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Samenvatting gynaecologie 2
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Samenvatting gynaecologie 2, gegeven in 1e master. Samenvatting van de volledig geschreven cursus.
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SAMENVATTING GYNAECOLOGIEINHOUD
1. Inleiding ............................................................................................................................................................... 3
2. Zwangerschap & bevalling (herhaling) ................................................................................................................ 4
2.1 Verloop zwangerschap (crash course youtube filmpje) ................................................................................ 4
2.2 Zwangerschapsbegeleiding en prenatale zorg .............................................................................................. 7
2.3 De normale bevalling .................................................................................................................................. 11
2.4 Ongestoorde kraambed .............................................................................................................................. 18
3. Gynaecologische infecties ................................................................................................................................. 18
4. Contraceptie ...................................................................................................................................................... 23
4.1 Combinatiepil .............................................................................................................................................. 23
4.2 Progestogen only methoden ....................................................................................................................... 26
4.3 Barrièremethoden ....................................................................................................................................... 27
4.4 Andere methoden ....................................................................................................................................... 28
4.5 Overzicht effectiviteit .................................................................................................................................. 28
4.5 Noodanticonceptie ...................................................................................................................................... 29
5. Seksuologie ....................................................................................................................................................... 30
6. Oligo- en polyhydramnios ................................................................................................................................. 32
6.1 Oligohydramnios ......................................................................................................................................... 32
6.2 Polhydramnios ............................................................................................................................................ 33
7. Groeiproblematiek tijdens de zwangerschap ................................................................................................... 34
7.1 Foetale groeirestrictie (FGR/IUGR) ............................................................................................................. 34
7.2 Macrosomie ................................................................................................................................................ 41
8. Intra-uteriene vruchtdood & zwangerschapsterminatie .................................................................................. 42
8.1 Intra-uteriene vruchtdood (IUVD) ............................................................................................................... 42
8.2 Zwangerschapsterminatie: technische procedures .................................................................................... 43
8.3 Laattijdige zwangerschapsafbreking ........................................................................................................... 44
9. meerlingenzwangerschap ................................................................................................................................. 47
9.1 Inleiding ....................................................................................................................................................... 47
9.2 Complicaties ................................................................................................................................................ 48
9.4 Zwangerschapsopvolging ............................................................................................................................ 52
9.5 bevalling ...................................................................................................................................................... 53
9.6 Prenatale therapie....................................................................................................................................... 54
10. Problemen tijdens arbeid en bevalling, kunstverlossing, traumatische ervaring ........................................... 54
10.1 Problemen tijdens arbeid & bevalling ....................................................................................................... 54
1
, 10.2 Kunstverlossing ......................................................................................................................................... 59
10.3 Traumatische bevalling ............................................................................................................................. 62
11. Hypertensieve aandoeningen in de zwangerschap ......................................................................................... 62
11. 1 Inleiding .................................................................................................................................................... 62
11.2 chronische/essentiële hypertensie ........................................................................................................... 63
11.3 Pre-eclampsie (PE) .................................................................................................................................... 64
11.4 Medicamenteuze BD-controle .................................................................................................................. 67
12. Hartaandoeningen in de zwangerschap .......................................................................................................... 68
12.1 Inleiding ..................................................................................................................................................... 68
Verschillende hartafwijkingen ........................................................................................................................... 68
12.2 Peripartum cardiomyopathie .................................................................................................................... 70
13. DIabetes, obesitas en zwangerschap .............................................................................................................. 71
13.1 Diabetes .................................................................................................................................................... 71
13.2 Obesitas ..................................................................................................................................................... 79
14. Pre- en postterme arbeid ................................................................................................................................ 80
14.1 Preterme arbeid ........................................................................................................................................ 80
14.2 Preterm prelabour rupture of membranes (PPROM) ............................................................................... 84
14.3 Postterme arbeid ...................................................................................................................................... 85
14.4 Inductie van de arbeid............................................................................................................................... 85
15. Infecties tijdens/na de zwangerschap ............................................................................................................. 87
15.1 Inleiding ..................................................................................................................................................... 87
15.2 Virale infecties ........................................................................................................................................... 87
15.3 Bacteriële infecties .................................................................................................................................... 93
15.4 Parasitaire infecties ................................................................................................................................... 96
15.5 Meest voorkomende vaginale infecties .................................................................................................... 98
15.6 Seksueel overdraagbare aandoeningen (SOA’s) ....................................................................................... 99
15.7 vaccinaties & antimicrobiële therapie .................................................................................................... 101
15.8 Endometriosis & mastitis ........................................................................................................................ 103
16. Bloedverlies ................................................................................................................................................... 105
16.1 Bloedverlies tijdens zwangerschap ......................................................................................................... 105
16.2 Postpartum bloedverlies ......................................................................................................................... 112
17. Stolling & zwangerschap ............................................................................................................................... 114
17.1 INleiding .................................................................................................................................................. 114
17.2 Veneuze Trombose ................................................................................................................................. 115
17.3 Trombofilie .............................................................................................................................................. 117
17.4 Vruchtwaterembool ................................................................................................................................ 118
18. Bloedgroepen ................................................................................................................................................ 119
2
, 18.1 Inleiding ................................................................................................................................................... 119
18.2 Bloedgroepantagonisme in zwangerschap ............................................................................................. 120
18.3 Maternele anemie ................................................................................................................................... 123
19. Vruchtbaarheidsproblemen .......................................................................................................................... 128
19.1 Polycistic ovarium syndrome (PCOS) ...................................................................................................... 128
19.2 Fertiliteitspreservatie .............................................................................................................................. 130
19.3 Wetgeving ............................................................................................................................................... 132
20. Endometriose & chronische pelviene buikpijn ............................................................................................. 133
20.1 Endometriose .......................................................................................................................................... 133
20.2 Chronische pelviene pijn (CPP)................................................................................................................ 136
20.3 Introductie gynaecologische echografie ................................................................................................. 137
21. Aandoeningen van de vulva, vagina & cervix ................................................................................................ 138
21.1 Vulvovaginale irritatie: vaginale uitscheiding & pruritis ......................................................................... 138
21.2 Cervix (baarmoederhals) ......................................................................................................................... 138
22. Pathologie van de uterus & tuba ovaria ........................................................................................................ 154
22.1 Uterus ...................................................................................................................................................... 154
22.2 (Pre)maligne aandoeningen .................................................................................................................... 165
23. Dysfunctionele bloedingspatronen ............................................................................................................... 175
23.1 Herhaling ................................................................................................................................................. 175
23.2 Abnormaal uteriene bloeding (AUB) ....................................................................................................... 178
23.3 Conclusie ................................................................................................................................................. 183
24. Pelvic Organ Prolapse.................................................................................................................................... 184
24.1 Fysiologie van de bekkenbodem ............................................................................................................. 184
24.2 pathologie van de bekkenbodem ............................................................................................................ 185
25. Senologie: mammapathologie ...................................................................................................................... 191
25.2 Benigne pathologie van de borst ............................................................................................................ 191
25.3 Maligne pathologie van de borst ............................................................................................................ 197
26. Seksueel geweld ............................................................................................................................................ 208
1. INLEIDING
6 meest voorkomende vrouwspecifieke aandoeningen (buiten zwangerschapsproblemen)
1. Uteriene/cyclus gerelateerde problemen
2. Climacteriële/hormonale problemen
3. Bekkenbodemproblemen
4. Buikpijn tgv endometriose/benigne adnexpathologie
5. Vulvaire problemen
6. Seksuele problemen
3
, → verminderde QoL, verminderde inzetbaarheid voor werk en maatschappelijke activiteiten & versterking
man-vrouw ongelijkheid.
2. ZWANGERSCHAP & BEVALLING (HERHALING)
EXAMEN: ongeveer 4 vragen.
Terminologie
Aborta (A) Aantal miskramen (= verlies van een zwangerschap tot een zwangerschapsduur
van 19 weken en 6 dagen).
Aborta arte provocatus Aantal zwangerschapsafbrekingen.
(A.a.p)
Amenorroeduur Tijd verlopen sinds de 1e dag van de laatste regels. Uitgedrukt in volledige
weken.
• Bij een regelmatige cyclus van 28 dagen → zwangerschapsduur =
amenorroeduur
• Bij een cyclus van meer/minder dan 28 dagen → zwangerschapsduur ≠
ammenorroeduur
A terme Tussen 37 – 42 voldragen weken of tussen 259 tot minder dan 294 dagen.
Embryo Vrucht tot de 8e week post-bevruchting (vanaf 8 weken is organogenese
volledig).
Foetus Vrucht vanaf 9 weken post-bevruchting tot aan de geboorte.
Gravida/graviditeit (G) Aantal zwangerschappen met inbegrip van de huidige.
Nulligravida Niet zwanger en nooit geweest.
Primigravida Eerste zwangerschap.
Multigravida Vanaf 2e zwangerschap.
Neonaat Vanaf geboorte tot en met dag 28.
Para/pariteit (P) Aantal bevallingen, gedefinieerd als een zwangerschapsduur vanaf 20 weken. Dit
aantal wordt niet beïnvloed door de manier van bevallen (vaginaal/per
sectionem). De getallen hebben betrekking op het aantal zwangerschappen, niet
op het aantal foetussen (vb. bevallen van 1 drieling per sectionem= G1P1)
Nullipara Kan ook multigravida zijn.
Primipara 1x bevallen.
Multipara Min. 2x bevallen.
Postterm/serotien Zwangerschapsduur ≥ 42 weken (294 dagen).
Preterm Zwangerschapsduur ˂ 37 voldragen weken of 259 dagen.
Very preterm Zwangerschapsduur ˂ 32 weken (224 dagen)
Extreem preterm Zwangerschapsduur ˂ 28 weken (196 dagen)
Vroeg neonataal Eerste weken van de geboorte (= pasgeborene).
Zuigeling Vanaf de geboorte tot aan de 1e verjaardag.
Zwangerschapsduur Tijd verlopen sinds de conceptie + twee weken.
2.1 VERLOOP ZWANGERSCHAP (CRASH COURSE YOUTUBE FILMPJE)
Verloop zwangerschap
Spermacel:
• Capacitatie:
o Spermacel komt in contact met vrouwelijke
voortplantingsorganen (vb. eileiders)
o Capacitatierespons: biochemische veranderingen van de
spermacel (vb. verwijderen moleculaire omhulsels, verhoogde
motiliteit,…) → spermacel geschikter voor bevruchting
• Acrosoom reactie:
4
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