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Year 2 Endocrine > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

What is the corpus luteum?

A

Bundle of cells in the ovary

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2
Q

What does the corpus luteum secrete?

A

Progesterone

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3
Q

If implantation of a fertilised egg occurs what is produced?

A

HcG

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4
Q

What hormone does the Ovum produce?

A

Oestradiol

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5
Q

What hormones does the placenta produce?

A

Human placental lactogen
Placental progesterone
Placental oestrogen

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6
Q

What does human placental lactogen do?

A

Increases the breast size

Development of ducts within breast tissue

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7
Q

Which to hormones trigger increased insulin resistance in pregnancy?

A

Progesterone

HPL Human placental lactogen

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8
Q

What is the functional benefit of an increased insulin resistance in pregnancy?

A

It diverts nutrients away from the mother towards the child was glucose isn’t taken up by the mothers tissues.

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9
Q

Why is an increased insulin resistance an issue in pregnancy in developed nation?

A

It was beneficial when there wasn’t an excess

Raised blood glucose prior to pregnancy leads to gestational diabetes.

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10
Q

In which trimester does gestational diabetes usually occur?

A

3rd trimester

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11
Q

Why does gestational diabetes usually occur in the third trimester?

A

Placenta undergoes rapid growth

  • increased HPL and progesterone secretion
  • increased resistance
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12
Q

At what stage do foetal organs start to develop?

A

Around 5 weeks

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13
Q

What hormone is used in pregnancy tests?

A

HCG

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14
Q

What does diabetes increase the risk of in pregnancy?

A 
Congenital malformations
Prematuritiy
Intrauterine growth retardation
Macrosomia - large babies in 90th gentile
Intrauterine death
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15
Q

Why does an increased insulin level lead to larger babies?

A

Insulin is a major growth factor in the foetus

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16
Q

What does gestational diabetes increase the risk off in neonates?

A

Respiratory failure - immature lungs
Hypoglycaemia
Hypocalcaemia

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17
Q

Why are neonates of mothers with gestational diabetes more likely to develop hypoglycaemia?

A

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.

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18
Q

What CNS risk factors do mothers with gestational diabetes expose their child to?

A

5x risk of spina bifida

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19
Q

What other risk factors do mothers with gestational diabetes expose their child to?

A

200x risk of caudal regression syndrome

20x risk of uterine duplication

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20
Q

In type I and II what is most important things to do prior to pregnancy?

A

Counselling on good sugar control and diabetic diet

Folic acid

21
Q

What is the dose of folic given in diabetes in contrast to non diabetics?

A

5mg

400μg

22
Q

What other medication should be given in diabetics?

A

Aspirin 150mg at 12 weeks

23
Q

What medication should pregnant diabetics be taken off?

A

ACE and statins

24
Q

What medication can be used in the place of ACE and statins in pregnant diabetes?

A

Labetalol - beta blocker

Nifedipine - Calcium channel blocker

25
Q

Why should pregnant diabetics undergo frequent eye reviews?

A

10/20/30 weeks

Pregnancy accelerates retinopathy

26
Q

What should be considered in a type I and II diabetics during pregnancy?

A

Switch to insulin

Metformin is okay for type 2

27
Q

What is the pre meal glucose target for pregnancy?

A

4-5.5

28
Q

What is the 2 hour post meal blood glucose target in pregnancy?

A

<6.5-7

29
Q

What should be monitored regularly throughout pregnancy in diabetics?

A

HB1Ac

Blood pressure

30
Q

During labour what is a common practise in diabetics?

A

IV infusion of insulin and dextrose

Allows close control of blood glucose levels

31
Q

Why is it important to have good control of glucose during pregnancy?

A

Due to stress adrenaline cortisol and growth hormones are released all of which lead to massive fluctuations in blood glucose levels.

32
Q

When is fasting blood glucose measured after pregnancy?

A

6 weeks

33
Q

If fasting glucose at 6 weeks is high what is diagnosis?

A

Undiagnosed type II diabetic

34
Q

What percentage of patients with gestational diabetes go onto have type II?

A

50%

80% if BMI over 30

35
Q

If a patient is thin and had gestational diabetes what is could it be?

A

Type I diabetes

5% of GDM are acutely type 1

36
Q

What is maternal thyroxine important in?

A

Development of foetal brain

37
Q

Why do mothers thyroid glands grow?

A

Increased demand means increased T4 production

Increase in size to meet the demand

38
Q

What is the target for TSH blood levels in pregnancy?

A

<3 mU/1

39
Q

What is the risk of hypothyroidism in pregnancy?

A

Increased abortions and post partum haemorrhage

Average reduction in child IQ by 7

40
Q

As soon as pregnancy is suspected how should the dose of thyroxine be altered?

A

increased by 25mg

41
Q

Hyperemesis

A

Morning sickness

42
Q

Why does hyperemesis occur?

A

hCG causes an increase in thyroxine

Suppress TSH

43
Q

What should be looked for if suspecting hyperemesis?

A

Low TSH

-ve TRab

44
Q

Why should you wait for as long as possible before treating hyperthyroidism in pregnancy?

A

Hyperemesis and hyperthyroidism present very similarly

After 20 weeks hCG levels decrease so symptoms would resolve in hyperemesis

45
Q

What pregnancy risks are associated with hyperthyroidism?

A

Still birth
Thyroid crisis
Spontaneous miscarriage

46
Q

If TRab antibodies are positive what is the issue?

A

Transient Neonatal Thyrotoxicosis
TRab are able to cross the placenta
Alert paeds

47
Q

What is initial treatment for first 20 weeks in suspected hyperthyroidism?

A

Symptomatic
Anti-emetic
B-Blockers

48
Q

If hyperthyroidism is confirmed what is 1st line drug?

A

Propylthiouracil 1 trimester

Carbimazole 2 and 3 trimester

49
Q

Post partum what is the risk with hypothyroidism?

A

Linked to postnatal depression

Year 2 Endocrine (21 decks)

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