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Samenvatting - M7 pathologische zwangerschap
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Duidelijke samenvatting M7 pathologische zwangerschap Inhoudstafel aanwezig Samengevat uit cursus & powerpoint Ongeveer 30 pagina's
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Pathologie zwangerschapInhoudsopgave
H1: Bepaling amenorroeduur zwangerschap.......................................................................................................2
HCG-waarde......................................................................................................................................................3
CRL-waarde........................................................................................................................................................3
H2: Bloedverlies tijdens eerste trim zwangerschap..............................................................................................3
Oorzaken bloedverlies.......................................................................................................................................3
Intra-uteriene zwangerschap............................................................................................................................4
Miskraam...........................................................................................................................................................4
Mola-zwangerschap..........................................................................................................................................5
Bloedverlies & buikpijn in 1e trim......................................................................................................................6
Extra-uteriene graviditeit..................................................................................................................................6
H3: Bloedverlies tijdens tweede & derde trim zwangerschap..............................................................................6
Inleiding.............................................................................................................................................................6
Banale oorzaken................................................................................................................................................7
Ernstige oorzaken..............................................................................................................................................7
H4: Schildklier in zwangerschap..........................................................................................................................10
Hypothyroide...................................................................................................................................................10
Hyperthyroide.................................................................................................................................................11
!!! TransiËnte subklinische hyperthyroide in eerste trimester !!!..................................................................11
H5: Stoornissen in foetale groei..........................................................................................................................12
normaal geboortegewicht...............................................................................................................................12
!!! schatting foetaal gewicht !!!.......................................................................................................................13
kleine foetus....................................................................................................................................................13
SGA & IUGR/FGR.............................................................................................................................................13
placentaire insufficuëntie & brain sparing......................................................................................................13
macrosomie/LGA.............................................................................................................................................14
H6: Vruchtwater..................................................................................................................................................14
volume.............................................................................................................................................................14
Hoeveelheid....................................................................................................................................................15
Oorzaken oligohydramnion.............................................................................................................................15
Oorzaken polyhydramnion..............................................................................................................................15
H7: Screening & behandeling van Groep B Streptokokken (GBS).......................................................................15
voorkomen......................................................................................................................................................15
hoe gebeurt een besmetting?.........................................................................................................................15
GBS infectie bij neonaat..................................................................................................................................16
GBS screening tijdens zwangerschap..............................................................................................................16
Preventieve antibiotische behandeling...........................................................................................................16
!!! H8: Gebroken vliezen & chorio-amnionitis !!!................................................................................................16
Terminologie...................................................................................................................................................16
Vochtverlies.....................................................................................................................................................16
Commerciële kits: Amnisure & Actim Prom....................................................................................................17
Beleid a term gebroken vliezen zonder arbeid...............................................................................................17
!!! Chorio-amnionitis !!!..................................................................................................................................17
1
, H9: Seroniteit......................................................................................................................................................18
Wat zijn de effecten van inductie van de baring bij 41 weken zwangerschapsduur in een laag risico
populatie met een kind in hoofdligging vergeleken met expectatief beleid?................................................18
H10: Hypertensieve aandoeningen.....................................................................................................................19
Definities..........................................................................................................................................................19
Pathogenese & voorkomen.............................................................................................................................20
Maternale cardiovasculaire maladaptatie......................................................................................................20
Risicofactoren..................................................................................................................................................20
Symptomen pre-eclampsie.............................................................................................................................20
HELPP...............................................................................................................................................................21
Complicaties....................................................................................................................................................21
Behandeling.....................................................................................................................................................21
Eclampsie.........................................................................................................................................................22
Aanpak eclamptisch insult...............................................................................................................................23
Herhalingsrisico...............................................................................................................................................23
H11: Infecties......................................................................................................................................................23
virale infecties.................................................................................................................................................23
Bacteriele infecties..........................................................................................................................................27
Parasitaire infecties.........................................................................................................................................28
Lage genitale infecties.....................................................................................................................................29
H12: Klimaatopwarming & hittegolven..............................................................................................................30
Hitte veroudert genen van baby’s...................................................................................................................30
Hoge temperaturen.........................................................................................................................................30
adviezen voor zwangeren tijdens hete zomerdagen......................................................................................30
H13: Bloedgroep & rhesusfactor.........................................................................................................................31
antigenen.........................................................................................................................................................31
waarom rhesusfactor belangrijk in zwangerschap.........................................................................................31
mogelijke contactmomenten..........................................................................................................................31
opvolging.........................................................................................................................................................32
H1: BEPALING AMENORROEDUUR ZWANGERSCHAP
Amenorroeduur
= tijd dat menstruatie wegblijft, duur van de zwangerschap
Waarom is nauwkeurige bepaling belangrijk?
2
, Grens levensvatbaarheid
Opvolging foetale groei (curve)
Grens prematuriteit & seroniteit/postdatisme
Mijlpalen foetale ontw (longrijpheid)
HCG-WAARDE
Detecteerbaar vanaf d8
Stijgt snel tot 7w
7w-10w trager stijgen
Vanaf 10w dalen
2e & 3e trim plateaufasse
In het eerste trim is er een brede HCG curve, het geeft een idee over amenorroeduur maar is NIET nauwkeurig
Casus
Een zwangere (G4A3, 14+3w) belt je: ze is ongerust omdat ze minder zwangerschapskwaaltjes ondervindt
(minder nausea & vermoeid).
NIPT en echografie 12 weken was normaal.
Ze is ongerust omdat HCG lager is dan 4 weken geleden.
Vanaf 10w daalt HCG-waarde, het was niet zinvol om HCG te bepalen om haar ‘gerust’ te stellen. Een echo
nemen was een betere optie geweest.
CRL-WAARDE
CRL = crown – rump - lengte
Embryo groeit 1mm/dag tussen 8w-10w
Vaginale echo
Zeer nauwkeurige bevallingsdatum
H2: BLOEDVERLIES TIJDENS EERSTE TRIM ZWANGERSCHAP
OORZAKEN BLOEDVERLIES
3
, Zwangerschap gerelateerd Niet-zwangerschap gerelateerd
IUG Vaginaal/cervicaal/uterien
o Evolutief Urinair/gastro-intestinaal
o Niet evolutief Post coïtaal
Extra uteriene zwangerschap
Trofoblastziekte* (ZELDZAAM)
Heterotope zwangerschap*
Bloedverlies in 1e trim komt VAAK voor!
*heterotope zwangerschap
= dubbele zwangerschap waarbij 1 foetus in baarmoeder en 1 extra uterien zit (ZELDZAAM)
*trofoblastziekte
= mola zwangerschap
INTRA-UTERIENE ZWANGERSCHAP
Vruchtzak is zichtbaar vanaf 5w
Miskraam
= niet evolutieve zwangerschap intra-uterien
Indeling miskraam volgens amenorroeduur
Vroegtijdig = < 14w
Laattijdig = 14w – 20w
Partus immaturus = 20w – 26w
MISKRAAM
Volledig miskraam Volledige *expulsie zwangerschapsproducten
Miskraam in gang Bloedverlies, geen harttoon & gedeeltelijke expulsie
Missed abortion GEEN bloedverlies, maar foetale pool zonder harttoon
(toevallige vondst)
Blighted ovum Zeer vroege, niet evolutieve IUG
(nog geen foetale pool zichtbaar)
Dreigend miskraam Bloedverlies bij echografisch intacte (= harttonen aanwezig)
zwangerschap
AAP = abortus arte provocatus Zwangerschapsonderbreking door medische reden
*expulsie
4
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