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Volledige samenvatting vroedvrouw als hoogrisico expert
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Samenvatting van alle geziene leerstof in olod VRVR als HRE
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HREHOOGRISICO EXPERT
HOOGRISICO EXPERT .................................................................................................................... 1
PATHOLOGISCHE VERLOSKUNDE .................................................................................................. 6
SCHOUDERDYSTOCIE ..................................................................................................................................... 6
STUITGEBOORTE DIA 62 .............................................................................................................................. 11
EXTERNE VERSIE ......................................................................................................................................... 15
MANUELE PLACENTAVERWIJDERING............................................................................................................... 17
UTERUSRUPTUUR ....................................................................................................................................... 19
VRUCHTWATEREMBOOL .............................................................................................................................. 20
NAVELSTRENGPROLAPS ............................................................................................................................... 21
INVERSO UTERI .......................................................................................................................................... 23
PRE-ECLAMPSIE / ECLAMPSIE ........................................................................................................................ 24
POSTPARTUMBLOEDING .............................................................................................................................. 25
PSYCHOPATHOLOGIE .................................................................................................................. 25
VISIES OP AFWIJKEND GEDRAG ...................................................................................................................... 25
STEMMINGSSTOORNISSEN ........................................................................................................................... 31
ANGSTSTOORNISSEN ................................................................................................................................... 37
PSYCHOSE EN DELIRIUM ............................................................................................................................... 43
INCONTINENTIE EN BEKKENBODEM-EDUCATIE............................................................................ 48
INLEIDING ................................................................................................................................................. 48
VORMEN VAN INCONTINENTIE ...................................................................................................................... 49
STELLINGEN ............................................................................................................................................... 51
VERLOSKUNDIG ECHOGRAFISCH ONDERZOEK ............................................................................. 52
INDICATIES VOOR VROEDVROUWEN ............................................................................................................... 52
DEEL 1: ALGEMENE BEGRIPPEN .................................................................................................................... 52
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,HRE
DEEL 2: ECHO ANATOMIE ............................................................................................................................ 57
DEEL 3: ECHOSCHOPISCH ZICHTBARE AFWIJKINGEN .......................................................................................... 67
CONCLUSIE ................................................................................................................................................ 81
WETGEVING ROND MEDISCH GEASSISTEERDE VOORTPLANTING ................................................. 81
MEDISCH GEASSISTEERDE BEVRUCTING........................................................................................................... 81
ADOPTIE ................................................................................................................................................... 83
ABORTUS ARTE PROVOCATUS ....................................................................................................................... 85
DRAAGMOEDERSCHAP................................................................................................................................. 86
ANONIEM BEVALLEN ................................................................................................................................... 86
KERING + CTG/STAN SOPHIE RIMAUX ......................................................................................... 87
LES 1: EXTERNE VERSIE ............................................................................................................... 87
INLEIDING ................................................................................................................................................. 87
TIMING .................................................................................................................................................... 87
ABSOLUTE CONTRA – INDICATIES .................................................................................................................. 87
RELATIEVE CONTRA – INDICATIES .................................................................................................................. 87
TECHNIEK ................................................................................................................................................. 88
COMPLICATIES ........................................................................................................................................... 88
SLAAGKANS ............................................................................................................................................... 88
LES 2: STAN BEOORDELING VAN HET KIND .................................................................................. 88
WAT WILLEN WE WETEN? ............................................................................................................................ 88
BEOORDELINGSMETHODEN .......................................................................................................................... 89
APGAR-SCORES ........................................................................................................................................ 89
ZUUR-BASE ............................................................................................................................................... 89
WAT IS ASFYXIE?........................................................................................................................................ 92
LES 3: STAN ECG BEOORDELING .................................................................................................. 92
INLEIDING ................................................................................................................................................. 92
ECG- COMPLEX ......................................................................................................................................... 93
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MYOCARDIALE ENERGIEBALANS .................................................................................................................... 93
ST-GOLFVORMEN....................................................................................................................................... 95
LES 4: STAN FOETAAL ECG INTERPRETATIE .................................................................................. 96
WAT REGISTREREN WE?............................................................................................................................... 96
PRESENTATIE VAN ST-GEGEVENS .................................................................................................................. 96
ST-VERANDERINGEN................................................................................................................................... 96
STAN® VEREENVOUDIGDE KLINISCHE RICHTLIJNEN ........................................................................................... 99
FOETALE VERDEDIGING ................................................................................................................................ 99
BEWAKING .............................................................................................................................................. 100
ZORGEN NEONAAT NICU .......................................................................................................... 100
BLOK 1: NLS.............................................................................................................................. 100
INLEIDING ............................................................................................................................................... 100
BLOK 1: ONTWIKKELINGSGERICHTE ZORG BIJ DE ALLERKLEINSTEN ............................................ 103
EVOLUTIE ................................................................................................................................................ 103
ONTWIKKELINGSGERICHTE ZORG ................................................................................................................. 104
1 STRESSREDUCTIE TGV OMGEVINGSFACTOREN ............................................................................................. 106
2. STRESSREDUCTIE MBT UITVOERING .......................................................................................................... 107
3. GEDRAGSOBSERVATIE VAN HET KIND (DISCOMFORT EN PIJN) ........................................................................ 107
4 NEURO-SENSORIËLE RIJPING VAN HET KIND BEVORDEREN ............................................................................. 108
SOCIALE OMGEVINGSASPECTEN .................................................................................................................. 111
BLOK 2 : O2 MONITORING ........................................................................................................ 111
RESPIRATIORE OBSERVATIE VAN HET KIND ..................................................................................................... 111
RESPIRATOIRE BEWAKING .......................................................................................................................... 113
ZUURSTOFTOEDIENING BIJ KINDEREN ........................................................................................................... 116
BLOK 3: INFUUSTHERAPIE ......................................................................................................... 129
DOEL ...................................................................................................................................................... 129
INDICATIES .............................................................................................................................................. 129
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PROBLEMEN INFUUSTHERAPIE .................................................................................................................... 129
SOORTEN TOEGANGSWEGEN ...................................................................................................................... 129
KATHETERSEPSIS ALS COMPLICATIE VAN INFUUSTHERAPIE ................................................................................ 135
VOCHTBEHOEFTE EN VOCHTBELEID BIJ HET KIND ............................................................................................ 136
BLOK 3: TRANSPORT VAN DE NEONAAT .................................................................................... 137
REDEN VOOR DOORVERWIJZING NAAR NICU ................................................................................................ 137
TRANSPORT VAN HIGH-RISK PASGEBORENE ................................................................................................... 138
BLOK 4: FARMACOLOGIE BINNEN DE NEONATOLOGIE ............................................................... 139
GENEESMIDDELEN EN DE NEONAAT ............................................................................................................. 139
FARMACOLOGIE TERMINOLOGIE.................................................................................................................. 139
LONGMIDDELEN ....................................................................................................................................... 140
CARDIALE MIDDELEN ................................................................................................................................. 141
VAATVERWIJDENDE MIDDELEN ................................................................................................................... 142
VOCHTAFDRIJVENDE MIDDELEN .................................................................................................................. 142
MIDDELEN BIJ BEADEMING (SEDERENDE MEDICATIE) ...................................................................................... 142
MIDDELEN BIJ OPEN D.A. .......................................................................................................................... 142
ANALGETICA ............................................................................................................................................ 143
ANTIBIOTICA ............................................................................................................................................ 143
ANTIVIRALE MIDDELEN .............................................................................................................................. 143
VITAMINES EN SUPPLEMENT ....................................................................................................................... 144
BLOK 4: SPECIFIEKE PATHOLOGIEËN EN THERAPIEËN OP DE NICU .............................................. 144
SPECIFIEKE PATHOLOGIEËN......................................................................................................................... 144
SPECIFIEKE THERAPIEËN ............................................................................................................................. 152
FERTILITEIT ............................................................................................................................... 159
2 BASISPRINCIPES ..................................................................................................................................... 159
OVULATIE- INDUCTIE ................................................................................................................................. 159
INTRA-UTERIENE INSEMINATIE (IUI) ............................................................................................................ 162
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IN-VITRO FERTILISATIE (IVF)........................................................................................................................ 164
REPRODUCTIEVE HEELKUNDE ...................................................................................................................... 170
PRE- IMPLANTATIE GENETISCHE DIAGNOSTIEK (PGD) ..................................................................................... 171
FERTILITEITSPRESERVATIE ........................................................................................................................... 174
REGISTRATIE ............................................................................................................................................ 174
FOLLOW UP KINDEREN .............................................................................................................................. 175
HOOGRISICO TECHNISCHE INTERVENTIES .................................................................................. 176
BEWAKING CARDIALE-CENTRALE CIRCULATIE ................................................................................................. 176
CVK ...................................................................................................................................................... 180
KNIEPEESREFLEX ...................................................................................................................................... 182
PLAATSEN VAN EEN MAAGSONDE................................................................................................................ 182
NEONATALE PROBLEMATIEK .................................................................................................... 183
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PATHOLOGISCHE VERLOSKUNDE
SCHOUDERDYSTOCIE
ALGEMENE INFORMATIE
INLEIDING
Een schouderdystocie is een obstetrische noodsituatie vanwege het risico op morbiditeit
bij het kind zoals asfyxie en/of trauma zoals plexus brachialislaesie.
Complicaties:
• Morbiditeit
• Asfyxie
• Trauma (plexus brachialislaesie)
Plexus brachialis: zenuwen thv van de nek die worden uitgerokken, kunnen zenuwletsels
en problemen op basis van kracht en handelingen, voornamelijk thv van de arm.
DEFINITIE
= Het blijven haken van de voorste schouder van het kind achter de symfyse van de moeder na het uitvoeren van
de gebruikelijke handgrepen
• Subjectieve definitie
• “hoofd-tot-romp-tijdsinterval” > 60 seconden
• Noodzaak tot uitvoeren van aanvullende manoeuvres om de schouders geboren te laten worden
INCIDENTIE
1% van de bevallingen in hoofdligging
Lage incidentie → ervaring van iedere clinicus met het oplossen van deze situatie gering
RISICOFACTOREN
•Eerder kind met een schouderdystocie
•Diabetes mellitus of zwangerschapsdiabetes :
o Kinderen van moeder met diabetes zijn vaak groter en hoeven niet per se zwaarder te zijn in
lichaamsgewicht. Ook bij normaal lichaamsgewicht zien we dat de kinderen breder
geschouderd zijn (bredere diameter thv schouder
• Obesitas
• Serotiniteit
• Multipariteit
• Ethnische, met name negroïde, afkomst
• Bekkenafwijkingen
Antepartum Intrapartum
• Macrosomie deze zw • Langdurige ontsluiting (>1cm/h)
• Macrosomie vorige zw • Langdurige uitdrijving (> 60 min)
• Obesitas • Oxytocine
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