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LR Endocrine > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Day 1 of the ovarian cycle is taken as…

A

The first day of the period

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2
Q

Describe phase 1 of the ovarian cycle

A

Follicular growth - the ovum is growing inside the follicle

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3
Q

Which hormone is secreted by the follicle?

A

Oestradiol (an oestrogen)

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4
Q

Secretion of which hormone peaks 1-2 days before ovulation?

A

Lutienising hormone (LH)

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5
Q

What happens to the follicle at ovulation?

A

The follicle releases the mature ovum and becomes the corpus luteum

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6
Q

At what day in the ovarian cycle does ovulation occur?

A

~day 14

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7
Q

Describe phase 2 of the ovarian cycle

A

Luteal function - the corpus luteum implants into the endometrial wall and secretes hormones which will thicken the endometrial wall and allow implantation of a fertilised ovum

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8
Q

Which hormones (2) does the corpus luteum secrete?

A

Progesterone (mainly)

Oestradiol (an oestrogen)

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9
Q

What happens to the corpus luteum of the ovum is not fertilised?

A

It shrinks, progesterone levels drop and the endometrial lining is shed

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10
Q

How long does the ovarian cycle last?

A

~28 days

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11
Q

Which hormone is detected in pregnancy tests?

A

hCG (human chorionic gonadotropin)

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12
Q

Where is hCG secreted from?

A

Trophoblast cells of an implanted fertilised ovum

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13
Q

The placenta releases which 3 hormones?

A

Human placental lactogen (hPL)

Placental progesterone

Placental oestrogens

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14
Q

What does human placental lactogen (hPL) do?

A
  • Stimulates breast development
  • Regulates metabolism of fats and carbohydrates so more glucose is free in the blood to provide energy to the foetus across the placenta
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15
Q

Which hormone is released by the pituitary in response to pregnancy and why?

A

Prolactin for breast milk production

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16
Q

Which 2 placental hormones can cause insulin resistance in a pregnant woman?

A

hPL (human placental lactogens)

Placental progesterones

17
Q

How can hPL and placental progesterones lead to gestational diabetes? (2)

A
  • Cause insulin resistance in the mother

- Raise blood glucose in the mother to provide nutrients for the foetus

18
Q

At what week does foetal organogenesis occur?

A

~5 weeks

19
Q

How can maternal hyperglycaemia lead to macrosomia (large birth weight)

A

Maternal hyperglycaemia leads to foetal hyperglycaemia as glucose crosses the placenta

Foetal hyperinsulinaemia occurs to combat this

Insulin is a major growth factor so leads to increased growth in the foetus

20
Q

In which trimester does the foetus start producing its own insulin?

A

3rd trimester

21
Q

How can maternal hyperglycaemia lead to neonatal hypoglycaemia at birth?

A

The mother’s glucose will stop crossing the placenta but foetal hyperinsulinaemia will still be occurring

This will deplete the foetus’ own supply of glucose

22
Q

How does thyroid disease reduce fertility?

A

Causes oligo/amenorrhoea

23
Q

Why is there increased demand on the thyroid during pregnancy? (2)

A
  • Maternal thyroxine is required for foetal CNS development

- Plasma protein binding of thyroxine increases so less is free

24
Q

How does the thyroid gland respond to increased demand during pregnancy?

A
  • Increases in size

- Increases T4 production to maintain normal concentration

25
Q

How does increased demand on the thyroid during pregnancy affect a woman with hypothyroidism?

A

The thyroid is unable to compensate for the increased demand

26
Q

How is Levothyroxine (thyroxine) dose changed in a pregnant woman with hypothyroidism? (3)

A
  • Dose increased by 25 micrograms as soon as pregnancy suspected
  • Monthly thyroid function tests
  • Average dose increase is by 50% by 20 weeks
27
Q

What are the complications of untreated hypothyroidism in pregnancy?

A
  • Impaired foetal neuropsychological development
  • Miscarriage
  • Pre-eclampsia
  • Pre-term labour
  • Post-partum haemorrhage
28
Q

How does hCG secretion from the embryo affect thyroxine and TSH levels?

A

Increases thyroxine which suppresses TSH (-ve feedback)

29
Q

Excess hCG in pregnancy mimics…
a) Hypothyroidism
b) Hyperthyroidism
?

A

Hyperthyroidism

increased T4 and decreased TSH

30
Q

What symptom is strongly associated with high hCG?

A

Hyperemesis (vomiting)

31
Q

What features make hCG-associated thyrotoxicosis more likely than hyperthyroidism?

A
  • Raised hCG and low TSH
  • Hyperemesis
  • Resolves by 20 weeks gestation
32
Q

Which anti-thyroid drugs can be used for hyperthyroidism in the…
-1st trimester
-2nd and 3rd trimesters
?

A

1st trimester: Propylthiouracil

2nd & 3rd: Carbimazole

33
Q

Which antibodies can cross the placenta and cause neonatal transient hyperthyroidism?

A

TRAb antibodies

34
Q

Describe the usual pattern of post-partum thyroiditis (3)

A
  • Transient overactive thyroid at ~6 weeks after delivery
  • Transient underactive thyroid at ~3 months after delivery
  • Usually resolves at ~1 year

LR Endocrine (12 decks)

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