Endocrinology in pregnancy Flashcards
when does the follicular growth phase take place
0-12 weeks
What happens after the follicular phase?
ovulation
What is the phase after ovulation and how long does it last?
luteal phase, 16-28 weeks
What is released during follicular growth phase
oestradiol
what is released during the luteal phase?
oestradiol and progesterone
when is there a massive spike in LH during ovarian cycle?
just before ovulation
when the follicle is implanted, what is released? (also thisis what is tested for during pregnancy)
HCG
`what does the corpus luteum release?
progesterone
in the placenta, what 3 things are released?
lactogen, progesterone and oestrogens
what does the pituitary secrete? and what does this hormone do?
prolactin- preps for lactation and encourages breast develpoment
when do LH and FSH both peak during the ovarian cycle?
at ovulation
when does your body temperature suddleny increase during pregnancy??
in the luteal phase
`what do progesterones and hPL cause in mothers?
insulin resistance
if mothers are already predisposed to insulin resistance, what happens to the blood glucose level and then as a result of that?
raised glucose level, resulting in gestational diabetes
when do organs start developing in foetus?
5 weeks (possibly earlier)
what are some complications with type 1 and 2 diabetes in pregnancy?
congenital malformation, prematurity, intrauterine growth retardation
what complications are present in gestational diabetes only?
macrosomia- large babies, polyhydramnios- excess fluid build up, intrauterine death
what are some complications in neonates?
resp distress, hypoglycaemia, hypocalcaemia
what CNS defects can you get in babies? and what is the increased rate having it with diabetes
spina bifida, anencephaly, 5x non diabetic rate?
what are other abnormalities caused by the mother having diabetes during pregnancy?
caudal regression syndrome, ureteric duplication
what is the process of foetal growth and macrosomnia
maternal hyperglycaemia, foetal hyperglycaemia, foetal hyperinsulinaemia- macrosomnia or hypoglycaemia
what happens in the third trimester which is a major growth factor?
baby produces its on insulin
In patients with type 1 and 32 diabetes prior to pregancny what is done to manage these patient?
1- education re good sugar control 2- folic acid 5mg (higher than in normal pregnancy) 3- change from tablets to insulin 4- get eye checks 5- avoid ACEI, statins
management for all diabetes in pregnancy
diabetic diet, good sugar control, monitor HbA1c, BP control, during labour maintain good blood glucose control and provide IV insulin and dextrose
what is the drug treatment for the various diabetes type 1, 2, MODY, GDM
1- insulin, 2- metformin (insulin later? ) 3- glibenclamide, 4- lifestyle, metformin (Insulin:?)
what should you do 6 weeks after pregnancy to ensure resolution of gestational diabetes? If it doesn’t resolve, what is it likely to be?
glucose tolerance test, type 2
what is th risk of getting type 2 diabetes after pregnancy?
50%
when does gestational diabetes usually present
third trimester
what is hyperemesis gravidarum
pregnancy sickness
what are the levels of HCG and TSH/ fT4 in hyperemesis gravidarum
High hCG, most have abnormal TSH, fT4
What does hyperemesis gravdidarum mimic?
hyperthyroidism
in patients with existing hypothyroidism, what do you do to their thyroxine dose during pregnancy?
increase dose by 25micrograms AS SOON AS PREGNANCY KNOWN
what are the risks of untreated hypothyroidism
pre-eclampsia, abortion, postpartum haemorrhage, preterm labour
what are causes of thyrotoxicosis in preganancy?
graves disease, thyroiditis, hyperemesis gravidarum, hyperthyroidism, toxic adenoma
what effects does TSH and hCG have on thyroxine and then TSH?
TSH anf hCG increase thyroxine levels which then suppress TSH release
in TSH and hCG they consist of 2 chains each- 1 I sidentical and 1 is different, which is which?
alpha- identical, b- different
what can hyperthyroidism cause?
infertility, still birth, miscarriage, thyroid crisis in labour, transient neonatal thyrotoxicosis,
what anti thyroid drugs should beprescribes in the relevant trimesters in hyperthyroidism
1st- propylthiouracil
2nd/3rd- carbimazole and b blocker if needed
when should you check for TRA antibodies
3rd trimester
if the antibodies can cross the placenta, what could this cause?
neonatal transient hyperthyroidisn
