29/3 Flashcards
Hyperthryoidism in pregnancy
Carbimazole and PTU – compete with tyrosyl residues of thyroglobulin for iodine -> inhibit TPO
PTU preferred in pregnancy – lower placental transfer and excretion in breast milk
Radio-iodine contraindicated
Aim for TFTs upper 1/3 normal
Carbimazole
aplasia cutis, choanal atresia, gastrointestinal anomalies, and abdominal wall defects.
Iron homeostasis in pregnancy
Increase in hCG which stimulates the thyroid gland
Increase in urinary iodide excretion, leading to decrease in plasma iodine
Increase in T4-binding globulin (TBG) during 1st trimester, leading to increase binding of T4
= increased demand for LT4 treatment during pregnancy
Dx of diabetes
PRE-DIABETES 6-8-42
HbA1c
42-47 mmol/mol
OGTT
7.8-11.0 mmol/L
Fasting plasma glucose
6.1 – 6.9 mmol/L
DIABETES 7-11-48
HbA1c
≥48 mmol/mol
OGTT
≥11.0 mmol/L
Fasting plasma glucose
≥7.0 mmol/L
Symptomatic → 1x HbA1c or fasting plasma glucose can be used
Asymptomatic → repeat test (ideally same test)
HbA1c that you would not advise conception at
86 mmol/mol
Plasma glucose levels to aim for in preg
Aim for fasting plasma glucose level of:
5–7 mmol/L on waking
4–7 mmol/L before meals at other times of the day
Monitor HbA1c monthly
Aim <48mmol/mol
Sodium valproate tetatogenicity
Cardiac anomalies, spina bifida, developmental delay, hypospadias
Men: Do not donate sperm during valproate Tx and for 3/12 after stopping
AED that effect neurodevelopment
Phenobarbital; phenytoin
Topiramate teratogenicity
Hypospadias, oral clefts
How long after MMR vaccine to avoid pregnancy for ?
4 weeks
Hep B transmission rate
1st trimester = 10%
3rd trimester = 90%
LH pulses in menstrual cycle
Beginning follicular phase = 1-2 hours
Mid cycle surge (surge mode)
4 hours luteal phase
LH pulses reduced in what condition
Prolacinaemia
LH pulses increased in what condition
PCOS
Chromosome deletions
Digeorge - 22
Criduchat - 5
Where in ant pit is hypothalamus
infundib/ arcuate nucleus
When to give acic in vzv
> 20 /40
rash within 24 hours
Toxplasmosis rx
Spiramycin
If risk of baby having then –> sulfadiazine / pyridine
Which congenital infective thing causes jaundice
CMV
Interstitial keratitis
scarring of cornea
late syphilis
Group B Streptococcus
S. agalactiae
High morbidity – blindness, mental retardation
Prophylactic Abx (IV benzylpenicillin) peri-partum if:
GBS in previous pregnancy
GBS found incidentally in urine/vagina
PROM at term
Preterm ROM (<37/40) w/ known GBS
Intrapartum fever
Drugs that dont cross the placenta
Heparin
Tubocurarine
Insulin
Abx to avoid in preg
Tetracyclines (e.g. Doxycycline)
→ permanent discoloration of teeth
→ impaired bone growth (chelate Ca2+)
Sulphonamides (e.g. Septrin)
Inhibit folate metabolism
Benzoic acid → folate (sulphonamides)
Folate → tetrahydrofolate by dihydrofolate reductase (trimethoprim; methotrexate)
Kernicterus (displace bilirubin from protein)
Abx caution in preg
Aminoglycosides (e.g. streptomycin, gentamicin)
→ nephrotoxic (tubular destruction)
→ ototoxic (8th CN nerve damage)
Quinolones
Permanent arthropathy
Nitrofurantoin
Neonatal haemolysis
Chloramphenicol
Grey baby syndrome (cardiovascular collapse) if given close to term
Isotretinoin embryopathy
CNS: microcephaly, hydrocephaly, Dandy Walker-malformation
Craniofacial: abnormalities/absent external ear, microphthalmia
Cardiac: Aortic arch defect
Thymic aplasia
Lithium teratogenicity
Ebstein’s anomaly (right ventricular outflow tract obstruction)
Complete molar on uss
5-7 weeks: polypoid mass
>8 weeks: cystic appearances of villous tissue, no gestation sac/fetus
>13 weeks: ‘bunch of grapes’ appearance
Oestrogen synthesis in pregnancy
The primary oestrogen in pregnancy is oestriol, the precursors of which are synthesised by the fetal adrenal cortex and liver (DHEA and 16-hydroxy DHEA respectively). Trophoblast cells aromatise 16-hydroxy DHEA to produce Oestriol.
Cell shrinkage
Cell cytoplasm condenses and organelles tightly packed
Pyknosis
Chromatin condensation
Blebbing
Small blebs in the plasma membrane form
Budding
Formation of apoptotic bodies: portions of cytoplasm and intact organelles with or without DNA
Budding prevents release of cellular contents into the surrounding interstitium
Plasma membrane remains intact
Phagocytosis
Macrophages quickly engulf apoptotic bodies
They do not release cytokines so there is no inflammatory response
Emergency abortion which HSA cert and order etc
HSA2 (Certificate B) Order 2
Which cells produce AMH
Sertoli cells
Germ layer origins of the reproductive system:
Ectoderm:
Epithelia of the distal urethra, penis and vulva
Intermediate mesoderm:
Urogenital system (excluding epithelium)
Pronephros
Paramesonephric duct
Mesonephric duct
Endoderm:
Epithelia of the urogenital system
Barr body
Klinefelter syndrome (XXY) where there is an additional X chromosome - not usually in XY
None in Turners XO when usually in XX
Meta-analysis
a technique in which results from a number of studies that are similar in nature are gathered to give one overall estimate of the effect.
The formal steps include
(1) decide on effect of interest,
(2) check for statistical homogeneity,
(3) estimate the average effect of interest with CIs,
(4) interpret the results and present the findings (forest plot).
The advantages include
refinement and reduction,
efficiency,
generalizability and consistency,
reliability,
power and precision.
The disadvantage include
publication bias,
clinical heterogeneity,
quality differences,
lack of independence of study subjects.
systemic review vs meta-analysis
A systematic review synthesizes evidence on a specific topic using a rigorous, transparent methodology,
—> A qualitative or quantitative summary of the findings, often including a narrative synthesis of the evidence
while a meta-analysis is a statistical technique used within a systematic review to combine data from multiple studies to obtain a more precise estimate of an effect
Refinements of simple randomization
stratified randomization (controls for effects of factors),
blocked randomization (assures treatment groups to be equal-sized),
cluster randomization (allocates groups of patients)
response-adaptive randomization (also termed outcome-adaptive randomization) in which the probability of being assigned to a group increases if the responses of the prior patients is deemed favorable.
Allocation bias and confounding are avoided as much as possible to maximize efficiency of the study.
