus produces its own insulin in the 3rd trimester,, which is a major growth factor so hyperinsulinaemia leads to increased growth

10
Q

What is the pre-pregnancy management for diabetic women wanting to conceive?

A
Good sugar control pre-conception
Folic acid 5mg (much higher dose than normal)
Consider change form tablets to insulin
Regular eye checks
Avoid ACEI 
Start aspirin
11
Q

What is the management during pregnancy for diabetic women?

A

Diabetic diet
Aim for good blood sugar control
Use continuous blood glucose monitoring
Monitor HbA1c
Monitor BP
maintain good blood glucose during labour with IV insulin and dextrose
Insulin in T1, metformin/insulin in T2, lifestyle and metformin/insulin in GDM

12
Q

What is the management post-pregnancy for GDM?

A

6 week postnatal fasting glucose or GTT to ensure resolution of DM - if still showing raised glucose they have T2DM

13
Q

What proportion of women that have GDM go on to develop T2DM after 10-15 years?

A

50%

Nearer 80% for those obese

14
Q

What advise is given to try and prevent diabetes after GDM?

A

Keep weight as low as possible
Healthy diet
Aerobic exercise
Annual fasting glucose

15
Q

How does thyroid disease affect pregnancy?

A

Hypo and hyperthyroidism cause anovulatory cycles - reducing fertility
Maternal thyroxine is important for neonatal development so demand on thyroid increases during pregnancy - problem in thyroid disease

16
Q

How does the thyroid cope with increased demand in pregnancy?

A

Increases in size

Increased T4 production to maintain normal concentration

17
Q

What management is needed in hypothyroid patients who get pregnant?

A

Increase thyroxine dose as soon as pregnancy suspected

Check TSTs monthly

18
Q

What complications can occur in untreated hypothyroidism in pregnancy?

A
Pre-eclampsia 
Abruption
Post-partum haemorrhage
Preterm labour
Abnormal foetal neuropsychological development
19
Q

What pregnancy-related complications can occur in hyperthyroidism?

A
Infertility/amenorrhoea
Spontaneous miscarriage
Stillbirth
Thyroid crisis in labour
Transient neonatal thyrotoxicosis
20
Q

What management is done for hyperthyroid patients in pregnancy?

A

Wait and see - may settle, check TRAb antibodies
Beta blockers if needed
low dose anti-thyroid drugs (PTU 1st trimester)