Pregnancy Flashcards
What are the 2 phases of menstural cycle?
In what phase is oestrogen highest?
In what phase is progesterone highest?
Why?
Follicular phase - 1-14 days
Luteal phase - post ovulation-1st day of period
Follicular phase - oestrogen highest
Luteal phase - progesterone highest
Corpus luteum (ovum once released from ovary) produces progesterone
Oestrogen and progesterone both have a negative feedback control on the hypothalamus/pituitary.
During days 12-14, oestrogen has a different response. Describe this and explain what it leads to.
Oestrogen during days 12-14 has a positive feedback response -> peak in LH and FSH -> peak in LH causes OVULATION
What effect does progesterone have on the endometrium?
Ignore
If the corpus lutuem becomes fertilised and implanted , what does it secrete.
Why is this hormone important?
HCG
Measured in pregnancy tests
What hormones does the placenta secrete?
hPL (human placental lactogen)
Placental progesterone
Placental oestrogens
Describe the process involved in gestational diabetes?
hPL and placental progesterone lead to increased insulin resistance -> increase blood sugars
Gestational diabetes goes away after birth. T/F?
T
Gestational diabetes starts during pregnancy and ends post partum
What is macrosomia?
Baby >90th centile for size
Gestational diabetes complication
Name a skeletal abnormality that is basically specific to diabetic mothers?
Caudal regression syndrome (abnormal development of the lower spine)
What week of pregnancy does organogenesis start?
Week 5
What are the two most important things to do in antental care in women with T1/T2DM?
- start on 5mg folic acid - 3 months prior to conception to 12 weeks pregnant
(note this is a much higher dose than folic acid in normal pregnancy) - establish good glycemic control
A T2 diabetic with HTN presents to clinic saying she is pregnant unexpectedly. What drugs should be reviewed for and taken off if still on them?
ACEi
Statin
Start on folic acid 5mg if not already on it
What causes macrosomia?
In the 3rd trimester the baby produces his own insulin (MAJOR growth factor)
If mother is hyperglycaemic -> baby is hyperglycaemic -> produce excess insulin
What are the diagnostic criteria for gestational diabetes?
How are these criteria set?
> 5.5mmol/l
Based on risk to neonate/foetus
Why is it important to review patients annually post gestational diabetes?
1/2 go on to develop T2DM
How many weeks postpartum should mothers come in to get their blood glucose measured?
6 weeks
In what trimester/s does gestational diabetes most commonly present?
2nd/3rd trimester
Why is thyroxine so important for neonates?
It helps in CNS development
Congenital hypothyroidism is one of the leading causes of intellectual disability
What effect does a severe over/underactive thyroid have on fertility?
Decreases fertility
What effect does HCG have on thyroid hormones?
Suppresses TSH -> increase in T3+T4
What hormone is high levels is responsible for morning sickness?
HCG
What is the difference in how we prescribe anti-thyroid drugs in pregnancy as opposed to normal?
Pregnancy - start on as low dose as possible as opposed to high dose in normal settings
Why do we wait as long as possible before prescribing anti-thyroid drugs?
What drugs do we use and when?
Need to be able to make sure its not the HCG effect (HCG suppresses TSH + causes hyperthyroidisim)
Propylthiouracil - 1st trimester
Carbimazole - 2nd and 3rd trimester
Describe post partum thyroiditis?
Post partum
Hyperthyroidism for about 6 weeks
Then hypothyroidism
Should be resolved by a year
How is hypothyroidism managed in pregancy?
Need to review levothyroxine levels and have patient iin regularly for checks - increasing dose if need be
What is a thyroid cause of post partum depression?
Post partum thyroiditis -> leads to hypothyroidism
