Summary
Samenvatting verloskunde blok 8: Lifestyle
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Deze samenvatting is geschreven door een student van de Academie Verloskunde Maastricht en omvat alle globale leerdoelen uit blok 8.
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By: suzannewillemse7 • 5 months ago
By: brianneprinsen • 4 months ago
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Samenvatting blok 8Lifestyle
Inhoudsopgave
1. Public Health ...............................................................................................................................................7
1.1 De volksgezondheid....................................................................................................................................... 7
1.1.2 Model van Dahlgren en Whitehead (ecologisch model) ....................................................................... 7
1.2 Preven5e ....................................................................................................................................................... 8
1.2.1 Preven;e naar doelgroep ...................................................................................................................... 8
1.2.2 Preven;e naar fase van de ziekte.......................................................................................................... 9
1.2.3 Preven;e naar doel ............................................................................................................................... 9
1.2.4 Preven;e naar pijlers integrale aanpak ................................................................................................. 9
1.3 We9elijke kaders rondom de geboortezorg .................................................................................................. 9
2. Diabetes .................................................................................................................................................... 10
2.1 De fysiologie van de bloedglucoseregula5e ................................................................................................ 10
2.1.1 Glucosemetabolisme ........................................................................................................................... 11
2.1.2 Bloedsuikerspiegel in de zwangerschap .............................................................................................. 12
2.2 De pathofysiologie van de bloedsuikerspiegel (diabetes type 1 en 2) ......................................................... 12
2.2.1 Diabetes type 1 ................................................................................................................................... 12
2.2.2 Diabetes type 2 ................................................................................................................................... 13
2.2.3 Vaststellen diabetes mellitus ............................................................................................................... 13
2.3 Effect van diabetes type 1 en 2 op zwangerschap....................................................................................... 14
2.4 Effect van de zwangerschap op diabetes .................................................................................................... 15
2.5 Diabetes gravidarum................................................................................................................................... 16
2.5.1 Risicofactoren voor GDM .................................................................................................................... 16
2.5.2 Risico’s van GDM voor moeder en kind............................................................................................... 16
2.5.3 Screening op GDM .............................................................................................................................. 17
2.5.4 Diagnose GDM .................................................................................................................................... 18
2.5.5 Het beleid pre-nataal .......................................................................................................................... 18
2.5.6 Het beleid nataal ................................................................................................................................. 19
2.5.7 Het beleid postpartum ........................................................................................................................ 20
2.6 Preven5emogelijkheden voor GDM en diabetes mellitus ........................................................................... 21
3. Obesitas .................................................................................................................................................... 22
3.1 Pathofysiologie ........................................................................................................................................... 22
3.2 Risicofactoren voor het krijgen van obesitas............................................................................................... 22
3.2.1 Omgevingsfactoren ............................................................................................................................. 22
3.2.2 Psychologische factoren ...................................................................................................................... 22
3.2.3 Ziektebeelden en gewichtstoename ................................................................................................... 23
3.2.4 Geneesmiddelen en gewichtstoename ............................................................................................... 23
3.2.5 Eetstoornis en gewichtstoename ........................................................................................................ 23
3.3 Risico’s ......................................................................................................................................................... 23
3.3.1 Preconcep;oneel ................................................................................................................................ 23
3.3.2 Pre-nataal ............................................................................................................................................ 24
3.3.3 Nataal .................................................................................................................................................. 24
, 3.3.4 Postnataal............................................................................................................................................ 25
3.4 Het beleid .................................................................................................................................................... 25
3.4.1 Preconcep;oneel ................................................................................................................................ 25
3.4.2 Pre-nataal ............................................................................................................................................ 25
3.4.3 Nataal .................................................................................................................................................. 26
3.4.4 Postpartum.......................................................................................................................................... 26
4. Posi8eve disconguren8e ........................................................................................................................... 27
4.1 Prevalen5e .................................................................................................................................................. 27
4.2 Risicofactoren.............................................................................................................................................. 27
4.3 Risico’s van macrosomie ............................................................................................................................. 27
4.4 Screening en diagnos5ek ............................................................................................................................ 27
4.5 Het beleid .................................................................................................................................................... 28
4.5.1 Preconcep;oneel ................................................................................................................................ 28
4.5.2 Pre-nataal ............................................................................................................................................ 28
4.5.3 Nataal .................................................................................................................................................. 28
4.5.4 Postnataal............................................................................................................................................ 29
5. Polyhydramnion ........................................................................................................................................ 29
5.1 Oorzaken polyhydramnion .......................................................................................................................... 29
5.2 Complica5es van polyhydramnion .............................................................................................................. 29
5.3 Screening en diagnos5ek ............................................................................................................................ 29
5.4 Beleid .......................................................................................................................................................... 30
6. Schouderdystocie ...................................................................................................................................... 30
6.1 Risicofactoren voor een schouderdystocie .................................................................................................. 31
6.1.1 Foetaal................................................................................................................................................. 31
6.1.2 Maternaal ............................................................................................................................................ 31
6.1.3 Natale predisponerende factoren ....................................................................................................... 32
6.2 Beleid .......................................................................................................................................................... 32
6.2.1 Signalen van een schouderdystocie .................................................................................................... 32
6.2.2 Het oplossen van een schouderdystocie ............................................................................................. 32
6.2.3 Postpartum.......................................................................................................................................... 36
7. Epilepsie.................................................................................................................................................... 36
7.1 Pathofysiologie ........................................................................................................................................... 37
7.2 Inciden5e..................................................................................................................................................... 37
7.3 Maternale risico’s ........................................................................................................................................ 37
7.4 Foetale risico’s ............................................................................................................................................. 39
7.5 Het beleid .................................................................................................................................................... 39
7.5.1 Preconcep;oneel ................................................................................................................................ 40
7.5.2 Pre-nataal ............................................................................................................................................ 40
7.5.3 Nataal .................................................................................................................................................. 41
7.5.4 Postnataal............................................................................................................................................ 42
7.5.5 Borstvoeding ....................................................................................................................................... 43
7.6 Eclamp5sch insult ....................................................................................................................................... 43
7.6.1 Inciden;e ............................................................................................................................................ 43
7.6.2 Predisponeerde factoren..................................................................................................................... 43
2
, 7.6.3 Beleid .................................................................................................................................................. 44
7.6.4 Complica;es ........................................................................................................................................ 44
8. Afwijkingen bij de foetus/neonaat ............................................................................................................ 44
8.1 Tractus urogenitalis..................................................................................................................................... 44
8.1.1 Hydronefrose....................................................................................................................................... 44
8.1.2 Nierangenesie ..................................................................................................................................... 47
8.1.3 Congenitale uterusanomaliën ............................................................................................................. 48
8.1.4 Dysplas;sche urinewegen ................................................................................................................... 49
8.1.5 Cystenieren ......................................................................................................................................... 49
8.1.6 Stenose (UPJ) ....................................................................................................................................... 50
8.1.7 Aangeboren uretrakleppen ................................................................................................................. 50
8.1.8 Hormonale stoornissen: congenitale bijnier hyperplasie (AGS) .......................................................... 50
8.1.9 Chromosomale stoornissen: syndroom van Turner ............................................................................ 52
8.1.10 Chromosomale stoornissen: syndroom van Swyer ........................................................................... 53
8.1.11 Hermafrodi;sme ............................................................................................................................... 54
8.1.12 Differen;a;e stoornissen .................................................................................................................. 54
8.2 Tractus diges5vus ........................................................................................................................................ 55
8.2.1 Pylorusstenose .................................................................................................................................... 55
8.2.2 Necro;sche enterocoli;s .................................................................................................................... 56
8.2.3 Anorectale malforma;es (ARM).......................................................................................................... 59
8.2.4 Meconiumplug(+syndroom) ................................................................................................................ 64
8.2.5 Hernia diafragma;ca ........................................................................................................................... 66
8.2.6 Hernia umbilicalis ................................................................................................................................ 68
8.2.7 Omphalocele ....................................................................................................................................... 69
8.2.8 Gastro-schisis ...................................................................................................................................... 70
8.2.9 Oesophagusatresie met of zonder oesofageale fistel ......................................................................... 71
8.2.10 Ziekte van Hirschsprung (aganglionose) ............................................................................................ 73
8.2.11 Malrota;e van de darmen ................................................................................................................ 74
8.2.13 Atresie of stenose van duodenum, ileum of jujunem ....................................................................... 75
9. Foetale en maternale hartafwijkingen ....................................................................................................... 76
9.1 Fysiologische aanpassingen van de foetus.................................................................................................. 76
9.2 Maternale fysiologische aanpassingen ....................................................................................................... 77
9.3 Effect van zwangerschap op aangeboren hartafwijking (AHA)................................................................... 77
9.3.1 Preconcep;oneel advies ..................................................................................................................... 79
9.4 De verschillende hartafwijkingen ................................................................................................................ 80
9.4.1 VSD ...................................................................................................................................................... 80
9.4.2 ASD ...................................................................................................................................................... 82
9.4.3 AVSD .................................................................................................................................................... 83
9.4.4 Aortaklepstenose ................................................................................................................................ 84
9.4.5 Pulmonalis stenose ............................................................................................................................. 86
9.4.6 Tertalogie van Fallot ............................................................................................................................ 87
9.4.7 Coarcta;o aorta .................................................................................................................................. 88
9.4.8 Persisterende open ductus van botali ................................................................................................. 90
9.4.9 Transposi;e van de groten vaten ........................................................................................................ 91
9.4.10 Hypoplas;sch linker hartsyndroom................................................................................................... 92
9.4.11 Endocardi;s....................................................................................................................................... 94
9.4.12 Hartziekten zoals har;nfarct en hartr;me stoornissen .................................................................... 95
9.4.13 Decompensa;o cordis ....................................................................................................................... 99
10. Vrouwelijke genitale verminking ........................................................................................................... 101
10.1 Inciden5e................................................................................................................................................. 102
3
, 10.2 Vormen van verminking .......................................................................................................................... 102
10.3 Gevolgen van genitale verminking .......................................................................................................... 103
10.3.1 Korte termijn ................................................................................................................................... 103
10.3.2 Lange termijn .................................................................................................................................. 103
10.4 Begeleiding ............................................................................................................................................. 104
10.4.1 Begeleiden van meisjes met een recente VGV ................................................................................ 104
10.4.2 Begeleiding van vrouwen met status na VGV.................................................................................. 105
10.5 Beleid ...................................................................................................................................................... 105
10.5.1 Zwangerschap ................................................................................................................................. 105
10.5.2 Partus .............................................................................................................................................. 106
10.5.3 Kraambed ........................................................................................................................................ 107
10.6 We9elijke kaders ..................................................................................................................................... 107
11. Seksuele disfunc8e ................................................................................................................................ 108
11.1 Seksuele aversie ...................................................................................................................................... 108
11.2 Dyspareunie ............................................................................................................................................ 109
11.3 Vaginisme................................................................................................................................................ 109
11.4 Automu5la5e/zel]eschadiging .............................................................................................................. 110
11.5 Seksueel misbruik .................................................................................................................................... 110
12. Schildklier ............................................................................................................................................. 114
12.1 Fysiologie van de schildklier .................................................................................................................... 114
12.1.1 Fysiologische verandering in de zwangerschap............................................................................... 115
12.2 Schildklierfunc5estoornissen ................................................................................................................... 116
12.2.1 Hyperthyreoïdie .............................................................................................................................. 116
12.2.3 Hypothyroïdie.................................................................................................................................. 119
12.2.3 Thryreoïdi;s .................................................................................................................................... 121
12.2.4 Congenitale hyperthyreoïdie ........................................................................................................... 122
13. Auto-immuunaandoening ..................................................................................................................... 125
13.1 MS ........................................................................................................................................................... 125
13.2 SLE ........................................................................................................................................................... 127
13.3 Ziekte van Crohn ..................................................................................................................................... 129
13.4 Coli5s ...................................................................................................................................................... 131
14. Subfer8liteit .......................................................................................................................................... 132
14.1 Inciden5e................................................................................................................................................. 132
14.2 Oorzaken ................................................................................................................................................. 132
14.3 Organisa5e van zorg ............................................................................................................................... 133
14.4 Behandelmogelijkheden.......................................................................................................................... 134
14.4.1 IUI .................................................................................................................................................... 134
14.4.2 IVF ................................................................................................................................................... 135
14.4.3 ICSI .................................................................................................................................................. 135
14.4.4 IVM .................................................................................................................................................. 136
14.4.5 MESA/PESA/TESE ............................................................................................................................ 136
14.4.6 KID ................................................................................................................................................... 136
14.4.7 Eiceldona;e ..................................................................................................................................... 137
14.4.8 Draagmoederschap ......................................................................................................................... 137
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