Endocrinology in pregnancy

Question 1

when does the follicular growth phase take place

Answer 1

0-12 weeks

Question 2

What happens after the follicular phase?

Answer 2

ovulation

Question 3

What is the phase after ovulation and how long does it last?

Answer 3

luteal phase, 16-28 weeks

Question 4

What is released during follicular growth phase

Answer 4

oestradiol

Question 5

what is released during the luteal phase?

Answer 5

oestradiol and progesterone

Question 6

when is there a massive spike in LH during ovarian cycle?

Answer 6

just before ovulation

Question 7

when the follicle is implanted, what is released? (also thisis what is tested for during pregnancy)

Answer 7

HCG

Question 8

`what does the corpus luteum release?

Answer 8

progesterone

Question 9

in the placenta, what 3 things are released?

Answer 9

lactogen, progesterone and oestrogens

Question 10

what does the pituitary secrete? and what does this hormone do?

Answer 10

prolactin- preps for lactation and encourages breast develpoment

Question 11

when do LH and FSH both peak during the ovarian cycle?

Answer 11

at ovulation

Question 12

when does your body temperature suddleny increase during pregnancy??

Answer 12

in the luteal phase

Question 13

`what do progesterones and hPL cause in mothers?

Answer 13

insulin resistance

Question 14

if mothers are already predisposed to insulin resistance, what happens to the blood glucose level and then as a result of that?

Answer 14

raised glucose level, resulting in gestational diabetes

Question 15

when do organs start developing in foetus?

Answer 15

5 weeks (possibly earlier)

Question 16

what are some complications with type 1 and 2 diabetes in pregnancy?

Answer 16

congenital malformation, prematurity, intrauterine growth retardation

Question 17

what complications are present in gestational diabetes only?

Answer 17

macrosomia- large babies, polyhydramnios- excess fluid build up, intrauterine death

Question 18

what are some complications in neonates?

Answer 18

resp distress, hypoglycaemia, hypocalcaemia

Question 19

what CNS defects can you get in babies? and what is the increased rate having it with diabetes

Answer 19

spina bifida, anencephaly, 5x non diabetic rate?

Question 20

what are other abnormalities caused by the mother having diabetes during pregnancy?

Answer 20

caudal regression syndrome, ureteric duplication

Question 21

what is the process of foetal growth and macrosomnia

Answer 21

maternal hyperglycaemia, foetal hyperglycaemia, foetal hyperinsulinaemia- macrosomnia or hypoglycaemia

Question 22

what happens in the third trimester which is a major growth factor?

Answer 22

baby produces its on insulin

Question 23

In patients with type 1 and 32 diabetes prior to pregancny what is done to manage these patient?

Answer 23

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

Question 24

management for all diabetes in pregnancy

Answer 24

diabetic diet, good sugar control, monitor HbA1c, BP control, during labour maintain good blood glucose control and provide IV insulin and dextrose

Question 25

what is the drug treatment for the various diabetes type 1, 2, MODY, GDM

Answer 25

1- insulin, 2- metformin (insulin later? ) 3- glibenclamide, 4- lifestyle, metformin (Insulin:?)

Question 26

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?

Answer 26

glucose tolerance test, type 2

Question 27

what is th risk of getting type 2 diabetes after pregnancy?

Answer 27

50%

Question 28

when does gestational diabetes usually present

Answer 28

third trimester

Question 29

what is hyperemesis gravidarum

Answer 29

pregnancy sickness

Question 30

what are the levels of HCG and TSH/ fT4 in hyperemesis gravidarum

Answer 30

High hCG, most have abnormal TSH, fT4

Question 31

What does hyperemesis gravdidarum mimic?

Answer 31

hyperthyroidism

Question 32

in patients with existing hypothyroidism, what do you do to their thyroxine dose during pregnancy?

Answer 32

increase dose by 25micrograms AS SOON AS PREGNANCY KNOWN

Question 33

what are the risks of untreated hypothyroidism

Answer 33

pre-eclampsia, abortion, postpartum haemorrhage, preterm labour

Question 34

what are causes of thyrotoxicosis in preganancy?

Answer 34

graves disease, thyroiditis, hyperemesis gravidarum, hyperthyroidism, toxic adenoma

Question 35

what effects does TSH and hCG have on thyroxine and then TSH?

Answer 35

TSH anf hCG increase thyroxine levels which then suppress TSH release

Question 36

in TSH and hCG they consist of 2 chains each- 1 I sidentical and 1 is different, which is which?

Answer 36

alpha- identical, b- different

Question 37

what can hyperthyroidism cause?

Answer 37

infertility, still birth, miscarriage, thyroid crisis in labour, transient neonatal thyrotoxicosis,

Question 38

what anti thyroid drugs should beprescribes in the relevant trimesters in hyperthyroidism

Answer 38

1st- propylthiouracil

2nd/3rd- carbimazole and b blocker if needed

Question 39

when should you check for TRA antibodies

Answer 39

3rd trimester

Question 40

if the antibodies can cross the placenta, what could this cause?

Answer 40

neonatal transient hyperthyroidisn