Vroedkundige zorgen bij een
hoogrisicozwangerschap
Inhoud
1. Let’s start, opname en zorgen op de MIC...........................................................................................5
1.1 Prenatale zorg...............................................................................................................................5
1.2 Zorg en begeleiding bij een hoogrisico-zwangerschap.................................................................5
1.2.1 Definities................................................................................................................................5
1.3 Vroedkundig – klinisch redeneren................................................................................................6
1.4 Vroedkundige zorgplanning..........................................................................................................7
1.5 Opname van zwangere “at risk” op verloskamer..........................................................................8
1.6 Risicoselectie................................................................................................................................8
2. Foetale bewaking tijdens de zwangerschap.......................................................................................9
2.1 CTG tijdens de zwangerschap.......................................................................................................9
2.1.1 Het antenataal CTG................................................................................................................9
2.2 CTG op de MIC............................................................................................................................11
3. Nausea en braken tijdens de zwangerschap.....................................................................................13
3.1 (Hyper)emesis Gravidarum........................................................................................................13
3.2 De pathofysiologie......................................................................................................................13
3.3 Risicofactoren en risico’s............................................................................................................13
3.4 Anamnese...................................................................................................................................14
3.5 Diagnose.....................................................................................................................................15
3.5.1 Algemeen.............................................................................................................................15
3.5.2 Onderzoeken.......................................................................................................................15
3.5.3 Differentieel diagnose..........................................................................................................15
3.6 Behandeling................................................................................................................................16
4. Bloedingen tijdens de zwangerschap <20w......................................................................................17
4.1 Bloedverlies tijdens de zwangerschap........................................................................................17
4.1.1 Diagnose..............................................................................................................................17
4.1.2 Risicofactoren......................................................................................................................18
4.2 Teken v Hartmann......................................................................................................................18
4.3 Miskraam....................................................................................................................................18
4.4 Ectopische zwangerschap...........................................................................................................20
4.5 Mola............................................................................................................................................20
5. Bloedingen tijdens de zwangerschap >20w......................................................................................23
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, 5.1 Enkele definities..........................................................................................................................23
5.2 Inleiding......................................................................................................................................23
5.3 Shock..........................................................................................................................................24
5.3.1 Behandeling.........................................................................................................................25
5.4 Bloedingen na 20 weken.............................................................................................................25
5.5 Placenta Praevia.........................................................................................................................27
5.5.1 Diagnose..............................................................................................................................27
5.5.2 Het beleid............................................................................................................................27
5.6 Abruptio Placentae.....................................................................................................................29
5.6.1 diagnose...............................................................................................................................29
5.6.2 Beleid en actieplan...............................................................................................................29
6. PPROM en preterme arbeid.............................................................................................................31
6.1 Risicofactoren en gevolgen.........................................................................................................31
6.2 Anamnese...................................................................................................................................32
6.3 Diagnose PPROM........................................................................................................................32
6.4 Behandeling................................................................................................................................33
6.4.1 Algemeen.............................................................................................................................33
6.4.2 Tocolyse...............................................................................................................................34
6.4.3 Het actieplan bij preterme geboorte...................................................................................34
6.5 Preventie....................................................................................................................................35
7. Hypertensieve aandoeningen tijdens de zwangerschap...................................................................37
7.1 Hypertensie................................................................................................................................37
7.2 Pet-HELLP-Eclampsie..................................................................................................................38
7.2.1 De pathologie......................................................................................................................38
7.3 Risicofactoren & gevolgen..........................................................................................................38
7.4 Anamnese...................................................................................................................................39
7.5 Diagnose.....................................................................................................................................39
7.6 De behandeling...........................................................................................................................40
7.6.1 Actieplan Eclampsie.............................................................................................................42
7.7 Interpretatie labo........................................................................................................................42
7.8 Preventie....................................................................................................................................42
8. Intra-uteriene groeirestrictie............................................................................................................45
8.1 Risicofactoren + Gevolgen..........................................................................................................45
8.1.1 Risicofactoren......................................................................................................................45
8.1.2 Gevolgen..............................................................................................................................45
8.2 Anamnese...................................................................................................................................45
2
, 8.3 Diagnose.....................................................................................................................................46
8.3.1 Klinisch onderzoek...............................................................................................................46
8.3.2 Verloskundig onderzoek......................................................................................................46
8.4 Behandeling................................................................................................................................46
8.5 Preventie....................................................................................................................................47
9. Meerlingen.......................................................................................................................................49
9.1 Risicofactoren en gevolgen.........................................................................................................50
9.1.1 Risicofactoren......................................................................................................................50
9.1.2 Gevolgen..............................................................................................................................50
9.2 Anamnese...................................................................................................................................50
9.3 Diagnose.....................................................................................................................................50
9.4 Plan van aanpak..........................................................................................................................51
10. Diabetes en zwangerschap.............................................................................................................53
10.1 Zwangerschapsdiabetes............................................................................................................53
10.1.1 enkele definities.................................................................................................................53
10.1.2 Risicofactoren en gevolgen................................................................................................53
10.1.3 Anamnese..........................................................................................................................54
10.1.4 Diagnose............................................................................................................................55
10.1.5 Behandeling.......................................................................................................................56
10.2 Diabetes Mellitus en de zwangerschap.....................................................................................57
10.2.1 Diabetes Mellitus en zwangerschap...................................................................................57
10.2.2 Risicofactoren en gevolgen................................................................................................58
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