Pregnancy Flashcards
What is the corpus luteum?
Bundle of cells in the ovary
What does the corpus luteum secrete?
Progesterone
If implantation of a fertilised egg occurs what is produced?
HcG
What hormone does the Ovum produce?
Oestradiol
What hormones does the placenta produce?
Human placental lactogen
Placental progesterone
Placental oestrogen
What does human placental lactogen do?
Increases the breast size
Development of ducts within breast tissue
Which to hormones trigger increased insulin resistance in pregnancy?
Progesterone
HPL Human placental lactogen
What is the functional benefit of an increased insulin resistance in pregnancy?
It diverts nutrients away from the mother towards the child was glucose isn’t taken up by the mothers tissues.
Why is an increased insulin resistance an issue in pregnancy in developed nation?
It was beneficial when there wasn’t an excess
Raised blood glucose prior to pregnancy leads to gestational diabetes.
In which trimester does gestational diabetes usually occur?
3rd trimester
Why does gestational diabetes usually occur in the third trimester?
Placenta undergoes rapid growth
- increased HPL and progesterone secretion
- increased resistance
At what stage do foetal organs start to develop?
Around 5 weeks
What hormone is used in pregnancy tests?
HCG
What does diabetes increase the risk of in pregnancy?
Congenital malformations Prematuritiy Intrauterine growth retardation Macrosomia - large babies in 90th gentile Intrauterine death
Why does an increased insulin level lead to larger babies?
Insulin is a major growth factor in the foetus
What does gestational diabetes increase the risk off in neonates?
Respiratory failure - immature lungs
Hypoglycaemia
Hypocalcaemia
Why are neonates of mothers with gestational diabetes more likely to develop hypoglycaemia?
They are exposed to consistent high blood glucose levels, as a result they over produce insulin.
After birth they continue to produce same levels of insulin but blood glucose is massively reduced.
What CNS risk factors do mothers with gestational diabetes expose their child to?
5x risk of spina bifida
What other risk factors do mothers with gestational diabetes expose their child to?
200x risk of caudal regression syndrome
20x risk of uterine duplication
In type I and II what is most important things to do prior to pregnancy?
Counselling on good sugar control and diabetic diet
Folic acid
What is the dose of folic given in diabetes in contrast to non diabetics?
5mg
400μg
What other medication should be given in diabetics?
Aspirin 150mg at 12 weeks
What medication should pregnant diabetics be taken off?
ACE and statins
What medication can be used in the place of ACE and statins in pregnant diabetes?
Labetalol - beta blocker
Nifedipine - Calcium channel blocker
Why should pregnant diabetics undergo frequent eye reviews?
10/20/30 weeks
Pregnancy accelerates retinopathy
What should be considered in a type I and II diabetics during pregnancy?
Switch to insulin
Metformin is okay for type 2
What is the pre meal glucose target for pregnancy?
4-5.5
What is the 2 hour post meal blood glucose target in pregnancy?
<6.5-7
What should be monitored regularly throughout pregnancy in diabetics?
HB1Ac
Blood pressure
During labour what is a common practise in diabetics?
IV infusion of insulin and dextrose
Allows close control of blood glucose levels
Why is it important to have good control of glucose during pregnancy?
Due to stress adrenaline cortisol and growth hormones are released all of which lead to massive fluctuations in blood glucose levels.
When is fasting blood glucose measured after pregnancy?
6 weeks
If fasting glucose at 6 weeks is high what is diagnosis?
Undiagnosed type II diabetic
What percentage of patients with gestational diabetes go onto have type II?
50%
80% if BMI over 30
If a patient is thin and had gestational diabetes what is could it be?
Type I diabetes
5% of GDM are acutely type 1
What is maternal thyroxine important in?
Development of foetal brain
Why do mothers thyroid glands grow?
Increased demand means increased T4 production
Increase in size to meet the demand
What is the target for TSH blood levels in pregnancy?
<3 mU/1
What is the risk of hypothyroidism in pregnancy?
Increased abortions and post partum haemorrhage
Average reduction in child IQ by 7
As soon as pregnancy is suspected how should the dose of thyroxine be altered?
increased by 25mg
Hyperemesis
Morning sickness
Why does hyperemesis occur?
hCG causes an increase in thyroxine
Suppress TSH
What should be looked for if suspecting hyperemesis?
Low TSH
-ve TRab
Why should you wait for as long as possible before treating hyperthyroidism in pregnancy?
Hyperemesis and hyperthyroidism present very similarly
After 20 weeks hCG levels decrease so symptoms would resolve in hyperemesis
What pregnancy risks are associated with hyperthyroidism?
Still birth
Thyroid crisis
Spontaneous miscarriage
If TRab antibodies are positive what is the issue?
Transient Neonatal Thyrotoxicosis
TRab are able to cross the placenta
Alert paeds
What is initial treatment for first 20 weeks in suspected hyperthyroidism?
Symptomatic
Anti-emetic
B-Blockers
If hyperthyroidism is confirmed what is 1st line drug?
Propylthiouracil 1 trimester
Carbimazole 2 and 3 trimester
Post partum what is the risk with hypothyroidism?
Linked to postnatal depression
