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Endocrinology > Endocrine in Pregnancy > Flashcards

Endocrine in Pregnancy Flashcards

1
Q

what are the stages of the of the ovarian cycle

A

menstruation starts
follicular growth
ovulation
luteal function

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2
Q

what happens in follicular growth

A

variable in length

when follicules grow with maturing egg inside them

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3
Q

what hormone is produced in the follicular growth phase

A

oestradiol and oestrogen

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4
Q

what hormone peaks just before ovulation

A

LH- luteinising hormone

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5
Q

what happens in the luteal phase

A

last 14 days

after ovulation, either fertilised egg implants and grows in endometrium or shedding of endometrial wall occurs

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6
Q

what hormones are increased in the luteal phase

A

progesterone and oestradiol

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7
Q

when should you measure progesterone

A

7 days before mentruation (e.g. if cycle is 30 days, 30 - 7 = 23, measure on the 23rd day)

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8
Q

what hormone is increase by a follicle produce

A

oestradiol

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9
Q

what is created when a implanted follicles becomes a fertilised ovum

A

corpus leteum

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10
Q

what hormone is produced when a corpus luteum is produced

A

progesterone

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11
Q

what hormone is produced when a corpus luteum implants

A

HCG

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12
Q

what hormone is measured in a pregnancy test

A

HCG

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13
Q

what hormones does the placenta produce

A

human placenta lactogen ((hPL)
placenta progesterone
placental oestrogens

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14
Q

what pregnancy hormone is produced by the pituitary gland

A

prolactin (lactogen)

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15
Q

what is the role of prolactin

A

develops breast tissue and milk production after delivery

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16
Q

what happens to insulin resistance in pregnancy

A

progesterone and hPL increase insulin resistance

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17
Q

what can result from increased insulin resistance in pregnancy (if predisposed)

A

raised blood glucose causing gestational diabetes

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18
Q

what is the adaptive reason for increased insulin resistance in pregnancy

A

so more glucose ans nutrients go through the placenta to the baby

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19
Q

when does gestational diabetes usually develop

A

in the 3rd trimester as when hormones at greatest concentration

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20
Q

when does foetal organogensis develop

A

starts at 5 week (possibly earlier)

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21
Q

what are the complications seen in pre existing diabetes

A 
congential malformation 
pre maturity 
intra-uterine growth retardation 
macrosomia (>90th centile for size)
polyhydramnios
intrauterine death
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22
Q

what complications are seen in gestational diabetes

A

macrosomia
polyhydramnios
intrauterine death

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23
Q

what is polyhydraminios

A

increases fluid around babies

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24
Q

what are complication seen in neonates from diabetic mothers

A

respiratory distress (immature lungs), hypoglycaemia and hypocalcaemia

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25
Q

why do neonates from diabetic mothers get hypos

A

If mother has high blood sugar at time of delivery- this goes to baby who has normal insulin response to this and stores it. If difficulty feeding then still have high insulin so at risk of hypos

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26
Q

what CNS defects are seen in diabetic pregnancies

A

anecephaly, spina bifida

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27
Q

what skeletal defects are seen in diabetic pregnancies

A

caudal regression syndrome

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28
Q

what GI/GU defects are seen in diabetic pregnancies

A

utereric duplication (duplication of collecting duct if kidney)

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29
Q

what causes macrosomia in diabetic pregancies

A

maternal hyperglycaemia- foetal hyperglycaemia- foetal hyperinsulinaemia

(insulin produced by foetus in 3rd trimester is a major growth factor

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30
Q

what defines macrosomia

A

new born greater than 90 percentile or more than 4 kg

31
Q

what should be done pre pregnancies for both type 1 and type 2

A

3 months prior to conception

counselling- good sugar control to limit congenital malformation

folic acid (5mg instead of 400 micrograms for diabetics)

consider changes from tablets to insulin

32
Q

what diabetic complication is accelerated in pregnancy

A

retinopathy

33
Q

what BP meds should you avoid in pregnancy

A

ACE inhibitor, statin (use labetalol, nifedipine, methyldopa instead)

34
Q

what are the blood pressure targets for diabetes in pregnancy

A

pre-meal <4- 5.5 mmol/l 2h post meal <6.5-7 mmol/l

35
Q

what should be giving for BG during labour

A

IV insulin and IV dextrose

36
Q

what is the pregnancy management for T1DM

A

insulin

37
Q

what is the pregnancy management for T2DM

A

metformin, will probably need insulin later

38
Q

what is the pregnancy management for gestation diabetes

A

lifestyle (reduce carbs and calories), metformin, may need insulin

39
Q

why is it important to check 6 week post natal fasting glucose or GTT in GDM

A

to ensure resolution of GDM- if not resolved by a year- may turn into T2DM

40
Q

what are the long term implications of GDM

A

50% resolve
50% develop T2DM after 10-15 yrs (higher is obese)
<5% T1DM (slim)

41
Q

how do you prevent T2DM GDM

A 
keep healthy weight
healthy diet 
(low refined sugar, predominant starch, low sat fat, low energy foods)
aerobic exercise 
annual fasting glucose
42
Q

true or false: Gestational diabetes usually presents in the first trimester

A

false- usually in third

43
Q

true or false: Methyldopa in pregnancy is the preferred treatment for blood pressure

A

false labetalol

44
Q

true or false: Maternal hyperinsulinaemia causes increased foetal growth?

A

False- FOETAL hyperinsulinaemia causes the increased growth

45
Q

true or false: Implanted fertilised ovum cells secretes HCG?

A

True what you measure in pregnancy test

46
Q

true or false: After a pregnancy with GDM, the risk of type 2 diabetes is 25% within the next 10 years?

A

False 50%

47
Q

how does hypo and hyper thyroidism affect fertility

A

anovulatory cycles- reduced fertility

48
Q

why are thyroid hormones important in pregnancy

A

maternal thyroxine important for neonatal development (especially CNS and brain)

49
Q

why do thyroid problems gets worse in pregnancy

A

increased demand on thyroid during pregnancy

plasma protein binding increases (need to thyroxine during pregnancy to populate these)

50
Q

why does the thyroid increase in size during pregnancy

A

increased T4 production to maintain normal concentration

51
Q

what happens to patients already on thyroxine in pregnancy

A

relative thyroid deficiency (thyroid cant meet demands)

52
Q

what should you do to meds in pre exisiting

hypothyroidism during pregnancy

A

increase thyroxine dose by 25 mcg as soon as pregnancy suspected

53
Q

what should the TSH goal be for patients in thyroxine in pregnancy

A

<3 mU/I

measure TFTs months for first 20 weeks then 2 monthly until term

54
Q

what are the risks of untreated hypothyroidism in pregnancy

A

increased abortion, preeclampsia, abruption, postpartum haemorrhage, preterm labour, foetal neuropsychological development, increased risk of low IQ

55
Q

what role does hCG have on the thyroid

A

hCG - increases thyroxine - suppress TSH

56
Q

what causes morning sickness (hyperemesis gravidarum)

A

hCG

57
Q

what does hyperemesis mimic biologically

A

hyperthyroidism

58
Q

how do you distinguish hyperemesis from hyperthyroidism

A

hyperemesis resolves 20 weeks gestation

hyperthyroid:
- nausea and vomiting - tachycardia - warm and sweaty - lack of wt gain

59
Q

when should you treat Gestational hCG-asscociated Thyrotoxicosis

A

if persists past 20 weeks

60
Q

how does hyperthyroidism affect reproduction

A

Infertility- lack of periods and ovulatory cycle
Spontaneous miscarriage
Stillbirth
Thyroid crisis in labour- esp in c sections

Transient Neonatal thyrotoxicosis

61
Q

what maternal hyperthyroidism cause in a new born

A

babies thyroid to be overactive in first few weeks- fidgety, weight loss

62
Q

what can cause thyrotoxucosis in pregnancy

A

Graves’ disease
toxic multinodular goitre, toxic adenoma
Thyroiditis

63
Q

what is the management for hyperthryoid in pregnancy

A

wait and see if hyperemesis (will settle)
graves may also settle as pregnancy suppresses autoimmunity

Beta blockers needed
LOSE DOSE anti-thyroid drugs
-propylthiouracil 1st trimester
-carbimazole 2/3rd trimester

64
Q

explain the prescription of anti thyroid drugs in pregnancy

A

use propylthioyracil in first trimester as less risk of embryopathy (scalp and GI abnormalities, choanal and oesophageal atresia)

Risks for liver toxicity with PTU much greater than carbimazole- why you switch after first trimester

65
Q

what is the relevance of TRAb antibodies in pregnancy

A

if present alert neonatalogist

TRAb antibodies can cross the placenta and cause neonatal transient hyperthryoidism

66
Q

what is post partum thyroiditis

A

2-4 months become thyroid over active- transient thyrotoxic

Then 4-10 months becomes underactive- Hypothyroid

small diffuse nontender goitre

should return to normal at 10-12 months

67
Q

what should you give in post partum thyroiditis

A

Don’t give carbinazole in over active phase as will make crash down a lot worse
If crash down produces symptoms then give thyroxine

68
Q

what is post partum depression closely linked to

A

post partum hypothyroidism

69
Q

what happens if post partum thyroiditis lasts longer than 1 year

A

becomes persistent hypothyroidism

70
Q

What is the thyroid status of this pregnant woman at 10 weeks gestation?fT4 22 (10-20); TT3 3.4 (up to 2.6); TSH 0.2 (0.4-4)

A

hyperemesis

71
Q

true or false: All antithyroid drugs should be avoided in pregnancy

A

False (avoid in first trimester if you can, rest of pregnancy okay)

72
Q

true or false: A woman in early pregnancy with known hypothyroidism should double her thyroxine dose when she finds she is pregnant

A

false- increase by 25 micrograms

73
Q

true or false: If a patient still needs thyroxine one year after delivery she is likely to need it life-long

A

true

Endocrinology (46 decks)

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