Dit is mijn samenvatting, gebaseerd op de lessen uit . Aan de hand van deze samenvatting heb ik voor het examen geleerd, en ben ik hiervoor geslaagd. (Resultaat: 16/20). Geleerd in combinatie met het kleine handboek.
Foetaal hartritme en bewaking
Inhoud
1. Inleiding..............................................................................................................................................2
2. Fysiologische betekenis van het foetale hartritme.............................................................................2
2.1 Regulatie FHR................................................................................................................................2
2.1.1 Gedurende de arbeid.............................................................................................................2
3. Interpretatie CTG terminologie..........................................................................................................4
3.1 Normale basishartfreuentie..........................................................................................................4
3.1.1 Tachycardie............................................................................................................................4
3.1.2 Bradycardie............................................................................................................................5
3.2 Hartritme variabiliteit...................................................................................................................5
3.3 Acceleraties..................................................................................................................................7
3.4 Deceleraties..................................................................................................................................7
4. Foetale hypoxie antenataal en tijdens de arbeid................................................................................9
4.1 Hypoxie tijdens de arbeid.............................................................................................................9
5. Belang van context / kliniek – Veranderingen op CTG......................................................................13
5.1 Meconiaal vruchtwater...............................................................................................................13
5.2 Oxytocine....................................................................................................................................13
5.3 Temperatuur...............................................................................................................................13
5.4 Hemorragie.................................................................................................................................14
5.5 epidurale anesthesie...................................................................................................................14
5.6 Rate of progress..........................................................................................................................14
5.7 Sectiolitteken..............................................................................................................................14
5.8 PPROM........................................................................................................................................14
5.9 IUGR – diabetes – pre-elampsie..................................................................................................14
6. Fysiologische interpretatie van het CTG...........................................................................................15
7. De STAN-monitor..............................................................................................................................16
7.1 ST-analyse...................................................................................................................................16
7.1.1 ST-veranderingen.................................................................................................................17
7.1.2 Betrouwbaarheid gebruik STAN...........................................................................................19
7.2 Hoe STAN-event interpreteren...................................................................................................20
8. Oefeningen.......................................................................................................................................21
1
, 1. Inleiding
Foetale bewaking: Bepaalt de perinatale uitkomst
2. Fysiologische betekenis van het foetale hartritme
2.1 Regulatie FHR
Autonoom zenuwstelsel: Parasympatisch
(FHT dalen) + sympatisch (FHT stijgen)
Activering parasympatisch ZS
o Via nervus vagus
o Zorgt vo snelle
aanpassing vh
cardiovasculaire systeem
o °Daling FHT
Activering sympathisch
zenuwstelsel
o Afgifte stresshomronen
(Vb. Adrenaline)
o Tragere aanpassing
o Stijging FHT
Baro-receptoren: Registratie & regulatie BD-veranderingen bij foetus
2
, Chemoreceptoren: Registreren O2 & CO2 veranderingen in bloed foetus
Navelstrengcompressie
1. Baroreceptoren
Begin contractie 1. Daling bloedvolume (via arterie nog
bloed nr moeder)
2. Daling BD
3. Druksensitieve baroreceptoren w
geactiveerd
4. Stijging FHT
Verdergaan & niet stoppen contractie 1. Arteries & vene dicht
2. Stijging BD
3. Druksensitieve baroreceptoren w
geactiveerd
4. Daling FHT
Einde contractie 1. Bloedvolume daalt (via arterie eerst
terug bloed nr moeder)
2. BD daalt
3. Druksensitieve baroreceptoren w
geactiveerd
4. FHT stijgt
Na contractie = Circulatie normaal FHT terug nr basisritme
2. Chemoreceptoren
= Registratie O2 & CO2 veranderingen in bloed vd foetus (enkel bij O2 / CO2 veranderingen w
chemoreceptoren geactiveerd)
1. Contractie bij verminderde placentaire doorbloeding
2. O2 aanvoer daalt
3. Chemoreceptoren w geactiveerd
a. Reactie later dan baroreceptor
4. °Daling FHT
Acute hypoxie Chronische hypoxie / Geleidelijk bestaande
hypoxie
= Verlengde deceleratie = FHT stijgt BHF stijgt
Foetus: minder O2 in bloed Sneller
pompen hart om organen v voldoende
O2 te voorzien
3
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