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    Obstetrics: Endocrine

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    This document discusses several physiological changes that occur during pregnancy related to the endocrine, thyroid, gastrointestinal, liver, gallbladder, and skin systems. The endocrine changes include insulin resistance promoted by placental lactogen and hormones that result in "lower lows and higher highs" of blood glucose levels. The thyroid is stimulated by hCG and estrogen, leading to increased TBG and total hormones but normal active hormone levels. Gastrointestinal changes include delayed emptying and transit, reflux, and hemorrhoids. Liver tests are similar to liver disease but morphology is unchanged. The gallbladder has impaired contraction and increased risk of stones. Common skin changes are melasma, striae, and linea nigra lines

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    Obstetrics: Endocrine

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    This document discusses several physiological changes that occur during pregnancy related to the endocrine, thyroid, gastrointestinal, liver, gallbladder, and skin systems. The endocrine changes include insulin resistance promoted by placental lactogen and hormones that result in "lower lows and higher highs" of blood glucose levels. The thyroid is stimulated by hCG and estrogen, leading to increased TBG and total hormones but normal active hormone levels. Gastrointestinal changes include delayed emptying and transit, reflux, and hemorrhoids. Liver tests are similar to liver disease but morphology is unchanged. The gallbladder has impaired contraction and increased risk of stones. Common skin changes are melasma, striae, and linea nigra lines

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    This document discusses several physiological changes that occur during pregnancy related to the endocrine, thyroid, gastrointestinal, liver, gallbladder, and skin systems. The endocrine changes include insulin resistance promoted by placental lactogen and hormones that result in "lower lows and higher highs" of blood glucose levels. The thyroid is stimulated by hCG and estrogen, leading to increased TBG and total hormones but normal active hormone levels. Gastrointestinal changes include delayed emptying and transit, reflux, and hemorrhoids. Liver tests are similar to liver disease but morphology is unchanged. The gallbladder has impaired contraction and increased risk of stones. Common skin changes are melasma, striae, and linea nigra lines

    Copyright:

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    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    70 views4 pages

    Obstetrics: Endocrine

    Uploaded by

    api-3829364
    This document discusses several physiological changes that occur during pregnancy related to the endocrine, thyroid, gastrointestinal, liver, gallbladder, and skin systems. The endocrine changes include insulin resistance promoted by placental lactogen and hormones that result in "lower lows and higher highs" of blood glucose levels. The thyroid is stimulated by hCG and estrogen, leading to increased TBG and total hormones but normal active hormone levels. Gastrointestinal changes include delayed emptying and transit, reflux, and hemorrhoids. Liver tests are similar to liver disease but morphology is unchanged. The gallbladder has impaired contraction and increased risk of stones. Common skin changes are melasma, striae, and linea nigra lines

    Copyright:

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    Download as doc, pdf, or txt
    of 4

    Obstetrics

    Dr: Mahabad Lec: -2-


    11-Oct-06

    Endocrine
     Normal pregnancy physiology shows
    • “lower lows and higher highs”
     Postprandial hyperglycemia
    • To ensure sustained glucose levels for fetus
     Accelerated starvation
    • Early switch from glucose to lipids for fuels
     Insulin resistance promotes hyperglycemia
    • Resistance-Reduced peripheral uptake of glucose for a given dose of
    insulin
     Mild fasting hypoglycemia occurs with elevated FFA, triglycerides,and
    cholesterol

    Insulin resistance

     Anti-insulin environment is aided by:


     placental lactogen
    • Like growth hormone
    • Increases lipolysis and FFA
    • Increases tissue resistance to insulin
     Increased unbound cortisol
     Estrogen and Progesterone may also exert some anti-insulin effects

    Thyroid

     Estrogen stimulates Increase in TBG


    • Total T3 and T4 are increased
    • However the active hormones remains unchanged
     hCG stimulates thyroid
    • TSH is reduced
     Iodine deficient state
    • Due to Increased renal clearance
     To rule out pathologic changes
    • Early in pregnancy TSH can be used
    • Later free T4 is needed

    1
    Gastrointestinal Tract
     Displacement of the stomach and intestines
     Appendix can be displaced to reach the right flank
     Gastric emptying and intestinal transit times are delayed secondary to
    hormonal and mechanical factors
     Pyrosis is common due to the reflux of secretions
     Vascular swelling of the gums
     Hemorrhoids due to elevated pressure in veins

    Liver
     Liver morphology unchanged
     Lab Tests similar to liver disease
    • Alkaline phosphatase doubles
    • AST, ALT, GGT and bilirubin are slightly lower
    • Decreased plasma albumin

    Gallbladder
     Impaired contraction
     High residual volumes
     Promotion of stasis
     Stasis associated with increased cholesterol saturation of pregnancy, supports
    predisposition of stones
     Intrahepatic cholestasis
     Retained bile salts-pruritus gravidarum

    Skin changes
     Chloasma or melasma gravidarum
     Striae
     Linea nigra

    2
    Melasma

     Also known as the mask of pregnancy


     More common in dark skin people
     More pronounced in the summer
     Fades a few months after delivery
     Repeated pregnancy can intensify
     Can occur in normal non-pregnant women with harmless hormonal
    imbalances or women on OCPs or depo

    Striae

     Reddish slightly depressed

    3
     Breasts, thighs, and abdomen
     In future pregnancies they appear as glistening, silver lines

    Linea nigra

    Hyperpigmentation
     Melasma and linea nigra
     Estrogen and progesterone
     Some melanocyte stimulating effect

    Prepared by:
    Rand Aras Najeeb

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