Pregnancy

Question 1

What are the 2 phases of menstural cycle?

In what phase is oestrogen highest?
In what phase is progesterone highest?
Why?

Answer 1

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

Question 2

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.

Answer 2

Oestrogen during days 12-14 has a positive feedback response
->
peak in LH and FSH 
->
peak in LH causes OVULATION

Question 3

What effect does progesterone have on the endometrium?

Answer 3

Ignore

Question 4

If the corpus lutuem becomes fertilised and implanted , what does it secrete.

Why is this hormone important?

Answer 4

HCG

Measured in pregnancy tests

Question 5

What hormones does the placenta secrete?

Answer 5

hPL (human placental lactogen)
Placental progesterone
Placental oestrogens

Question 6

Describe the process involved in gestational diabetes?

Answer 6

hPL and placental progesterone lead to increased insulin resistance -> increase blood sugars

Question 7

Gestational diabetes goes away after birth. T/F?

Answer 7

T

Gestational diabetes starts during pregnancy and ends post partum

Question 8

What is macrosomia?

Answer 8

Baby >90th centile for size

Gestational diabetes complication

Question 9

Name a skeletal abnormality that is basically specific to diabetic mothers?

Answer 9

Caudal regression syndrome (abnormal development of the lower spine)

Question 10

What week of pregnancy does organogenesis start?

Answer 10

Week 5

Question 11

What are the two most important things to do in antental care in women with T1/T2DM?

Answer 11

• 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

Question 12

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?

Answer 12

ACEi
Statin

Start on folic acid 5mg if not already on it

Question 13

What causes macrosomia?

Answer 13

In the 3rd trimester the baby produces his own insulin (MAJOR growth factor)

If mother is hyperglycaemic -> baby is hyperglycaemic -> produce excess insulin

Question 14

What are the diagnostic criteria for gestational diabetes?

How are these criteria set?

Answer 14

> 5.5mmol/l

Based on risk to neonate/foetus

Question 15

Why is it important to review patients annually post gestational diabetes?

Answer 15

1/2 go on to develop T2DM

Question 16

How many weeks postpartum should mothers come in to get their blood glucose measured?

Answer 16

6 weeks

Question 17

In what trimester/s does gestational diabetes most commonly present?

Answer 17

2nd/3rd trimester

Question 18

Why is thyroxine so important for neonates?

Answer 18

It helps in CNS development

Congenital hypothyroidism is one of the leading causes of intellectual disability

Question 19

What effect does a severe over/underactive thyroid have on fertility?

Answer 19

Decreases fertility

Question 20

What effect does HCG have on thyroid hormones?

Answer 20

Suppresses TSH -> increase in T3+T4

Question 21

What hormone is high levels is responsible for morning sickness?

Answer 21

HCG

Question 22

What is the difference in how we prescribe anti-thyroid drugs in pregnancy as opposed to normal?

Answer 22

Pregnancy - start on as low dose as possible as opposed to high dose in normal settings

Question 23

Why do we wait as long as possible before prescribing anti-thyroid drugs?

What drugs do we use and when?

Answer 23

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

Question 24

Describe post partum thyroiditis?

Answer 24

Post partum
Hyperthyroidism for about 6 weeks
Then hypothyroidism
Should be resolved by a year

Question 25

How is hypothyroidism managed in pregancy?

Answer 25

Need to review levothyroxine levels and have patient iin regularly for checks - increasing dose if need be

Question 26

What is a thyroid cause of post partum depression?

Answer 26

Post partum thyroiditis -> leads to hypothyroidism