Summary
Samenvatting verloskunde blok 6: Coördinerend zorgverlener
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Deze samenvatting is geschreven door een student van de Academie Verloskunde Maastricht en omvat alle globale leerdoelen van blok 6.
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Samenvatting blok 6Coördinerend zorgverlener
Inhoudsopgave
1. Taken en bevoegdheden coördinerend zorgverlener ...................................................................................7
1.1 De casemanager, het geboorteplan en het huisbezoek ................................................................................ 7
De casemanager ............................................................................................................................................. 7
Zorgplan .......................................................................................................................................................... 9
Het huisbezoek ............................................................................................................................................. 10
1.2 Een Zorgpad ................................................................................................................................................ 11
Soorten zorgpaden ....................................................................................................................................... 11
R4U ............................................................................................................................................................... 12
Mind2Care .................................................................................................................................................... 12
Het model 2move ......................................................................................................................................... 12
1.3 Samenwerking ............................................................................................................................................. 13
Multidisciplinaire samenwerking .................................................................................................................. 13
Interprofessionele samenwerking ................................................................................................................ 13
2. Zorg op maat (tienerzwangerschap) .......................................................................................................... 14
2.1 Preventie ..................................................................................................................................................... 16
2.2 Sociale kaart ................................................................................................................................................ 17
3. Angst voor de baring ................................................................................................................................. 18
3.1 Functie van baringspijn ............................................................................................................................... 19
3.2 Pijngedrag ................................................................................................................................................... 19
3.3 Basisvormen van baringspijn ....................................................................................................................... 19
3.4 Complexiteit baringspijnfenomeen.............................................................................................................. 20
3.5 Emotie, cognitie, stress en baringspijn ........................................................................................................ 21
3.6 Catastroferen en vermijdingsmodel van baring en pijn .............................................................................. 21
3.7 Het model van Loeser .................................................................................................................................. 22
3.8 Tocofobie ..................................................................................................................................................... 22
Prevalentie .................................................................................................................................................... 23
Klinisch beeld ................................................................................................................................................ 23
Risicofactoren ............................................................................................................................................... 24
3.9 Interventies bij angst ................................................................................................................................... 24
Geboorteplan ................................................................................................................................................ 24
Hypnobirthing ............................................................................................................................................... 25
4. Medicamenteuze en niet-medicamenteuze pijnbestrijding ....................................................................... 25
4.1 Niet-medicamenteuze pijnbestrijding ......................................................................................................... 25
4.1.1 Steriel waterinjecties (SWI).................................................................................................................. 25
4.1.2 Acupunctuur ........................................................................................................................................ 26
4.1.3 Acupressuur ......................................................................................................................................... 26
4.1.4 TENS ..................................................................................................................................................... 26
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, 4.2 Medicamenteuze pijnbestrijding ................................................................................................................. 26
4.2.1 Regionale analgesie ............................................................................................................................. 27
4.2.2 Pethidine .............................................................................................................................................. 29
4.2.3 Remifentanil......................................................................................................................................... 30
4.2.4 Lachgas................................................................................................................................................. 30
5. Pathofysiologie van afwijkende liggingen .................................................................................................. 31
5.1 Anatomie van het bekken ............................................................................................................................ 31
Afmetingen bekken ....................................................................................................................................... 32
Bekkenvormen .............................................................................................................................................. 32
5.2 Anatomie van de schedel van de foetus ...................................................................................................... 33
Afmetingen van foetale schedel ................................................................................................................... 33
5.3 Definities ..................................................................................................................................................... 34
Vlakken van Hodge ....................................................................................................................................... 34
De positie ...................................................................................................................................................... 34
De excentrische pool .................................................................................................................................... 34
Draaiingen ..................................................................................................................................................... 34
Het draaipunt ................................................................................................................................................ 35
Liggingen ....................................................................................................................................................... 35
5.4 afwijkende schedelliggingen ....................................................................................................................... 35
5.4.1 Achterhoofdsligging, achterhoofd voor (Aav) ...................................................................................... 35
5.4.2 Kruinligging (Kaa) ................................................................................................................................. 36
5.4.3 Achterhoofdsligging, achterhoofd achter (Aaa)................................................................................... 38
5.4.4 Voorhoofdsligging ................................................................................................................................ 39
5.4.5 Aangezichtsligging (Aakv)..................................................................................................................... 40
5.4.6 Hoge rechtstand (Aav/OA of Aaa/OP) ................................................................................................. 41
5.4.7 Diepe dwarsstand (Aaldw/LOT of Aardw/ROT) ................................................................................... 43
5.4.8 Wandbeenligging (Waldw)................................................................................................................... 44
5.5 Liggingsafwijkingen ..................................................................................................................................... 45
5.5.1 Stuitligging ........................................................................................................................................... 45
5.5.2 Dwarsligging ......................................................................................................................................... 51
5.5.3 Uitgezakte extremiteiten ..................................................................................................................... 51
5.5.4 Uitgezakte navelstreng ........................................................................................................................ 54
5.5.5 Versie ................................................................................................................................................... 57
5.5.6 Gemelli ................................................................................................................................................. 62
6. Langdurig gebroken vliezen ....................................................................................................................... 70
6.1 Definitie ....................................................................................................................................................... 70
6.2 Prevalentie .................................................................................................................................................. 70
6.3 Risicofactoren .............................................................................................................................................. 70
6.4 Risico’s voor moeder en kind ....................................................................................................................... 70
Moeder ......................................................................................................................................................... 70
Kind ............................................................................................................................................................... 70
6.5 Diagnose...................................................................................................................................................... 71
6.6 Beleid ........................................................................................................................................................... 71
7. Niet vorderende ontsluiting ...................................................................................................................... 72
7.1 In partu ........................................................................................................................................................ 72
7.2 De fasen van de ontsluiting ......................................................................................................................... 73
7.3 De definitie van NVO ................................................................................................................................... 74
2
, 7.4 Langdurige ontsluiting en complicaties ....................................................................................................... 75
7.5 Oorzaken van NVO tijdens de latente fase .................................................................................................. 76
Iatrogene oorzaak ......................................................................................................................................... 76
Weerstand van de cervix .............................................................................................................................. 76
Inadequate uterusactiviteit .......................................................................................................................... 76
Pijn en angst.................................................................................................................................................. 77
Overgewicht .................................................................................................................................................. 77
7.6 Oorzaken van NVO tijdens de actieve fase .................................................................................................. 77
Inadequate uterusactiviteit .......................................................................................................................... 77
Uitputting ...................................................................................................................................................... 78
Volle blaas ..................................................................................................................................................... 79
Infecties ........................................................................................................................................................ 79
Wanverhouding ............................................................................................................................................ 79
7.7 Interventies bij niet vorderende ontsluiting................................................................................................. 80
7.8 Het beleid van de verloskundige in een stroomdiagram ............................................................................. 81
Het eerste bezoek ......................................................................................................................................... 81
De latente fase .............................................................................................................................................. 81
De actieve fase .............................................................................................................................................. 82
8. Serotiniteit, meconiumhoudend vruchtwater en inleiden ......................................................................... 82
8.1 Serotiniteit ................................................................................................................................................... 82
Incidentie ...................................................................................................................................................... 82
Risicofactoren ............................................................................................................................................... 82
Prognose voor de moeder ............................................................................................................................ 83
Prognose voor de foetus/neonatus .............................................................................................................. 83
Beleid ............................................................................................................................................................ 83
Preventie ....................................................................................................................................................... 84
8.2 Meconiumhoudend vruchtwater ................................................................................................................. 84
Neonatale risico’s ......................................................................................................................................... 84
Risicofactoren MAS ....................................................................................................................................... 85
Preventie MAS .............................................................................................................................................. 85
Behandeling MAS .......................................................................................................................................... 85
Beleid meconiumhoudend vruchtwater ....................................................................................................... 85
8.3 Inleiden ........................................................................................................................................................ 85
Definitie ........................................................................................................................................................ 85
Maternale gevolgen ...................................................................................................................................... 86
Neonatale gevolgen ...................................................................................................................................... 87
De verschillende inleid mogelijkheden ......................................................................................................... 88
9. Niet vorderende uitdrijving ....................................................................................................................... 90
9.1 Het uitdrijvingstijdperk ................................................................................................................................ 90
9.2 Niet-vorderende uitdrijving ......................................................................................................................... 92
Oorzaken niet-vorderende uitdrijving .......................................................................................................... 92
Beleid ............................................................................................................................................................ 93
10. Kunstverlossingen ................................................................................................................................... 93
10.1 Incidentie ................................................................................................................................................... 93
10.2 Indicaties ................................................................................................................................................... 93
10.3 Contra-indicaties ....................................................................................................................................... 93
10.4 Indeling ...................................................................................................................................................... 94
3
, 10.5 Voorwaarden voor vacuüm- of forcipale extractie .................................................................................... 94
10.6 Voor- en nadelen vacuüm vs forceps ......................................................................................................... 95
10.7 Complicaties .............................................................................................................................................. 95
Neonatale complicaties ................................................................................................................................ 95
Infecties ........................................................................................................................................................ 96
Maternale complicaties ................................................................................................................................ 96
10.8 Forceps ...................................................................................................................................................... 97
Techniek van een forcipale extratie .............................................................................................................. 97
10.9 Vacuümextractie ....................................................................................................................................... 98
Materiaal....................................................................................................................................................... 98
Vorm ............................................................................................................................................................. 98
Afmeting ....................................................................................................................................................... 99
Vacuümdruk.................................................................................................................................................. 99
Techniek bij een vacuümextractie ................................................................................................................ 99
Oorzaken van mislukken van vacuümextractie .......................................................................................... 100
Beleid na vacuümextraxtie ......................................................................................................................... 100
11. Sectio .................................................................................................................................................... 101
11.1 Incidentie ................................................................................................................................................. 101
11.2 Perioperatieve fase.................................................................................................................................. 101
Counseling .................................................................................................................................................. 101
Preoperatieve onderzoeken ....................................................................................................................... 101
Antibiotica................................................................................................................................................... 101
Tromboseprofylaxe ..................................................................................................................................... 102
Preventie van nabloeding ........................................................................................................................... 102
Maternale positionering ............................................................................................................................. 102
Blaaskatheterisatie ..................................................................................................................................... 102
Placentalokalisatie ...................................................................................................................................... 102
11.3 Anesthesie ............................................................................................................................................... 103
Regionale anesthesie .................................................................................................................................. 103
Algehele anesthesie .................................................................................................................................... 103
Lokale anesthesie........................................................................................................................................ 103
Adipositas als een extra risicofactor bij sectio ............................................................................................ 103
11.4 Operatieve aspecten................................................................................................................................ 104
Openen van de buikwand ........................................................................................................................... 104
Geboorte van het kind ................................................................................................................................ 106
Geboorte van placenta ............................................................................................................................... 106
11.5 ‘Gentle-cesarean’-techniek...................................................................................................................... 107
11.6 Maternale complicaties ........................................................................................................................... 107
Niche vorming ............................................................................................................................................. 107
12. Foetale bewaking .................................................................................................................................. 109
12.1 De foetale hartfrequentie ........................................................................................................................ 109
Veranderingen in de hartfrequentie ........................................................................................................... 109
Hartfrequentie tijdens de bevalling ............................................................................................................ 110
12.2 Foetale bewaking .................................................................................................................................... 111
Basishartfrequentie .................................................................................................................................... 112
Variabiliteit ................................................................................................................................................. 112
Acceleraties................................................................................................................................................. 113
Deceleraties ................................................................................................................................................ 113
Registratie van contracties ......................................................................................................................... 115
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