GYNAECOLOGIE
H1: inleiding ................................................................................................................................. 4
H2: zwangerschap en bevalling (herhaling) .................................................................................... 5
2.1 Verloop zwangerschap (crash course YouTube filmpje).............................................................. 5
2.2 Zwangerschapsbegeleiding en prenatale zorg ........................................................................... 7
2.3 De normale bevalling ............................................................................................................11
2.4 Ongestoorde kraambed ........................................................................................................17
H3: gynaecologische infecties......................................................................................................18
Syfilis testen .............................................................................................................................19
Aerobe vaginitis .........................................................................................................................19
Pelvic inflammatory disease (PID)................................................................................................20
Vulvaire ulcera ..........................................................................................................................21
H4: contraceptie..........................................................................................................................22
4.1 Combinatiepil ......................................................................................................................22
4.2 Progestogen only methoden ..................................................................................................25
4.3 Barrièremethode ..................................................................................................................26
4.4 Andere methoden .................................................................................................................26
4.5 Overzicht effectiviteit ............................................................................................................27
4.6 Noodanticonceptie ...............................................................................................................27
H5: seksuologie ...........................................................................................................................29
H6: oligo- en polyhydramnios .......................................................................................................31
6.1 Oligohydramnios ..................................................................................................................31
6.2 Polyhydramnios ...................................................................................................................32
H7: groeiproblematiek tijdens de zwangerschap ...........................................................................33
7.1 Foetale groeirestrictie (FGR/IUGR)..........................................................................................33
7.2 Macrosomie ........................................................................................................................38
H8: intra-uteriene vruchtdood & zwangerschapsterminatie ...........................................................40
8.1 Intra-uteriene vruchtdood (IUVD)............................................................................................40
8.2 Zwangerschapsterminatie: technische procedures ..................................................................41
8.3 Laattijdige zwangerschapsafbreking .......................................................................................42
H9: meerlingenzwangerschap ......................................................................................................44
9.1 Inleiding ..............................................................................................................................44
9.2 Complicaties .......................................................................................................................45
9.4 Zwangerschapsopvolging ......................................................................................................49
9.5 Bevalling .............................................................................................................................49
9.6 Prenatale therapie ................................................................................................................50
1
,H10: problemen tijdens arbeid en bevalling, kunstverossing, tramautische ervaring ......................52
10.1 Problemen tijdens arbeid & bevalling ....................................................................................52
10.2 Kunstverlossing ..................................................................................................................56
10.3 Traumatische bevalling .......................................................................................................58
H11: hypertensieve aandoeningen in de zwangerschap .................................................................59
11.1 Inleiding ............................................................................................................................59
11.2 Chronische/essentiële hypertensie ......................................................................................60
11.3 Pre-eclampsie (PE) .............................................................................................................61
11.4 Medicamenteuze BD-controle..............................................................................................63
H12: hartaandoeningen in de zwangerschap .................................................................................65
12.1 Inleiding ............................................................................................................................65
Verschillende hartafwijkingen .....................................................................................................65
12.2 Peripartum cardiomyopathie ...............................................................................................66
H13: diabetes, obesitas en zwangerschap ....................................................................................68
13.1 Diabetes ............................................................................................................................68
13.2 Obesitas ............................................................................................................................74
14: pre- en postterme arbeid ........................................................................................................76
14.1 Preterme arbeid .................................................................................................................76
14.2 Preterm prelabour rupture of membranes (PPROM) ................................................................79
14.3 Postterme arbeid ................................................................................................................80
14.4 Inductie van de arbeid .........................................................................................................80
H15: infecties tijdens/na de zwangerschap ...................................................................................82
15.1 Inleiding ............................................................................................................................82
15.2 Virale infecties ...................................................................................................................82
15.3 Bacteriële infecties .............................................................................................................87
15.4 Parasitaire infecties ............................................................................................................90
15.5 Meest voorkomende vaginale infecties ..................................................................................91
15.6 Seksueel overdraagbare aandoeningen (SOA’s) .....................................................................93
15.7 Vaccinaties & antimicrobiële therapie ...................................................................................94
15.8 Endomyometritis & mastitis .................................................................................................96
H16: bloedverlies ........................................................................................................................99
16.1 Bloedverlies tijdens zwangerschap .......................................................................................99
16.2 Postpartum bloedverlies ................................................................................................... 105
H17: stolling en zwangerschap ................................................................................................... 107
17.1 Inleiding .......................................................................................................................... 107
17.2 Veneuze trombose ............................................................................................................ 107
17.3 Trombofilie ...................................................................................................................... 109
2
, 17.4 Vruchtwaterembool .......................................................................................................... 110
H18: bloedgroepen .................................................................................................................... 111
18.1 Inleiding .......................................................................................................................... 111
18.2 Bloedgroepantagonisme in zwangerschap........................................................................... 111
18.3 Maternele anemie ............................................................................................................. 114
H19: vruchtbaarheidsproblemen ................................................................................................ 120
19.1 Polycystic ovarium syndrome (PCOS) ................................................................................. 120
19.2 Fertiliteitspreservatie ........................................................................................................ 121
19.3 Wetgeving ........................................................................................................................ 123
H20: endometriose & chronische pelviene buikpijn ..................................................................... 125
20.1 Endometriose .................................................................................................................. 125
20.2 Chronische pelviene pijn (CPP) .......................................................................................... 127
20.3 Introductie gynaecologische echografie .............................................................................. 128
H21: aandoeningen van de vulva, vagina & cervix ........................................................................ 129
21.1 Cervix .............................................................................................................................. 129
21.2 Vulva ............................................................................................................................... 131
21.3 Vagina ............................................................................................................................. 132
H22: pathologie van de uterus & tuba ovaria ............................................................................... 134
22.1 Benigne pathologie ........................................................................................................... 134
22.2 (Pre)maligne aandoeningen ............................................................................................... 144
H23: dysfunctionele bloedingspatronen ..................................................................................... 149
23.1 Herhaling ......................................................................................................................... 149
23.2 Abnormaal uteriene bloeding (AUB) .................................................................................... 151
23.3 Conclusie ........................................................................................................................ 155
H24: pelvic organ prolaps........................................................................................................... 156
24.1 Fysiologie van de bekkenbodem ......................................................................................... 156
24.2 Pathologie van de bekkenbodem ........................................................................................ 157
H25: borstpathologie ................................................................................................................. 163
Klinisch zichtbare afwijkingen van de borst (inspectie) ................................................................. 163
Palpabele afwijkingen .............................................................................................................. 163
Niet-palpabele afwijkingen en screening .................................................................................... 163
Triple diagnostiek .................................................................................................................... 163
Benigne borstletsels ................................................................................................................ 164
Ductaal Carcinoma In Siut (DCIS) .............................................................................................. 164
Invasieve borstcarcinomen ....................................................................................................... 164
Kernpunten ............................................................................................................................. 165
H26: seksueel geweld ................................................................................................................ 168
3
, H1: 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
Verminderde QoL, verminderde inzetbaarheid voor werk en maatschappelijke activiteiten &
versterking man-vrouw ongelijkheid
4
H1: inleiding ................................................................................................................................. 4
H2: zwangerschap en bevalling (herhaling) .................................................................................... 5
2.1 Verloop zwangerschap (crash course YouTube filmpje).............................................................. 5
2.2 Zwangerschapsbegeleiding en prenatale zorg ........................................................................... 7
2.3 De normale bevalling ............................................................................................................11
2.4 Ongestoorde kraambed ........................................................................................................17
H3: gynaecologische infecties......................................................................................................18
Syfilis testen .............................................................................................................................19
Aerobe vaginitis .........................................................................................................................19
Pelvic inflammatory disease (PID)................................................................................................20
Vulvaire ulcera ..........................................................................................................................21
H4: contraceptie..........................................................................................................................22
4.1 Combinatiepil ......................................................................................................................22
4.2 Progestogen only methoden ..................................................................................................25
4.3 Barrièremethode ..................................................................................................................26
4.4 Andere methoden .................................................................................................................26
4.5 Overzicht effectiviteit ............................................................................................................27
4.6 Noodanticonceptie ...............................................................................................................27
H5: seksuologie ...........................................................................................................................29
H6: oligo- en polyhydramnios .......................................................................................................31
6.1 Oligohydramnios ..................................................................................................................31
6.2 Polyhydramnios ...................................................................................................................32
H7: groeiproblematiek tijdens de zwangerschap ...........................................................................33
7.1 Foetale groeirestrictie (FGR/IUGR)..........................................................................................33
7.2 Macrosomie ........................................................................................................................38
H8: intra-uteriene vruchtdood & zwangerschapsterminatie ...........................................................40
8.1 Intra-uteriene vruchtdood (IUVD)............................................................................................40
8.2 Zwangerschapsterminatie: technische procedures ..................................................................41
8.3 Laattijdige zwangerschapsafbreking .......................................................................................42
H9: meerlingenzwangerschap ......................................................................................................44
9.1 Inleiding ..............................................................................................................................44
9.2 Complicaties .......................................................................................................................45
9.4 Zwangerschapsopvolging ......................................................................................................49
9.5 Bevalling .............................................................................................................................49
9.6 Prenatale therapie ................................................................................................................50
1
,H10: problemen tijdens arbeid en bevalling, kunstverossing, tramautische ervaring ......................52
10.1 Problemen tijdens arbeid & bevalling ....................................................................................52
10.2 Kunstverlossing ..................................................................................................................56
10.3 Traumatische bevalling .......................................................................................................58
H11: hypertensieve aandoeningen in de zwangerschap .................................................................59
11.1 Inleiding ............................................................................................................................59
11.2 Chronische/essentiële hypertensie ......................................................................................60
11.3 Pre-eclampsie (PE) .............................................................................................................61
11.4 Medicamenteuze BD-controle..............................................................................................63
H12: hartaandoeningen in de zwangerschap .................................................................................65
12.1 Inleiding ............................................................................................................................65
Verschillende hartafwijkingen .....................................................................................................65
12.2 Peripartum cardiomyopathie ...............................................................................................66
H13: diabetes, obesitas en zwangerschap ....................................................................................68
13.1 Diabetes ............................................................................................................................68
13.2 Obesitas ............................................................................................................................74
14: pre- en postterme arbeid ........................................................................................................76
14.1 Preterme arbeid .................................................................................................................76
14.2 Preterm prelabour rupture of membranes (PPROM) ................................................................79
14.3 Postterme arbeid ................................................................................................................80
14.4 Inductie van de arbeid .........................................................................................................80
H15: infecties tijdens/na de zwangerschap ...................................................................................82
15.1 Inleiding ............................................................................................................................82
15.2 Virale infecties ...................................................................................................................82
15.3 Bacteriële infecties .............................................................................................................87
15.4 Parasitaire infecties ............................................................................................................90
15.5 Meest voorkomende vaginale infecties ..................................................................................91
15.6 Seksueel overdraagbare aandoeningen (SOA’s) .....................................................................93
15.7 Vaccinaties & antimicrobiële therapie ...................................................................................94
15.8 Endomyometritis & mastitis .................................................................................................96
H16: bloedverlies ........................................................................................................................99
16.1 Bloedverlies tijdens zwangerschap .......................................................................................99
16.2 Postpartum bloedverlies ................................................................................................... 105
H17: stolling en zwangerschap ................................................................................................... 107
17.1 Inleiding .......................................................................................................................... 107
17.2 Veneuze trombose ............................................................................................................ 107
17.3 Trombofilie ...................................................................................................................... 109
2
, 17.4 Vruchtwaterembool .......................................................................................................... 110
H18: bloedgroepen .................................................................................................................... 111
18.1 Inleiding .......................................................................................................................... 111
18.2 Bloedgroepantagonisme in zwangerschap........................................................................... 111
18.3 Maternele anemie ............................................................................................................. 114
H19: vruchtbaarheidsproblemen ................................................................................................ 120
19.1 Polycystic ovarium syndrome (PCOS) ................................................................................. 120
19.2 Fertiliteitspreservatie ........................................................................................................ 121
19.3 Wetgeving ........................................................................................................................ 123
H20: endometriose & chronische pelviene buikpijn ..................................................................... 125
20.1 Endometriose .................................................................................................................. 125
20.2 Chronische pelviene pijn (CPP) .......................................................................................... 127
20.3 Introductie gynaecologische echografie .............................................................................. 128
H21: aandoeningen van de vulva, vagina & cervix ........................................................................ 129
21.1 Cervix .............................................................................................................................. 129
21.2 Vulva ............................................................................................................................... 131
21.3 Vagina ............................................................................................................................. 132
H22: pathologie van de uterus & tuba ovaria ............................................................................... 134
22.1 Benigne pathologie ........................................................................................................... 134
22.2 (Pre)maligne aandoeningen ............................................................................................... 144
H23: dysfunctionele bloedingspatronen ..................................................................................... 149
23.1 Herhaling ......................................................................................................................... 149
23.2 Abnormaal uteriene bloeding (AUB) .................................................................................... 151
23.3 Conclusie ........................................................................................................................ 155
H24: pelvic organ prolaps........................................................................................................... 156
24.1 Fysiologie van de bekkenbodem ......................................................................................... 156
24.2 Pathologie van de bekkenbodem ........................................................................................ 157
H25: borstpathologie ................................................................................................................. 163
Klinisch zichtbare afwijkingen van de borst (inspectie) ................................................................. 163
Palpabele afwijkingen .............................................................................................................. 163
Niet-palpabele afwijkingen en screening .................................................................................... 163
Triple diagnostiek .................................................................................................................... 163
Benigne borstletsels ................................................................................................................ 164
Ductaal Carcinoma In Siut (DCIS) .............................................................................................. 164
Invasieve borstcarcinomen ....................................................................................................... 164
Kernpunten ............................................................................................................................. 165
H26: seksueel geweld ................................................................................................................ 168
3
, H1: 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
Verminderde QoL, verminderde inzetbaarheid voor werk en maatschappelijke activiteiten &
versterking man-vrouw ongelijkheid
4
