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Samenvatting Module 3 verloskunde

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  • Course
  • Jaar 1, Module 3
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  • Hogeschool InHolland (InHolland)

Uitgebreide samenvatting van module 3 die alle onderwerpen bij langs gaat. Uitgebreide uitleg over verschillende embryologieonderwerpen o.a. ossificatie; gastrulatie; neurulatie en vorming van de extremiteiten. Daarnaast worden alle baringsmechanismen en variaties hierop uitgebreid besproken. De ve...

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  • December 16, 2021
  • 87
  • 2021/2022
  • Summary

Subjects

  • embryologie
  • anatomie
  • bekkenanatomie
  • vrouwelijke anatomie
  • bekken
  • vaten
  • bloedvaten
  • spieren
  • ligamenten
  • huid
  • foetus
  • experimenteel onderzoek
  • gastrulatie
  • neurulatie
  • ossificatie
  • extremiteiten
  • placenta
  • observ

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  • Hogeschool InHolland (InHolland)
  • Verloskunde
  • Jaar 1, Module 3
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Module 3
De bouw van moeder en kind

,Inhoud
Anatomische-topografische terminologie ..................................................................................................................................................................7
Botten ........................................................................................................................................................................................................................7
Bloed- en lymfevaten thorax en abdomen .................................................................................................................................................................9
Maternale bekken incuslief spieren en ligamenten....................................................................................................................................................9
Vlakken van Hodge ..............................................................................................................................................................................................11
Bekkenvormen ....................................................................................................................................................................................................11
Spieren ................................................................................................................................................................................................................11
Ligamenten .........................................................................................................................................................................................................12
Maternale veranderingen in de bekken ...................................................................................................................................................................12
Urine incontinentie .............................................................................................................................................................................................13
Rupturen .............................................................................................................................................................................................................13
Baringsmechanisme en inwendige spildraai.............................................................................................................................................................14
Draaiing ...............................................................................................................................................................................................................15
De spildraai .........................................................................................................................................................................................................16
Spildraaifactoren .................................................................................................................................................................................................16
Baringsmechanisme achterhoofdsligging achterhoofd voor (A.a.v.) ...................................................................................................................17
Foetale schedel ........................................................................................................................................................................................................17
Veranderingen in de huid tijdens de zwangerschap .................................................................................................................................................18
Hyperpigmentatie: ..............................................................................................................................................................................................18
Melasma of zwangerschapsmasker: ....................................................................................................................................................................18
Striae gravidarum: ...............................................................................................................................................................................................18
Pathofysiologie van de huid in de zwangerschap .....................................................................................................................................................18
Pruritus gravidarum of zwangerschapscholestase: .............................................................................................................................................18
Prurigo gestationis ..............................................................................................................................................................................................19
Impetigo herpetiformis .......................................................................................................................................................................................19
Pemphigus gestationis of herpes gestationis ......................................................................................................................................................20
Experimenteel onderzoek ........................................................................................................................................................................................20
Soorten randomisatie: ....................................................................................................................................................................................21
Andere type trials ...........................................................................................................................................................................................21
Modus en mediaan.........................................................................................................................................................................................21
Bias......................................................................................................................................................................................................................21
Mogelijke misstappen: ........................................................................................................................................................................................21
Gastrulatie ...............................................................................................................................................................................................................23
Extra embryonaal mesoderm ..............................................................................................................................................................................24
Intra-embryonaal mesoderm ..............................................................................................................................................................................24
Neurulatie ................................................................................................................................................................................................................24
Somieten ..................................................................................................................................................................................................................25
Ossificatie.................................................................................................................................................................................................................26
Intramembraneuze ossificatie .............................................................................................................................................................................26
Endochondrale ossificatie ...................................................................................................................................................................................26
Ontwikkeling axiaal skelet ........................................................................................................................................................................................27
Ontwikkeling schedel ..........................................................................................................................................................................................28

2

,Ontwikkeling appendiculair skelet ...........................................................................................................................................................................29
Vorming extremiteiten .............................................................................................................................................................................................29
Vouwing van het embryo .........................................................................................................................................................................................30
Embryonale ontwikkelingsstadia ..............................................................................................................................................................................31
Gewicht-lengte en romp-hoofd ...............................................................................................................................................................................31
Afwijkingen steun- en bewegingsapparaat ..............................................................................................................................................................32
Extra rib ..........................................................................................................................................................................................................33
Hemivertebrae (scoliose) ...............................................................................................................................................................................33
Talipes equinovarus (klompvoetje).................................................................................................................................................................33
Achondroplasie ..............................................................................................................................................................................................33
Thanatofore dysplasie ....................................................................................................................................................................................33
Cleidocraniale dysostose ................................................................................................................................................................................33
Arthrogrypose ................................................................................................................................................................................................34
Osteogenese imperfecta ................................................................................................................................................................................34
Osteopetrose .................................................................................................................................................................................................34
Placenta ...................................................................................................................................................................................................................34
Placentale circulatie ............................................................................................................................................................................................36
Placentale afwijkingen .............................................................................................................................................................................................37
Vasa praevia: als gevolg van een velamenteuze insertie lopen de vaten door de vliezen naar de placenta waardoor bij het breken van de
vliezen deze vaten kunnen scheuren .............................................................................................................................................................38
Calcificatie van de placenta ............................................................................................................................................................................38
Placenta na de geboorte ..........................................................................................................................................................................................38
Gemelligraviditeit.....................................................................................................................................................................................................39
Dizygotische tweelingen......................................................................................................................................................................................39
Monozygotische tweelingen ...............................................................................................................................................................................39
Ontwikkeling van de huid .........................................................................................................................................................................................40
Epidermis .......................................................................................................................................................................................................40
Dermis ............................................................................................................................................................................................................41
Vetweefsel .....................................................................................................................................................................................................41
Overige structuren .........................................................................................................................................................................................41
Observationeel onderzoek .......................................................................................................................................................................................41
Dwarsdoorsnede .................................................................................................................................................................................................41
Cohortonderzoek ................................................................................................................................................................................................41
Case-control onderzoek ......................................................................................................................................................................................41
Bias in observationeel onderzoek........................................................................................................................................................................42
Celorganellen ...........................................................................................................................................................................................................42
Koolhydraten ...........................................................................................................................................................................................................42
Lipiden .....................................................................................................................................................................................................................43
Vetzuren .........................................................................................................................................................................................................43
Triglyceriden...................................................................................................................................................................................................43
Fosfolipiden ....................................................................................................................................................................................................43
Steroiden ........................................................................................................................................................................................................43
Eiwitten ....................................................................................................................................................................................................................43

3

, Aminozuren ....................................................................................................................................................................................................43
Polypeptiden ..................................................................................................................................................................................................43
Eiwitstructuren....................................................................................................................................................................................................43
Nucleïnezuren ..........................................................................................................................................................................................................44
DNA ................................................................................................................................................................................................................44
RNA ................................................................................................................................................................................................................44
ATP...........................................................................................................................................................................................................................44
Glycolyse ..................................................................................................................................................................................................................44
Citroenzuurcyclus ....................................................................................................................................................................................................45
Oxidatieve fosforylering ...........................................................................................................................................................................................46
Vetmetabolisme.......................................................................................................................................................................................................47
Vetsynthese ........................................................................................................................................................................................................47
Eiwitvorming ............................................................................................................................................................................................................47
Spieren .....................................................................................................................................................................................................................48
Spiersamentrekking .................................................................................................................................................................................................49
Excitatie contractie koppeling .............................................................................................................................................................................50
Glad spierweefsel .....................................................................................................................................................................................................51
Beïnvloeding van de samentrekking van gladde spiercellen ...........................................................................................................................52
Hartspierweefsel ......................................................................................................................................................................................................52
spierweefsel van het myometrium en de uterus......................................................................................................................................................53
Verweken van de cervix ......................................................................................................................................................................................53
weeënactiviteit....................................................................................................................................................................................................54
Thermoregulatie ......................................................................................................................................................................................................54
Warmteoverdracht .............................................................................................................................................................................................55
Warmteproductie ...............................................................................................................................................................................................55
Bruinvetweefselmetabolisme..............................................................................................................................................................................55
Proces van verbranding bruin vetweefsel.......................................................................................................................................................56
Warmteverlies.....................................................................................................................................................................................................56
Conductie (geleiding) .....................................................................................................................................................................................56
Convectie (stroming) ......................................................................................................................................................................................56
Evaporatie (verdamping) ................................................................................................................................................................................57
Radiatie (straling) ...........................................................................................................................................................................................57
Hypothermie ............................................................................................................................................................................................................57
Neonaten met een risico voor problemen met thermoregulatie ........................................................................................................................58
Gevolgen hypothermie........................................................................................................................................................................................59
Hyperthermie...........................................................................................................................................................................................................59
Verloskundige begeleiding tijdens het eerste tijdperk .............................................................................................................................................60
Zorg voor de barende..........................................................................................................................................................................................60
Het eerste tijdperk: ontsluiting ................................................................................................................................................................................60
Diagnose in partu ...........................................................................................................................................................................................60
Duur ontsluiting..............................................................................................................................................................................................61
Vliezen ............................................................................................................................................................................................................61
Voortijdig gebroken vliezen ............................................................................................................................................................................62

4

, Diagnostiek voortijdig gebroken vliezen .........................................................................................................................................................62
Mogelijke gevolgen ........................................................................................................................................................................................62
Bepalen indaling.......................................................................................................................................................................................................62
Baringsmechanisme achterhoofdsligging achterhoofd voor (A.a.v) .........................................................................................................................62
Achterhoofdsligging in verscherpt mechanisme ......................................................................................................................................................63
Baringsmechanisme bij kruinligging .........................................................................................................................................................................64
Baringsmechanisme bij achterhoofdsligging achterhoofd achter (A.a.a) .................................................................................................................65
Spildraaistoornis bij achterhoofdsligging .................................................................................................................................................................66
Liggingsafwijkingen van de foetus in hoofdligging ...................................................................................................................................................66
Deflexieliggingen: voorhoofdsligging en aangezichtsligging ................................................................................................................................66
Baringsmechanisme bij voorhoofdsligging (V.k.v) ...............................................................................................................................................66
Baringsmechanisme bij aangezichtsligging (Aa.k.v) .............................................................................................................................................67
Overige standafwijkingen (diepe dwarsstand hoge rechtstand wandbeenligging) ...................................................................................................69
Baringsmechanisme bij hoge rechtstand (A.a.v anterior of A.a.a posterior) .......................................................................................................69
Baringsmechanisme bij diepe dwarsstand ..........................................................................................................................................................69
Baringsmechanisme bij wandbeenligging (W.v of W.a) .......................................................................................................................................70
Weeën .....................................................................................................................................................................................................................70
Verloop van de weeën....................................................................................................................................................................................71
Niet-vorderende ontsluiting .....................................................................................................................................................................................71
Dynamische baringsvariaties en mechanische baringsvariaties ...............................................................................................................................71
Primaire weeënzwakte ...................................................................................................................................................................................71
Secundaire weeënzwakte ...............................................................................................................................................................................72
Mechanische baringsstoornissen .............................................................................................................................................................................72
Wanhouding tussen hoofd en bekken ............................................................................................................................................................72
Begeleiding van de baring ..............................................................................................................................................................................72
Maximale ontsluiting ......................................................................................................................................................................................73
Het tweede tijdperk: uitdrijving ...............................................................................................................................................................................74
Pershoudingen en persadvies.........................................................................................................................................................................75
Foetale conditie ..................................................................................................................................................................................................75
Indalingsbradycardie ......................................................................................................................................................................................75
Foetale nood tijdens uitdrijving ......................................................................................................................................................................75
Duur van de uitdrijving.............................................................................................................................................................................................75
De spildraai ..............................................................................................................................................................................................................76
Spildraaifactoren ............................................................................................................................................................................................76
Inwendige spildraai ........................................................................................................................................................................................76
Uitwendige spildraai .......................................................................................................................................................................................77
Episiotomie ..............................................................................................................................................................................................................77
Afnavelen .................................................................................................................................................................................................................77
Niet-vorderende ontsluiting .....................................................................................................................................................................................77
Mogelijke oorzaken NVU: ...............................................................................................................................................................................77
Interventies bij NVU .......................................................................................................................................................................................78
Gevolgen NVU ................................................................................................................................................................................................78
Verhoogde kans op NVU: ...............................................................................................................................................................................78

5

,Vaginale kunstverlossing ..........................................................................................................................................................................................78
Indicaties voor een kunstverlossing ................................................................................................................................................................78
Voorwaarden vaginale kunstverlossing ..........................................................................................................................................................78
Soorten vacuüm- of forcepsextracties ............................................................................................................................................................78
Risico vaginale kunstverlossing .......................................................................................................................................................................79
Instrumentkeuze ............................................................................................................................................................................................79
Uitvoering.......................................................................................................................................................................................................79
Aanbevelingen................................................................................................................................................................................................80
Het derde tijdperk: nageboorte ...............................................................................................................................................................................80
Beleid .............................................................................................................................................................................................................80
Schöne Schultze .............................................................................................................................................................................................81
Dirty duncan ...................................................................................................................................................................................................81
Onderzoek placenta en vliezen.......................................................................................................................................................................81
Differentiaal Diagnose bloedverlies: ...............................................................................................................................................................81
Verhoogde kans voor bloedverlies: ................................................................................................................................................................81
Controles: .......................................................................................................................................................................................................81
Het vierde tijdperk: postplacentair ..........................................................................................................................................................................81
Controles: .......................................................................................................................................................................................................82
De pasgeborene .......................................................................................................................................................................................................82
Algemeen lichamelijk onderzoek .............................................................................................................................................................................82
Algemene indruk ............................................................................................................................................................................................82
Kleur ...............................................................................................................................................................................................................82
Ademhaling ....................................................................................................................................................................................................82
Tonus..............................................................................................................................................................................................................82
Huid ................................................................................................................................................................................................................83
Hoofd .............................................................................................................................................................................................................83
Ogen ...............................................................................................................................................................................................................83
Oren ...............................................................................................................................................................................................................83
Mond..............................................................................................................................................................................................................83
Neus ...............................................................................................................................................................................................................83
Thorax ............................................................................................................................................................................................................83
Buik ................................................................................................................................................................................................................83
Genitaliën .......................................................................................................................................................................................................83
Rug en wervelkolom .......................................................................................................................................................................................84
Armen en benen.............................................................................................................................................................................................84
Huidafwijkingen neonaat .........................................................................................................................................................................................84
Staphyloccal scalded skin syndroom (SSSS) ....................................................................................................................................................84
Impetigo bullosa .............................................................................................................................................................................................84




6

,Anatomische-topografische terminologie
Zie medische termenlijst




Occipitaal: richting het achterhoofd

Rostraal: richting het voorhoofd

Dorsaal: rugzijde

Ventraal: buikzijde

Craniaal: richting het hoofd

Caudaal: richting de staart/voeten

Botten
Functies skelet:

o Bescherming
o Aanhechting
o Stevigheid

7

, o Aanmaak bloedcellen
o Ca2+ -voorraad
Ossa = botten -> vormen benig skelet

Passief bewegingsapparaat: botten kunnen zonder spieren niet bewegen

Bestaat uit cellen:

o Osteoclasten: samengesmolten cellen met veel kernen die botweefsel afbreken
o Osteoblasten: botvormende cellen in het beenvlies rondom het bot
o Osteocyten: inactieve osteoblast die omringd is door eigen botmateriaal
Gewrichten (junctura): verbindingen tussen afzonderlijke botten die beweging mogelijk maken

o Kogelgewricht (ball & socket joint)
o Zadelgewricht (saddle joint)
o Scharniergewricht (hinge joint)




Kraakbeen (cartilage)

o Steun weken delen
o Verbinding botten
o Glijvlak voor gewrichten
o Groei pijpbeenderen
3 typen kraakbeen

o Hyalien kraakbeen: gewrichten en borstbeen
o Vezelig kraakbeen: tussenwervelschijven en symfyse
o Elastisch kraakbeen: neus en oorschelp
Kraakbeen is niet doorbloed


8

,Bloed- en lymfevaten thorax en abdomen
3 soorten bloedvaten:

Arteriën (a.):

o Vervoeren O2-rijk bloed vanuit het hart naar organen
o Goede spierlaag en elastisch
o Vaak naam van het orgaan waar de arterie heen gaat
Capillairen:

o Uitwisseling tussen bloed en weefsels
o Dunne wand bevorderd uitwisseling
Venen (v.):

o Lage weerstand en hoge capaciteit
o Vervoeren O2-arm bloed van organen naar het hart
o Kleppen die terugstroom beperken
o Minder dik en elastisch dan arteriën
Kleine bloedsomloop: rechter ventrikel – a. pulmonalis – longen – v. pulmonalis – linker atrium

Grote bloedsomloop: linker ventrikel – aorta – a. willekeurig orgaan – willekeurig orgaan – v. willekeurig orgaan – v.
cava inferior/superior – rechter atrium

Lymfe:

Wordt gedraineerd uit intercellulaire ruimten naar de lymfevaten
Belangrijkste lymfevaten: ductus thoracicus en ductus lympathicus dexter
Lymfeklieren:

Tussenstation voor lymfevaten
Kunnen opzwellen bij infectie
Nek; oksels; liezen; langs de luchtpijp; bij longen; bij darmen en achter in de buikholte


Maternale bekken incuslief spieren en ligamenten
Functies van het bekken:

o Zorgt voor de krachtoverdracht naar de benen
o Bescherming van de weke delen die in de bekken liggen
o Stabilisatie van de romp met de bekkenbodemspieren
o Zorgt voor beweging van de benen
Bekken:

o Os coxae
• Os ilium
• Os ischii
• Os pubis
o Os sacrum
o Os coccygis
9

, De sacro-ilacale gewrichten verbinden os coxae met os sacrum en os coccygis

Os pubis is twee delen en worden verbonden door de symphysis pubica

Spina ischiadica zijn twee botte uitsteeksels. De bekken is hier het smalste

o Tuber ischiadicum posterior: kuiltjes in je rug
o Tuber ischiadicum anterior: botten waar je op zit
o Crista iliaca: aan de bovenkant bij je heupen
Baringskanaal heeft twee delen: weke en benige baringskanaal

Weke baringskanaal:

o Onderste uterussegment
o Cervix
o Vagina
o Vulva
o Bekkenbodemspieren
Benige baringskanaal:

Bekkeningang:

Dwars ovaal van vorm en wordt gevormd door: linea innominata;
promontorium en bovenrand os pubis

o Conjugata vera: 11 cm
o Diameter diagonale: 12 cm
o Diameter transversa: 13 cm
o Conjugata diagnoalis: onderrand symphysis pubica tot promontorium
12-13 cm
Bekkenholte:

Rond van vorm en sterk gebogen

Rond spinae ischiadicae smalst: 10 cm

Bekkenuitgang:

Voor achterwaars ovaal van vorm en gevormd uit twee driehoeken:

o Lijn tussen de tubera ischiadica is de basis
o Onderrand symphysis pubica is top voorste driehoek
o Os coccygis is top achterste driehoek




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