pregnancy Flashcards
what hormone is produced if implantation occurs in pregnancy
HCG
-pregnancy test
what hormone is produced by the corpus luteum
progesterone
what hormones are produced by the placenta
- human placental lactogen
- placental progesterone
- placental oestrogen
what happens if there is insulin resistance in mothers
raised blood glucose then gestational diabetes
what are the three types of diabetes in pregnancy
- type 1
- type 2
- gestational
when do foetal organs start to develop
at 5 weeks or even earlier
complications associated with diabetes in pregnancy
- congenital malformation
- prematurity
- intra-uterine growth retardation
GDM
- macrosomia (big baby)
- polyhydramnios
- intrauterine death
complications in the neonate
- respiratory distress
- hypoglycaemia
- hypocalcaemia
how does maternal diabetes cause macrosomia
- maternal hyperglycaemia causes foetal hyperglycaemia
- this then causes foetal hyperinsulinaemia
- in third trimester foetus produces own insulin which is a major growth factor
management for type 1 and 2 maternal diabetes
- pre pregnancy counseling
- folic acid 5mg 3 months prior to pregnancy
- consider change from tablets to insulin
- regular eye checks
- avoid ACEI and statin
- start aspirin 150mg at 12 weeks
management for all diabetic pregnancys
-diabetic diet
-tight blood glucose controls
(pre meal <4-5.5, 2hr post meal <6-6.5mmol/l)
-continuous glucose monitoring
-monitor HbA1c
-monitor BP
-IV insulin and IV dextrose during labour
what drugs needed during type 1 pregnancy
insulin
what drugs needed during type 2 pregnancy
- metformin
- insulin later
what drugs needed for GDM
- lifestyle
- metformin
- maybe insulin
what should be done 6 weeks after GDM
post natal fasting glucose to ensure its gone or not turned into type 2
how can type 2 be prevented after GDM
- keep weight low
- healthy diet
- aerobic exercise
- metformin, acarbose, pioglitazone (not as accurate)
- annual fasting glucose
hypo and hyperthyroidism affect on fertility
reduced fertility
why is there an increased demand on the thyroid during pregnancy
increased plasma protein binding
what happens to thyroid during pregnancy
- increase in size
- increased T4 production
what happens to thyroid in a patient already on thyroxine
- relative thyroid deficiency
- thyroid cant meet increased demands
- thyroxine dose has to be increased
how much is dose increased in hypothyroidism pregnancy
- 25mg as soon as pregnancy is suspected
- check TFTs monthly for first 20 weeks then 2 monthly
what are the risks of untreated hypothyroidism
- increased abortion
- preeclampsia
- abruption
- postpartum haemorrhage
- preterm labour
- foetal neuropsychological development
hCG effect on thyroid
- increase thyroxine
- increase free T4
- suppress TSH
what is hyperemesis
high hCG
how do you distinguish between hyperemesis and hyperthyroidism
- hyperemesis is increase hCG decreased TSH
- not TRab antibody positive
- resolves by 20wks gestation
risks of hyperthyroidism in pregnancy
- infertility/ammenorhoea
- spontaneous miscarriage
- stillbirth
- thyroid crisis in labour
- transient neonatal thyrotoxicosis
hyperthyroid management in pregnancy
- supportive
- b blockers if needed
- low dose anti-thyroid drugs (prophylthiouracil 1st trimester, carbimazole 2nd/3rd trimester)
will hyperemesis settle
yes
side effects of carbimazole in pregnancy
- embryopathy in 1st trimester
- scalp abnormalities
- GI abnormalities
- choanal and oesophageal atresia
side effects of prophylthiouracil in pregnancy
risk of liver toxicity
what causes neonatal hyperthyroidism
when the TRAb antibodies get transferred across the placenta
how long does postpartum thyroiditis last
up to one year
