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Samenvatting Zwangerschap 2

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Alle stof voor Zwangerschap 2 (collegeaantekeningen, extra stof, te studeren voor het examen). Inhoud De pathologische zwangerschap 5 1. Stoornissen in de foetale groei en vruchtwater 5 1. Intra-uteriene groeirestrictie (IUGR) 6 2. Intra-uteriene vruchtdood (IUVD) – mors in utero (MIU) 9 3. Mac...

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  • August 25, 2020
  • 152
  • 2020/2021
  • Summary

3  reviews

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By: femkerylant2001 • 1 year ago

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By: annabelhorst • 3 year ago

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By: marjanfrimpong • 3 year ago

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Zwangerschap 2
Doris Nusselder

1. Fysiologie, zorg en begeleiding
 De student beschrijft de screenings- en diagnostische mogelijkheden (of technieken) naar
genetische en congenitale afwijkingen
2. Risicodetectie/ risicoselectie
 De student herkent genetische en congenitale afwijkingen aan de hand van prenatale
diagnostiek en kent de doorverwijsmogelijkheden
 De student informeert de vrouw en partner correct betreffende prenatale diagnostische
onderzoeken en behandelingen
 De student onderkent de mogelijke genetische en congenitale risico’s en afwijkingen
3. Pathologie, zorg & begeleiding
 De student beschrijft mogelijke gastro-intestinale aandoeningen die kunnen voorkomen in de
zwangerschap
 De student evalueert prenatale laboratorium onderzoeken
 De student evalueert voedingsstijl en geeft gepast advies bij zwangerschapsdiabetes
 De student formuleert mogelijke pathologieën van de zwangerschap
 De student herkent de signalen en benoemt de mogelijke behandelingen van vroeggeboorte
en premature arbeid
 De student kan de metabolische behoefte van de neonaat van de diabetische moeder
bepalen
 De student kan onderscheid maken in normale en afwijkende foetale groei en benoemt de
daarachterliggende pathologie
 De student onderkent algemene pathologie die gevolgen kunnen hebben op de
zwangerschap
 De student schets mogelijke intrinsieke en omgevingsfactoren die effect kunnen hebben op
de zwangerschap
 De student schets te verschillende vormen van meerlingzwangerschappen en hun specifieke
opvolging
 De student verduidelijkt mogelijke cardiovasculaire en hematologische aandoeningen die
kunnen voorkomen in de zwangerschap.
4. Psychosociale context
 De student herkent de impact van stress op zwangerschap en formuleert mogelijke te
ondernemen acties hierbij
6. Gezondheidspromotie
 De student kent en hanteert de perinatale sociale kaart
10. Evidence-based zorg
 De student kan wetenschappelijke (vak)literatuur zelfstandig verwerven en verwerken met
het oog op de uitvoering bij het professioneel handelen




1

,Inhoudsopgave
De pathologische zwangerschap ................................................................................................... 5
1. Stoornissen in de foetale groei en vruchtwater .............................................................................. 5
1. Intra-uteriene groeirestrictie (IUGR) ........................................................................................... 6
2. Intra-uteriene vruchtdood (IUVD) – mors in utero (MIU) ........................................................... 9
3. Macrosomie ................................................................................................................................. 9
4. Polyhydramnion ........................................................................................................................ 10
5. Oligohydramnion ....................................................................................................................... 10
2. Bloedverlies ................................................................................................................................... 11
Eerste trimester ............................................................................................................................. 11
Afwijkingen placenta en navelstreng ............................................................................................ 16
3. Stoornissen in de duur van de zwangerschap ............................................................................... 19
Preterme arbeid ............................................................................................................................ 19
Cervixinsufficientie ........................................................................................................................ 21
PPROM........................................................................................................................................... 22
Serotiniteit ..................................................................................................................................... 22
Inductie .......................................................................................................................................... 23
X 4. Meerlingzwangerschappen ........................................................................................................ 24
Definities........................................................................................................................................ 24
Incidentie ....................................................................................................................................... 26
Diagnose ........................................................................................................................................ 26
Verwikkelingen van een meerlingzwangerschap .......................................................................... 27
Beleid tijdens de zwangerschap .................................................................................................... 30
Beleid bij de partus ........................................................................................................................ 30
Specifieke bio-psychologische problemen tijdens de tweelingzwangerschap ............................. 30
5. Hematologische problemen: ......................................................................................................... 31
1. Iso-immunisatie ......................................................................................................................... 31
2. Maternele anemie ..................................................................................................................... 32
3. Thrombocytopenie ................................................................................................................ 33
4. Trombo-embolie, trombose en trombofilie .............................................................................. 34
6. Hypertensieve aandoeningen ................................................................................................... 35
Pre-eclamsie .................................................................................................................................. 36
Chronische hypertensie ................................................................................................................. 39
Zwangerschapshypertensie ........................................................................................................... 39
Eclampsie ....................................................................................................................................... 39

2

, HELLP syndroom ............................................................................................................................ 39
7. Urologische problemen ................................................................................................................. 40
Urolithiasis ..................................................................................................................................... 40
Urineweginfecties.......................................................................................................................... 40
Urineretentie ................................................................................................................................. 41
8. Endocrinologie en zwangerschap .................................................................................................. 42
9. Neurologische (en neuro-musculaire) aandoeningen ................................................................... 43
10. Immunologische ziekten.............................................................................................................. 44
11. Hartziekten .................................................................................................................................. 45
12. Longziekten ................................................................................................................................. 45
13. Trauma tijdens de zwangerschap ................................................................................................ 45
14. Orthopedische problemen .......................................................................................................... 46
15. Gatro-intestinale problemen ....................................................................................................... 46
16. Dermatosen ................................................................................................................................. 47
17. Oncologische therapie tijdens de zwangerschap ........................................................................ 48
18. Externe invloeden op de zwangerschap...................................................................................... 49
19. Zwangerschap bij bijzondere bevolkingsgroepen ....................................................................... 49
20. Psychiatrische aandoeningen ...................................................................................................... 50
21. Gynaecologische problemen ....................................................................................................... 51
Medische genetica ..................................................................................................................... 52
Inleiding (congenitale afwijkingen) ................................................................................................... 53
Geschiedenis van de genetica ........................................................................................................... 54
Cytogenetica ...................................................................................................................................... 55
Moleculaire genetica ......................................................................................................................... 55
Cytogenetica ...................................................................................................................................... 57
FISH 59
Micro-array / array-CGH.................................................................................................................... 59
Indicaties voor chromosoomonderzoek............................................................................................ 60
Chromosoomafwijkingen .................................................................................................................. 60
Structurele afwijkingen ..................................................................................................................... 61
Chromosoomafwijkingen bij pasgeborenen ..................................................................................... 63
Geslachtschromosomen .................................................................................................................... 66
Geslachtsdifferentiatie ...................................................................................................................... 66
Geslachtschromosomale afwijkingen................................................................................................ 67
Overervingspatronen ........................................................................................................................ 69
Mendeliaanse overerving / monogene overerving / klassieke overerving ....................................... 69

3

, Autosomaal dominante overerving................................................................................................... 70
Autosomaal recessieve overerving ................................................................................................... 73
Geslachtsgebonden overerving ......................................................................................................... 75
Niet klassieke overervingspatronen .................................................................................................. 78
Multifactoriele erfelijkheid................................................................................................................ 80
Erfelijke kankersyndromen................................................................................................................ 85
Erfelijke darmkanker ......................................................................................................................... 89
Prenatale diagnostiek ........................................................................................................................ 92
Serologie tijdens prenatale raadpleging ...................................................................................... 96
Vaststellen zwangerschap ................................................................................................................. 96
Prenatale controles ........................................................................................................................... 96
1e Prenatale controle ........................................................................................................................ 98
Prenatale controle +/- 12 weken..................................................................................................... 107
Prenatale controle +/- 20 weken..................................................................................................... 108
Prenatale controle: +/- 25 weken ................................................................................................... 108
Prenatale controle: +/- 28 weken ................................................................................................... 109
Prenatale controle 34-40 weken ..................................................................................................... 111
Bijbepalingen ................................................................................................................................... 111
Voeding bij zwangerschapsdiabetes ...........................................................................................120
Diabetes mellitus ............................................................................................................................. 120
Koolhydraten ................................................................................................................................... 126
Verdeling van de maaltijden ........................................................................................................... 127
Opdracht ‘Voeding bij zwangerschapsdiabetes’ ..........................................................................136
Neonaat van de diabetische moeder + TPN ................................................................................138
De sociale kaart .........................................................................................................................142
Stress- en stressmanagement ....................................................................................................149




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