endocrinology of pregnancy (thyroid) Flashcards
what happens in days 1-4 of period cycle
menstruation
when does ovulation occur and what triggers it
day 15 - after LH surge
when and what is the luteal phase
day 15-28, helps uterus prepare for pregnancy.
what is the ovum and what does it secrete
egg - oestradiol
what is the corpus luteum and what does it secrete
clump of cells made from follicle of released egg - progesterone
what does an implanted fertilised ovum secrete
HCG - used in pregnancy test
what does the placenta secrete
human placental lactogen (hPL), human progesterone, oestrogen
what causes physiological response causes raised blood glucose in pregnancy and what will this cause some women to develop if predisposed
progesterone and hPL make mother slightly insulin resistant - can cause gestational diabetes
what complications can occur in pregnancy due to diabetes (8)
malformation, premature, intra-uterine growth retardation, macrosomia (huge baby), polyhdramnios (excess fluid, fatal), spina bifida, caudal regression syndrome, ureteric duplications
which pregnancy complication is almost exclusive to diabetes
caudal regression syndrome
what complications can occur in newborns as a result of diabetes
resp distress, foetal hypoglycaemic + fits (hyperinsulinaemia)
when does gestational diabetes present (GDM)
3rd trimester
what management is given in diabetic mothers
sugar control and 5mg folic acid first 3 months of pregnancy
what is given IV to diabetic mothers in labour
IV insulin and dextrose
what drug treatment is given for T1DM, T2DM and GDM
1: insulin, 2: metformin (+insulin) 3: lifestyle (+metformin)
when does GDM considered to be T2DM
if it doesn’t resolve after pregnancy
what present of mothers who have GDM go in to develop T2DM
50%
if pregnant and hypothyroidism what is done immediately
increase thyroxine by 25mg
what risks are there in hypothyroidism and pregnancy to mother and baby
pre-eclampsia, abortion, preterm labour, neurological underdevelopment - babies have reduced IQ
why is hyperthyroidism hard to diagnose in pregnancy
high HCG increases thyroxine (T4) which also lowers TSH
what causes morning sickness in pregnancy
HCG
why should ATD’s be held off in prescribing in pregnancy
do avoid malformation of baby
what complications can occur in pregnancy with hyperthyroidism (5)
infertility, miscarriage, still birth, thyroid crisis, transient neonatal thyrotoxicosis
how do you manage hyperthyroidism in pregnancy
wait as long as possible to prescribe ATDs, if you have too: PTU 1st trimester –> carbimazole
