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Samenvatting verloskunde blok 3: Kind in ontwikkeling
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Deze samenvatting is geschreven door een student van de Academie Verloskunde Maastricht en omvat alle globale leerdoelen van blok 3.
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Samenvatting blok 3Kind in ontwikkeling
Inhoudsopgave
1 De embryogenese ........................................................................................................................................6
De bevruchting .................................................................................................................................................... 6
Capacipatie..................................................................................................................................................... 7
De klievingsdelingen ........................................................................................................................................... 8
De nidatie ............................................................................................................................................................ 8
De gastrulatie ................................................................................................................................................... 10
De neurale buis (en neurale buisdefecten) ........................................................................................................ 12
Neurale buisdefecten ................................................................................................................................... 12
Foliumzuur ................................................................................................................................................... 12
Plooivorming ..................................................................................................................................................... 13
Organogenese ................................................................................................................................................... 14
De ontwikkeling van het ectoderm ................................................................................................................... 16
De ontwikkeling van het mesoderm.................................................................................................................. 17
Het paraxiale mesoderm .............................................................................................................................. 17
Het intermediaire mesoderm ...................................................................................................................... 18
Zijplaatmesoderm ........................................................................................................................................ 18
De ontwikkeling van het endoderm .................................................................................................................. 18
De ontwikkeling van de inwendige geslachtsorganen ...................................................................................... 19
De ontwikkeling van de cloaca ..................................................................................................................... 19
De gangen van Wolff en Müller ................................................................................................................... 22
De ontwikkeling van de vagina .................................................................................................................... 24
De ontwikkeling van de uitwendige geslachtsorganen ..................................................................................... 25
De descendus van de testis en ovaria ............................................................................................................... 27
Aangeboren afwijkingen ................................................................................................................................... 28
Afwijkingen aan de allantois ........................................................................................................................ 28
Afwijkingen aan de uterus en vagina ........................................................................................................... 29
Afwijkingen uitwendige geslachtsorganen van de man ............................................................................... 30
Afwijkingen van de descendus testes .......................................................................................................... 30
Het ontstaan van tweelingen ............................................................................................................................ 30
Het tweelingfusiesyndroom ......................................................................................................................... 31
Miskraam .......................................................................................................................................................... 31
Spontane miskraam ..................................................................................................................................... 32
Niet-intacte zwangerschap .......................................................................................................................... 32
Kwetsbare momenten van de organogenese ................................................................................................... 32
De ontwikkeling van de placenta ...................................................................................................................... 33
De vroege ontwikkeling van de placenta ..................................................................................................... 33
De late ontwikkeling van de placenta .......................................................................................................... 34
De anatomie van de placenta ........................................................................................................................... 36
De functie van de placenta ............................................................................................................................... 36
1
, Gasuitwisseling ............................................................................................................................................ 37
Transportfunctie .......................................................................................................................................... 38
De placentabarrière ..................................................................................................................................... 39
Hormonale functie ....................................................................................................................................... 39
De invloeden van teratogenen op de placenta ............................................................................................ 40
De ontwikkeling van vruchtwater ..................................................................................................................... 41
2 De foetale periode ..................................................................................................................................... 42
De normale foetale groei .................................................................................................................................. 42
Foetale groei factoren....................................................................................................................................... 44
Maternale determinanten ........................................................................................................................... 44
Foetale determinanten ................................................................................................................................ 46
Placentaire determinanten .......................................................................................................................... 47
Foetale groeivertraging .................................................................................................................................... 47
Symmetrische groeivertraging ..................................................................................................................... 47
Asymmetrische groeivertraging ................................................................................................................... 47
Foetale groeivertraging (FGV) ...................................................................................................................... 47
Small for gestational age (SGA) .................................................................................................................... 47
Large for gestational age (LGA) .................................................................................................................... 48
Verschillen tussen FGV en SGA .................................................................................................................... 48
Gevolgen van foetale groeivertraging .............................................................................................................. 48
Perinatale mortaliteit ................................................................................................................................... 49
Perinatale morbiditeit .................................................................................................................................. 49
Eerste levensjaren ........................................................................................................................................ 49
Latere leeftijd ............................................................................................................................................... 49
Het meten van de groei..................................................................................................................................... 49
Fundushoogte gerelateerd aan anatomische referentiepunten.................................................................. 49
Fundus-symfysemeting ................................................................................................................................ 50
Echoscopie ................................................................................................................................................... 50
Groeicurves ....................................................................................................................................................... 50
Geboortegewichtcurve ................................................................................................................................ 51
Foetale populatiecurve ................................................................................................................................ 51
Het meten van het vruchtwater ........................................................................................................................ 51
Serotiniteit ........................................................................................................................................................ 53
3 Medicijnen ................................................................................................................................................. 53
Farmacodynamiek en farmacokinetiek ............................................................................................................. 53
Algemene termen ........................................................................................................................................ 53
Farmacokinetiek........................................................................................................................................... 54
Farmacodynamiek ........................................................................................................................................ 57
De werking van medicijnen in de zwangere vrouw ........................................................................................... 57
De invloed van het geneesmiddel op de vrucht ................................................................................................ 59
Invloed van medicijnen op de lactatie............................................................................................................... 60
Medicijnen die de verloskundige mag voorschrijven ........................................................................................ 62
Ijzerpreparaten ............................................................................................................................................ 62
Oxytocine ..................................................................................................................................................... 63
Moederkoornalkaloïden .............................................................................................................................. 64
Anti-D-rhesus immunoglobuline .................................................................................................................. 65
Hepatitis B immunoglobuline....................................................................................................................... 65
Hepatitis B vaccin ......................................................................................................................................... 66
2
, Vitamine K .................................................................................................................................................... 67
Lokale anesthetica ....................................................................................................................................... 68
Belangrijke medicatie ....................................................................................................................................... 69
Corticosteroïden .......................................................................................................................................... 69
Ventolin ........................................................................................................................................................ 69
Amoxicilline .................................................................................................................................................. 70
Antihistaminica ............................................................................................................................................ 71
Zovirax .......................................................................................................................................................... 71
Daktarin........................................................................................................................................................ 72
NSAID ........................................................................................................................................................... 72
Paracetamol/codeïne ................................................................................................................................... 73
Maagzuurremmers....................................................................................................................................... 73
SSRI............................................................................................................................................................... 73
Sintjanskruid ................................................................................................................................................ 74
Melatonine ................................................................................................................................................... 75
Ascal ............................................................................................................................................................. 75
Homeopathische en plantaardige geneesmiddelen.......................................................................................... 76
Teratogeniteit ................................................................................................................................................... 76
Recept schrijven ................................................................................................................................................ 77
4 De tractus circulatorius van de foetus ........................................................................................................ 78
5 De tractus respiratorius van de foetus ........................................................................................................ 82
6 Foetale bewaking ....................................................................................................................................... 85
Veranderingen in de hartfrequentie ................................................................................................................. 86
Hypoxemie, hypoxie en asfyxie ......................................................................................................................... 88
Doptone en CTG ................................................................................................................................................ 90
Basishartfrequentie...................................................................................................................................... 91
Variabiliteit ................................................................................................................................................... 91
Acceleraties .................................................................................................................................................. 92
Deceleraties ................................................................................................................................................. 92
Registratie van contracties........................................................................................................................... 95
De fysiologie van zuur-base .............................................................................................................................. 95
Afname navelstrengbloed ................................................................................................................................. 98
Normaalwaarden ......................................................................................................................................... 98
7 De neonaat ................................................................................................................................................ 99
De apgarscore ................................................................................................................................................... 99
Onderzoek neonaat........................................................................................................................................... 99
Algemeen lichamelijk onderzoek .................................................................................................................... 100
Kleur ........................................................................................................................................................... 100
Ademhaling ................................................................................................................................................ 100
Tonus.......................................................................................................................................................... 100
Middelbare schedelomtrek ........................................................................................................................ 100
Lengte ........................................................................................................................................................ 100
Temperatuur .............................................................................................................................................. 100
Specifiek lichamelijk onderzoek ...................................................................................................................... 101
Huid ............................................................................................................................................................ 101
Het hoofd ................................................................................................................................................... 101
Ogen ........................................................................................................................................................... 102
3
, Oren ........................................................................................................................................................... 103
Neus ........................................................................................................................................................... 103
Mond .......................................................................................................................................................... 103
Hals ............................................................................................................................................................ 104
Thorax ........................................................................................................................................................ 104
Buik ................................................................................................................................................................. 105
Genitaliën ................................................................................................................................................... 105
Anus ........................................................................................................................................................... 106
Rug en wervelkolom .................................................................................................................................. 106
Heupen ....................................................................................................................................................... 106
Armen en benen ........................................................................................................................................ 106
Neurologisch onderzoek.................................................................................................................................. 107
Huidaandoeningen neonaat ........................................................................................................................... 108
Milia ........................................................................................................................................................... 108
Naevus unnae ............................................................................................................................................ 108
Naevus flammeus ....................................................................................................................................... 109
Capillaire en caverneuze hemangiomen .................................................................................................... 110
Mongolenvlek ............................................................................................................................................ 111
Petechiën ................................................................................................................................................... 112
Impertigo bullosa ....................................................................................................................................... 112
Erythema toxicum neonatorum ................................................................................................................. 112
Zuig- blaren ................................................................................................................................................ 113
Vluchtige neonatale pustulaire melanose.................................................................................................. 113
Hyperplasie ................................................................................................................................................ 114
PROVOKE .................................................................................................................................................... 115
Vitamine K....................................................................................................................................................... 115
Vitamine D ...................................................................................................................................................... 115
Controles kraamweek ..................................................................................................................................... 116
Temperatuur .............................................................................................................................................. 116
Flesvoeding ................................................................................................................................................ 116
Mictie ......................................................................................................................................................... 116
Defecatie .................................................................................................................................................... 117
Navel .......................................................................................................................................................... 117
Huid ............................................................................................................................................................ 117
Gedrag........................................................................................................................................................ 118
Het hoofd ................................................................................................................................................... 118
De ogen ...................................................................................................................................................... 118
8 Regulatiesystemen van de neonaat .......................................................................................................... 118
De extra-uteriene circulatie ............................................................................................................................ 119
De extra-uteriene respiratoire circulatie ......................................................................................................... 120
9 Het thermoregulatiesysteem en immunologie.......................................................................................... 123
Het thermoregulatiesysteem .......................................................................................................................... 123
Kern en schil .................................................................................................................................................... 123
Temperatuurcentrum...................................................................................................................................... 123
Temperatuurregulatie van de neonaat ...................................................................................................... 126
Het afweersysteem van een volwassen .......................................................................................................... 127
Leukocyten ................................................................................................................................................. 127
Het lymfestelsel ......................................................................................................................................... 128
De afweer ........................................................................................................................................................ 131
4
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