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Endocrine > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

How long is the typical menstrual cycle?

A

28 days

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2
Q

What is the first phase of the menstrual cycle?

A

follicular phase

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3
Q

when does the LH surge occur?

A

around day 14 (ovulation)

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4
Q

What is the second phase of the menstrual cycle?

A

Luteal phase

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5
Q

What hormone does the follicle produce?

A

Oestradiol - type of oestrogen

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6
Q

What does the ovulating follicle ( corpus luteum) produce?

A

progesterone

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7
Q

If implantation occurs what does the implanting embryo produce?

ii. what can this be used for?

A

hCG

ii. pregnancy tests

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8
Q

What hormones does the placenta produce?

A

hPL - human placental lactogen - hCG levels decrease

Placental progesterone

Placental oestrogens

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9
Q

During pregnancy what hormone does the anterior pituitary gland release?

A

Prolactin (lactogen) - required for milk production

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10
Q

what does placental progesterones and hPL do to the mother?

ii. what condition can this lead to?

A

makes them insulin resistant - sugar isn’t taking up by the mother but rather given to the foetus

ii. if mother is already insulin resistant it can led to gestational diabetes

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11
Q

When does foetal organogensis?

A

around 5 weeks

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12
Q

what are the complications of diabetes?

A

Foetal complications

Congenital Malformation

Prematurity

Intra-uterine growth retardation (IUGR)- poor growth of a foetus

Gestational diabetes only:

Macrosomia - a newborn who’s much larger than average. They are usually over 90% centile for size. Problem in delivery

Polyhydramnios - excess of amniotic fluid in the amniotic sac

intrauterine death

Neonate complications

Respiratory distress

Hypoglycaemia

Hypocalcaemia

caudal regression syndrome

Genital & GI abnormalities

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13
Q

What is the pathophysiology of Macrosomia?

A
  1. Mothers Hyperglycaemia is passed to foetal hyperglycaemia via placenta
  2. Foetus’s pancreas needs to create more insulin - hyperinsulinemia
  3. High insulin leads to growth in size
  4. As soon as Baby is delivered it is cut off from the mothers high sugar supply. The baby is quiet slow at removing the high level of insulin so neonatal hypoglycaemia occurs.
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14
Q

How do you manage Diabetes in pregnancy?

A

A. Controlling diabetes: T1 and T2

  1. Pre-pregnancy counseling:

Good sugar control pre conception - limits risk of congenital malformation

  1. Folic acid - given for at least 3 months before pregnancy. give 5mg
  2. Retinopathy eye checks - every 10 weeks in pregnancy
  3. Blood pressure:

Labetalol (most common)

Nifedipine

methyldopa

  1. High risk pregnancy:

Aspirin 150mg at 12 weeks - reduces risk of pregnancy induced hypertension

Type 2 specific:

change from tablets to insulin.

Avoid:

ACE inhibitors - increase risk of teratogenic development

Statin - also increase risk of teratogenic development

B. Controlling Diabetes: for T1,T2 and gestational

  1. Diabetic diet
  2. Blood sugar control:

pre-meal <4 - 5.5 mmol/L

2h post meal <6-6.5 mmol/L

  1. Monitor HbA1c
  2. Monitor BP
  3. Maintain good blood glucose during labour:

if the patient is on insulin switch to IV insulin and IV dextrose

Pharmacological: Treating diabetes

T1 - Insulin

T2 - metformin. will probs need insulin later

GDM - can be Lifestyle changes only. However if not use Metformin and may need insulin later.

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15
Q

How should you check that gestational diabetes has gone?

A

6 week post natal fasting glucose or GTT

if the diabetes has persists after 6 weeks then it is undiagnosed T2DM

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16
Q

What are the implications of Gestational diabetes?

A

50% of patients will go on to form T2DM

5% will go on to form T1DM

17
Q

How do you prevent patient from getting diabetes after GDM?

A

Mainly lifestyle management

  1. Low weight
  2. Health diet:

Low refined sugar

Predominant starch

Low saturated fat

Low energy food

  1. Aerobic exercise

Patients should be encouraged for annual fasting glucose so they can catch their diabetes early

18
Q

When does gestational diabetes usually present?

A

third trimester

19
Q

what effect does Hypo/Hyperthyroidism on pregnancy?

A

reduces fertility

causes anovulatory cycles - menstrual cycle with no ovulation

20
Q

what physiological changes occur to the thyroid during pregnancy?

A

it thickens - mother needs to make more thyroxine as this is important for neonatal development.

Also needs to make more to maintain normal concentration

21
Q

How do you manage hypothyroidism in pregnancy?

A
  1. Pre-existing hypothyroidism:

Want to control it pre pregnancy

When pregnant:

increase thyroxine dose by 25mcg ASAP once pregnancy is suspected

Check TFTs monthly for first 20 weeks then 2 monthly until term

increase thyroxine if TSH is rising. Aim for TSH <3mU/l

22
Q

What are the risks of untreated hypothyroidism?

A

Increased abortions

Preeclampsia

abruption

postpartum haemorrhage

preterm Labour

Foetal neuropsychological development:

average child will have 7 IQ points less if their mother has hypothyroidism

23
Q

What effects does high hCG have on TSH?

A

suppresses it as it increases T4

24
Q

What does High hCG cause?

A

Hyperemesis - vomiting in pregnancy

25
Q

How do you distinguish between Hyperemesis and hyperthyroidism?

A

Gestational hCG associated thyroxicosis:

Hyperemesis gravidarum - hCG increase - causes decreases TSH

Not TRab antibody positive

improves after 20 weeks. If not then it is hyperthyroidism (graves disease)

26
Q

What are the risks of Hyperthyroidism in pregnancy?

A

infertility

Spontaneous miscarriage

stillbirth

Thyroid crisis in labour

transient neonatal thyrotoxicosis

27
Q

what is the most common cause of hyperthyroidism in pregnant women?

A

Graves disease

other causes:

TMNG

toxic adenoma

Thyroiditis

28
Q

How do you manage Hyperthyroidism in pregnancy?

A

Wait and see:

Hyperemesis will settle

Graves may settle as pregnancy suppresses autoimmunity

Check TRAB antibodies

Beta blockers can be helpful

Low dose anti-thyroid drugs: delay as long as possible and start at lowest dose possible.

Propylthiouracil - 1st trimester - thought to have less effects on embryogenesis. Can be toxic to the mother so only use in 1st trimester

Carbimazole 2/3rd trimester

side effects:

Carbimazole:

embryopathy in 1st trimester

Scalp abnormalities

GI abnormalities

Choanal & oesophageal atresia

Propylthiouracil:

Risk of liver toxicity in mother

Antibodies:

check TRAb antibodies during pregnancy - ideally third trimester.

TRAb antibodies cause neonatal transient hyperthyroidism

29
Q

What is postpartum thyroiditis?

A

occurs when patient with diabetes after delivery

Mother develops transient over active thyroid (around 6 weeks) and then under active thyroid. Can persist up to a year

Forms a small, diffuse non tender goitre

Hypothyroid phase is associated with post natal depression

Only treat Hypothyroidism - give thyroxine if symptomatic

Endocrine (7 decks)

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