BSC repro phys montemayor and michels

Question 1

What is the main metabolic change in pregnant mothers during first trimester

Answer 1

increased, insulin sensitivity, so increase in fat deposition

Question 2

What is a concern during the first trimester for fetus if mother is hyperglycemic

Answer 2

malformations

cardiac defects

Question 3

What is the main metabolic change in pregnant mothers during 2nd and 3rd trimester

Answer 3

insulin resistance because baby wants all glucose, insulin production increases 2-3x

Question 4

What is the effect of increased human placental growth hormone on GH release

Answer 4

GH decreased because feedback

Question 5

What factors contribute to insulin resistance in pregnant mothers

Answer 5

human placental growth hormone
hPL
progesterone and placental TNF alpha

Question 6

What are the concerns for the fetus if mom has gestational diabetes

Answer 6

neonatal death
overweight macrosomia
shoulder dystocia
clavicular fractures
low APGAR
increased risk DM II
develop hypoglycemia when born

Question 7

What hormones act as anti-insulin, proteolytic and lipolytic

Answer 7

placental hPL and progesterone

maternal prolactin and cortisol

Question 8

What are risk factors for GDM

Answer 8

diabetes in first degree relative
history of glucose intolerance
marked obesity
current glycosuria
Age
ethnic background
previous infant with macrosomia

Question 9

What are the 3 abnormalities that may exist in GDM

Answer 9

insuline resistance
impaired insulin secretion
increased hepatic glucose production

Question 10

How do we Dx GDM

Answer 10

50 mg non fasting glucose challenge
between 24 and 28 weeks gestation
passing is less than 130-140 mg/dL

Question 11

How do we confirm GDM

Answer 11

75 mg and 100 mg oral glucose tolerance test
fasting >90
1 hr>180, 2 hr>155 and 3 hr>140

Question 12

Best Tx for GDM

Answer 12

diet modifications, exercise

and if those don’t help add on insulin therapy

Question 13

When is insulin usually added to Tx for GDM

Answer 13

inadequate glucose control
lack of expected weight gain
patient consistently hungry
fasting blood glucose >95 mg/dL

Question 14

What are the dietary changes for GDM

Answer 14

emphasis on complex carbs and avoidance of simple carbs

Question 15

What percent of women with GDM develop DM II in 5-10 years

Answer 15

50 %

Question 16

What actions of progesterone are essential during first week pregnancy

Answer 16

stimulate glands in oviduct and uterus to secrete nutrients for embryo
prepares uterine endometrium for implantation
inhibits smooth m contraction- maintains myometrial quiescence

Question 17

What is placental abruption

Answer 17

separation of placenta from uterine wall prior to delivery

Question 18

what are risk factors for placental abruption

Answer 18

smoking, diabetes, hypertension, increased maternal age, uterine fibroids, high alcohol consumption during pregnancy

Question 19

What 2 factors facilitate efficient placental exchange of O2

Answer 19

increase fetal Hb [ ]

increased Hb binding affinity(left shift in dissociation curve)

Question 20

what are normal pCO2 levels

Answer 20

greater than 40

Question 21

What causes increases sensitivity to CO2 during pregnancy

Answer 21

progesterone mainly and estrogen
dec medullary resp center set point
increase tidal volume and ventilation

Question 22

what hormone is responsible for acid reflux in pregnancy

Answer 22

progesterone

Question 23

what is the placental enzyme that converts fetal precursors into DHEA and 16 alpha OH DHEA

Answer 23

sulfatase

Question 24

What causes x-linked ichthyosis

Answer 24

x linked steroid sulfatase deficiency

Question 25

what are the 3 main actions of estrogen leading to parturition

Answer 25

increased gap junctions
increased oxytocin R expression
increased PG production

Question 26

What is RU-486 Midepristone

Answer 26

progesterone R blocker that increases uterine sensitivity to PG and oxytocin