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SM Endocrine > Endocrinology of Pregnancy > Flashcards

Endocrinology of Pregnancy Flashcards

1
Q

What days does follicular growth occur

A

1 -9

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2
Q

At what day in the ovarian cycle does LH spike

A

13-15

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3
Q

What days does occupation occur

A

usually 15

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4
Q

What is the fate of the ovum

A

Ovum to corpus luteum to placenta

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5
Q

What hormones does the placenta produce

A

Human placental lactogen
placental progesterone
palcental oestrogens

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6
Q

What does the corpus luteum produce

A

Progesterone

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7
Q

What does the ovium produce

A

Oestradiol

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8
Q

What hormone does the pituitary gland produce that is particularly important to pregnancy

A

Prolactin (lactogen)

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9
Q

Why does gestational diabetes occur

A

Hormones cause an increase in insulin resistance

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10
Q

What 2 hormones can cause an increase in insulin resistance in the mother

A

Progesterones and hPL

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11
Q

When does gestational diabetes occur in pregnancy

A

The 3rd trimester (28 weeks)

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12
Q

When does foetal organogenesis occur

A

5 weeks (around the time the mother realises she has missed a period and notices she might be pregnant)

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13
Q

What are 6 complications in pregnancy for mothers with either type 1 or type 2 diabetes

A 
congenital malformation
prematurity
intra-uterine growth retardation (IUGR) 
Macrosomia 
Polyhydramnios
Intrauterine death
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14
Q

What complications can occur in gestational diabetes

A

Macrosomia
Polyhydramnios
Intrauterine death

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15
Q

What is polyhydramnios

A

fluid around the baby resulting in premature death and early delivery

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16
Q

what are some of the complications in a neonate of a mother with diabetes

A

Respiratory distress - immature lungs
Hypoglycaemia
Hypocalcaemia

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17
Q

Why would a neonate end up hypoglycaemic rather than hyperglycaemic

A

The pancreas has had to secrete more insulin during development due to the mothers increased glucose level. Now there is a normal glucose level but still too much insulin..

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18
Q

What part of the spine is affected by caudal regression syndrome

A

Lumbar spine

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19
Q

What patients are affected by caudal regression syndrome

A

Babies to mothers with diabetes. Unusual outside diabetes

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20
Q

What is a major growth factor for a foetus

A

When it produces its own insulin in the 3rd trimester

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21
Q

How can we manage patients with diabetes

A

Pre-pregnancy counselling and ensuring good glycemic control
Folic acid 5mg
Regular eye checks
Avoid ACEI an statins

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22
Q

What does folic acid do

A

Reduces the risk of CNS congenital malformations

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23
Q

What is the dose for a non-diabetic pregnant woman and a diabetic pregnant woman

A

400micrograms for non-diabetic

5milligrams for diabetic

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24
Q

What drugs can be used to control blood pressure in pregnancy

A

Labetalol
Nifedipine
Methyl dopa

25
Q

How can we maintain good blood glucose during labour

A

IV insulin and IV dextrose

26
Q

How often should blood sugars be monitored during pregnancy

A

pre-meal
post-meal and pre bed
some will do one during the night as well

27
Q

What drugs can be used to control glucose levels during pregnancy

A

Insulin
Metformin
Glibenclamide

28
Q

What type of diabetes is indicative of glibenclamide

A

MODY

29
Q

When should a woman who has had gestational diabetes be tested again to ensure the blood glucose has returned to normal

A

6 weeks post natal

30
Q

If the glucose levels have not returned to normal after 6 weeks, what does this indicate

A

Either type 1 or Type 2 diabetes

31
Q

How can we prevent diabetes after gestational diabetes

A

Keep weight as low as possible
Healthy diet
Aerobic exercise
Annual fasting glucose

32
Q

Foetal hyperinsulinaemia causes increased foetal growth

A

True

33
Q

What is the risk of type 2 diabetes in a mother who developed gestational diabetes within 10 years after the baby has been born

A

50%

34
Q

What is maternal thyroxine particularly important for

A

Neonatal development

35
Q

What is the usual increase in the dose of thyroxine in a pregnant lady already on thyroxine

A

25mcg

36
Q

What are some normal findings of thyroid tests during pregnancy

A

Low TSH

increased fT4

37
Q

How often should TFTs be checked during pregnancy

A

Monthly for first 20 weeks then 2 monthly until term

38
Q

What is the optimum level of TSH in the first trimester

A
39
Q

What is the optimum level of TSH in the second or third trimester

A
40
Q

What are some of the risks of untreated hypothyroidism

A

Increased abortion, preeclampsia, abruption, postpartum, haemorrhage,
preterm labour
Increased risk of foetal neuropsychological development

41
Q

What are some causes of thyrtoxicosis and pregnancy

A

Grave’s disease
TMNG, toxic adenoma
Thyroiditis
Gestational hCG associated Thyrotoxicosis

42
Q

What hormones can increase thyroxine

A

TSH and hCG

43
Q

What happen if there is an increase in thyroxine

A

Suppression of TSH

44
Q

What can hyperthyroidism cause in pregnancy

A 
Infertility 
Spontaneous miscarriage 
stillbirth 
thyroid crisis in labour 
Grave's disease 
Transient neonatal thyrotoxicosis
45
Q

What are some signs that a baby may hyperthyroid

A

Not good at feeding, failing to put on weight, fidgety

46
Q

What is transient neonatal thyrotoxicosis

A

When auto-antibodies from the mum have passed to the baby through the placenta and remain in the baby for 4-6 weeks until they are excreted from the baby’s body

47
Q

What is the main strategy applied for hyperthyroidism in pregnancy

A

conservative and supportive management

48
Q

What can be used if hyperthyroidism is unmanageable

A

Beta blockers

Low dose anti-thyroid drugs

49
Q

What antithyroid drug can be used in the 1st trimester

A

Propylthiouracil

50
Q

What antithyroid drug can be used in the 2nd or 3rd trimester

A

Carbimazole

51
Q

Why is carbimazole not used in the 1st trimester

A

Proven to cause foetal abnormalities

52
Q

Why is propylthiouracil not used in the 2nd and 3rd trimester

A

Can cause liver damage

53
Q

If TRAb antibodies cross the placenta, what can they cause

A

Neonatal transient hyperthyroidism

54
Q

When should TRAb antibodies be tested

A

Ideally third trimester

55
Q

What percentage of postpartum women have postpartum thyroiditis

A

5%

56
Q

What do patients present with if they have postpartum thyroiditis

A

small diffuse, non-tender goitre

57
Q

When is the classic time to develop hyperemesis

A

10th week of pregnancy

58
Q

If a patient still needs thyroxine 1 year after delivery, how likely is it that she will require it life-long

A

Very likely

SM Endocrine (27 decks)

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