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Samenvatting module gynaecologie en urologie
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Mijn samenvatting bevat de lessen van gynaecologie en urologie met de notities van de takken die gekend moeten zijn voor het examen
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MODULE GYNAECOLOGIEInhoudstafel
1) Perinatale kinesitherapie................................................................................................................. 9
A. Inleiding ....................................................................................................................................... 9
B. De normale zwangerschap .......................................................................................................... 9
1. Structurele verandering van de baarmoeder ........................................................................ 10
2. Fysiologische veranderingen ................................................................................................. 12
3. Psychische veranderingen ..................................................................................................... 17
2) Afwijkingen tijdens de zwangerschap ........................................................................................... 18
A. Abnormale zwangerschapsduur ................................................................................................ 18
1. Abortus - miskraam: .............................................................................................................. 18
2. Preterme bevalling: ............................................................................................................... 18
3. Postterme bevalling:.............................................................................................................. 18
4. Hoog risico patiënten ............................................................................................................ 18
B. Hypertensie ............................................................................................................................... 19
C. Bloedgroepsensibilisatie............................................................................................................ 20
D. Zwangerschapsdiabetes ............................................................................................................ 21
E. Toxoplasmose ............................................................................................................................ 22
F. Rubella ....................................................................................................................................... 22
G. CMV- cytomegalovirus .............................................................................................................. 22
H. Algemene aanbevelingen .......................................................................................................... 23
3) Opvolging tijdens de zwangerschap .............................................................................................. 25
A. Klinische richtlijn ....................................................................................................................... 25
B. Prenatale bezoeken: .................................................................................................................. 25
C. Diagnose van de zwangerschap ................................................................................................ 26
D. Prenatale controle ..................................................................................................................... 26
1. Klinisch onderzoek................................................................................................................. 26
2. Technisch onderzoek ............................................................................................................. 27
3. Bloedonderzoek..................................................................................................................... 27
4. Screening infecties ................................................................................................................ 27
5. Screening naar klinische problemen bij de moeder .............................................................. 31
E. Prenatale screening T21 ............................................................................................................ 31
1. Combinatie test ..................................................................................................................... 32
F. Prenatale diagnostiek ................................................................................................................ 33
1. Vlokkentest – chorionbiopsie: ............................................................................................... 33
1
, 2. Vruchtwaterpunctie – amniocentese: ................................................................................... 33
4) De bevalling 24/02......................................................................................................................... 34
A. Bevallen in België ...................................................................................................................... 34
B. Baringsproces afhankelijk van : ................................................................................................. 34
1. Baringskanaal : ...................................................................................................................... 34
2. Kind: ....................................................................................................................................... 35
3. Uitdrijvende kracht:............................................................................................................... 35
4. Hormonen tijdens de baring: ................................................................................................ 36
C. Verloop van de baring ............................................................................................................... 37
1. FASE 1 : ONTSLUITING ........................................................................................................... 37
2. FASE 2 : UITDRIJVING ............................................................................................................ 39
3. FASE 3 : NAGEBOORTE .......................................................................................................... 40
D. Kunstverlossing.......................................................................................................................... 40
1. Vaginale kunstverlossing ....................................................................................................... 41
2. Episiotomie ............................................................................................................................ 41
3. Andere methoden ................................................................................................................. 41
4. Abdominale kunstverlossing ................................................................................................. 41
E. Complicaties bevalling ............................................................................................................... 42
1. Perineumruptuur ................................................................................................................... 42
2. Stoornissen ten gevolge van afwijkende ligging v/d foetus .................................................. 42
3. schouderdystrocie ................................................................................................................. 43
4. Navelstrengprolaps ............................................................................................................... 44
5. Vruchtwaterembolie ............................................................................................................. 44
6. Foetale nood en hypoxie ....................................................................................................... 44
5) Pijnbestrijding ................................................................................................................................ 45
A. Pijn ............................................................................................................................................. 45
B. Baringspijn ................................................................................................................................. 45
C. Niet-farmacologische pijnbestrijding ........................................................................................ 46
D. Farmacologische pijnbestrijding................................................................................................ 46
E. Epidurale pijnbestrijding ........................................................................................................... 46
6) Prenatale voorbereiding op de bevalling ...................................................................................... 47
A. Elementen die de baring bevorderen........................................................................................ 47
1. Dynamiek van het bekken – houding en mobiliteit: ............................................................. 47
2. Hellingshoek van het bekken: ............................................................................................... 47
3. Kracht van de contracties en de zwaartekracht: ................................................................... 48
4. As van de foetus tov de bekkenvlakken: ............................................................................... 48
2
, 5. Tonus van de bekkenbodemspieren: .................................................................................... 48
6. Attitude en welbevinden van de parturiëntie: ...................................................................... 48
B. Begeleiding van de parturiënte (kine) ....................................................................................... 48
1. Houdingen en bewegingen tijdens de arbeid ....................................................................... 49
2. Houdingen en bewegingen tijdens de uitdrijving ................................................................. 49
C. Comfort elementen tijdens de arbeid ....................................................................................... 50
3. Conclusie ............................................................................................................................... 50
7) Fysieke activiteit tijdens en na de zwangerschap ......................................................................... 51
A. Perinatale kinesitherapie volgens Canadese guidelines ........................................................... 51
1. Richtlijnen voor FA ................................................................................................................ 51
2. Intensiteit .............................................................................................................................. 51
3. Contra-indicaties ................................................................................................................... 52
4. Veiligheidsmaatregelen ......................................................................................................... 52
B. Prenatale oefeningen ................................................................................................................ 52
1. Cardiorespiratoire training .................................................................................................... 52
2. Spierversterkende oefeningen .............................................................................................. 53
3. Bekkenbodemtraining ........................................................................................................... 53
4. Houdingsoefeningen ............................................................................................................. 53
5. Ontspanningsoefeningen ...................................................................................................... 53
6. Ademhalingsoefeningen........................................................................................................ 53
C. Preventie en behandeling van prenatale symptomen .............................................................. 54
1. Lage Rugpijn (LRP) en bekkeninstabiliteit (BI): ...................................................................... 54
2. Bekkensinstabilietit BI/ PGP .................................................................................................. 55
3. Gewichtstoename: ................................................................................................................ 57
4. Zwangerschapsdiabetes (ZD): ............................................................................................... 58
5. Urine incontinentie (UI):........................................................................................................ 58
6. Perineale pijn, dyspareunia: .................................................................................................. 58
7. Varices, oedemateuze benen, DVT: ...................................................................................... 59
8. Angst: ..................................................................................................................................... 59
9. Prenatale depressie: .............................................................................................................. 59
D. Postnatale kinesitherapie .......................................................................................................... 59
1. Fysieke activiteit na de bevalling ........................................................................................... 60
2. Kinesitherapie........................................................................................................................ 61
E. Diastase van de rectus abdominis (DRA)................................................................................... 61
F. Postnatale sport ........................................................................................................................ 62
8) UROLOGIE ...................................................................................................................................... 64
3
, A. Anatomie van het kleine bekken en bekkenbodem .................................................................. 64
1. Kleine bekken: ....................................................................................................................... 64
2. Bekkenbodem:....................................................................................................................... 64
3. Bekkenbodemspieren:........................................................................................................... 65
4. Bindweefsel: .......................................................................................................................... 65
B. Fysiologie van de continentie .................................................................................................... 66
1. Urethraal afsluitmechanisme : .............................................................................................. 66
C. Neurofysiologie v/d blaas .......................................................................................................... 68
1. De perifere bezenuwing: ....................................................................................................... 68
2. Het centrale zenuwstelsel: .................................................................................................... 68
3. Centrale banen ...................................................................................................................... 69
4. Stoornissen in reflexbanen: ................................................................................................... 71
5. Regeling: ................................................................................................................................ 72
D. Pathofysiologie .......................................................................................................................... 73
1. Risicofactoren voor bekkenbodemdysfunctie:...................................................................... 73
2. Bekkenbodemdysfunctie: ...................................................................................................... 73
3. Incontinentie: 4 soorten !...................................................................................................... 74
4. Stress incontinentie: .............................................................................................................. 75
5. Urge incontinentie:................................................................................................................ 76
6. Incontinentie bij mannen: ..................................................................................................... 77
7. Liggingsafwijkingen van pelvische organen: ......................................................................... 77
E. Onderzoek & Pelvische reëducatie Bij volwassenen ................................................................. 79
1. Lichamelijk onderzoek ........................................................................................................... 79
2. Adviezen over mictie ............................................................................................................. 81
3. Bekkenbodemoefeningen: .................................................................................................... 83
4. Casus 1 ................................................................................................................................... 84
9) Mictieproblemen bij kinderen ....................................................................................................... 86
A. Inleiding mictieproblemen kinderen ......................................................................................... 86
B. Ontwikkeling van zindelijk worden: .......................................................................................... 86
C. Dysfuncties bij kinderen: ........................................................................................................... 86
D. Incidentie bedplassen:............................................................................................................... 86
E. Oorzaken bedplassen: ............................................................................................................... 86
F. Therapie:.................................................................................................................................... 87
G. Bekkenbodemreëducatie .......................................................................................................... 87
H. Casus .......................................................................................................................................... 88
10) Zwangerschapsdiabetes ............................................................................................................ 89
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