GYNAECOLOGIE
PROF. TIMMERMAN, VAN GORP, FROYMAN, DEPREST, VAN DER MEWE
INHOUDSOPGAVE
LES 1: INTRODUCTIE ....................................................................................................................10
1. INLEIDING TOT HET VAK ..................................................................................................................... 10
2. ANATOMIE VAN DE UITWENDIGE GENITALIA (KLINISCH!) ............................................................................. 10
3. BASIS GYNAECOLOGISCHE INGREPEN ................................................................................................... 11
4. HYSTERECTOMIE – TYPES (EXAMEN!) .................................................................................................. 13
5. NIEUWE TECHNIEKEN ....................................................................................................................... 13
6. OVERZICHT PATHOLOGIE PER COMPARTIMENT ........................................................................................ 14
7. ABNORMAAL UTERIEN BLOEDVERLIES (AUB) .......................................................................................... 14
Definities .................................................................................................................................... 14
Methodologie bij AUB .................................................................................................................. 15
Oorzaken van AUB – FIGO ........................................................................................................... 17
Behandeling AUB ........................................................................................................................ 18
8. ENDOMETRIUMPATHOLOGIE .............................................................................................................. 19
12. ENDOMETRIUMHYPERPLASIE ............................................................................................................ 20
13. MYOMETRIUMPATHOLOGIE – FIBROMEN .............................................................................................. 21
14. EXAMENKAPSTOK AUB ................................................................................................................... 24
VOORBEELD EXAMENVRAAG .............................................................................................................. 24
LES 2: BORSTPATHOLOGIE ...........................................................................................................25
LES 3: ENDOMETRIOSE EN ADENOMYOSE ....................................................................................25
H9: ENDOMETRIOSE............................................................................................................................ 25
1. Definitie .................................................................................................................................. 25
2. Pathogenese ........................................................................................................................... 25
3. Prevalentie.............................................................................................................................. 26
4. Symptomen ............................................................................................................................ 26
5. Klinisch onderzoek .................................................................................................................. 26
6. Vormen ................................................................................................................................... 27
7. Diagnostiek ............................................................................................................................. 28
8. Behandeling ............................................................................................................................ 29
H4: ADENOMYOSE .............................................................................................................................. 30
1. Definitie .................................................................................................................................. 30
2. Echografische kenmerken ....................................................................................................... 30
3. Symptomen ............................................................................................................................ 30
4. Behandeling ............................................................................................................................ 31
H12: ONDERZOEK EN BEHANDELING VAN VERMINDERDE VRUCHTBAARHEID ....................................................... 31
1. Definities ................................................................................................................................ 31
, 2. De normale fertiliteit ................................................................................................................ 31
3. Leeftijd en ovariële reserve....................................................................................................... 31
4. Factoren van normale fertiliteit................................................................................................. 32
5. Oorzaken ................................................................................................................................ 33
6. Diagnostiek ............................................................................................................................. 33
7. BEHANDELING VAN INFERTILITEIT ........................................................................................... 34
5. Pre-implantatie genetische diagnostiek (PGD) .......................................................................... 39
6. Fertility preservation ................................................................................................................ 39
VOORBEELDVRAAG ............................................................................................................................. 39
LES 4: ANTICONCEPTIE ................................................................................................................41
10.1. DE ANTICONCEPTIEVE NOOD ......................................................................................................... 42
10.1.1. Epidemiologische cijfers (wereldbevolking als achtergrond) ............................................... 42
10.1.2. Oorzaken van anticonceptieve nood ................................................................................. 42
10.2. OVERZICHT VAN METHODEN .......................................................................................................... 43
10.3. ANTICONCEPTIEVE WERKZAAMHEID – METHODOLOGIE ......................................................................... 43
TABEL 10.4: PERFECT VS TYPICAL USE PI (SELECTIE) .................................................................................... 44
10.4. NATUURLIJKE FAMILIEPLANNING (NFP) ............................................................................................ 45
10.5. COÏTUSGEBONDEN METHODEN ...................................................................................................... 46
10.5.1. Coïtus interruptus (withdrawal)......................................................................................... 46
10.5.2. Condooms ...................................................................................................................... 47
10.5.3. Vaginale middelen ........................................................................................................... 48
10.6. INTRA-UTERIENE APPARATEN (IUCD)............................................................................................... 49
10.6.1. Types .............................................................................................................................. 49
10.6.2. Werkingsmechanisme ..................................................................................................... 49
10.6.4. Nadelen, nevenwerkingen, complicaties (heel examengericht) ........................................... 50
10.7. HORMONALE ANTICONCEPTIE ........................................................................................................ 53
10.7.1. Gecombineerde oestroprogestagenen (PPR-methoden) .................................................... 53
10.7.2. Progestagenen alleen ...................................................................................................... 55
10.8. DEFINITIEVE ANTICONCEPTIE (STERILISATIE) ....................................................................................... 56
10.9. NOODANTICONCEPTIE (EC) .......................................................................................................... 56
10.9.1. Orale EC.......................................................................................................................... 56
10.9.2. IUCD als EC ..................................................................................................................... 57
10.9.3. Counseling na EC ............................................................................................................ 57
10.10. ABORTUS ARTE PROVOCATUS (AAP) – CONCEPTUEEL OVERZICHT .......................................................... 57
10.10.1. Methoden ...................................................................................................................... 57
10.10.2. Nadelen/complicaties .................................................................................................... 58
10.10.4. Opvolging ...................................................................................................................... 58
SAMENVATTENDE TABELLEN ................................................................................................................... 59
LES 5: ABNORMAAL VAGINAAL BLOEDVERLIES .............................................................................60
CASUSSEN .................................................................................................................................... 60
Casus 1 ...................................................................................................................................... 60
Casus 2 ...................................................................................................................................... 61
Casus 3 ...................................................................................................................................... 62
1. DEFINITIE EN KLINISCHE INDELING ....................................................................................................... 63
2. POSTMENOPAUZAAL BLOEDVERLIES (PMB)............................................................................................ 63
3. DIFFERENTIËLE DIAGNOSE ................................................................................................................. 64
4. DIAGNOSTISCH STAPPENPLAN BIJ AUB ................................................................................................. 64
5. TRANSVAGINALE ECHOGRAFIE (TVS) .................................................................................................... 65
, 6. MORFOLOGISCHE EVALUATIE OP ECHOGRAFIE ........................................................................................ 65
6.1. Cyclische veranderingen ....................................................................................................... 65
6.2. Myomen (fibromen) .............................................................................................................. 65
6.3. Endometriale/endocervicale poliep ....................................................................................... 66
6.4. Endometriumcarcinoom ....................................................................................................... 66
6.5. Adenomyose ........................................................................................................................ 66
6.6. hematometrium ................................................................................................................... 67
7. SIS (SALINE INFUSION SONOGRAPHY) .................................................................................................. 69
8. IETA-CLASSIFICATIE ........................................................................................................................ 69
9. NIET-UTERIENE OORZAKEN VAN “UTERIEN” BLOEDVERLIES ......................................................................... 69
10. COMPLICATIES VAN AUB ................................................................................................................ 70
11. BEHANDELING.............................................................................................................................. 70
12. OVERZICHT .................................................................................................................................. 70
13. VOORBEELDVRAAG ........................................................................................................................ 71
LES 6: CERVIX PREMALIGNE LETSELS + SCREENING CERVIXCARCINOOM ......................................72
1. GOEDAARDIGE AANDOENINGEN VAN DE CERVIX ........................................................................ 72
1.1 anatomie en fysiologie van de cervix ....................................................................................... 72
1.2 transformatiezone (TZ) en metaplasie ..................................................................................... 72
1.2 Cervicale ectopie (ectropion) ............................................................................................ 73
1.3 Naboth-cyste ........................................................................................................................ 73
1.4 Cervicale erosie .................................................................................................................... 73
1.5 Cervicale wratten .................................................................................................................. 73
1.6 Cervicale poliep .................................................................................................................... 74
2. PREMALIGNE LETSELS (CIN/SIL) .................................................................................................. 74
2.1 Pathogenese ......................................................................................................................... 74
2.2 HPV ...................................................................................................................................... 74
2.3 Cervicale intra-epitheliale neoplasie (CIN) .............................................................................. 76
2.4 Risicofactoren cervixcarcinoom ............................................................................................. 77
3. PREVENTIE ................................................................................................................................. 77
3.1 Primaire preventie: HPV-vaccinatie ........................................................................................ 77
3.2 Secundaire preventie ............................................................................................................. 79
4. DIAGNOSTIEK: COLPOSCOPIE .................................................................................................... 82
5. BEHANDELING PREMALIGNE LETSELS ......................................................................................... 82
6. CERVIXCARCINOOM ................................................................................................................... 83
6.1 Epidemiologie ....................................................................................................................... 83
6.2 symptomen ........................................................................................................................... 83
6.3 Verspreiding .......................................................................................................................... 84
6.4 Prognosefactoren .................................................................................................................. 84
7. BEHANDELING INVASIEF CARCINOOM ........................................................................................ 84
Bilan .......................................................................................................................................... 84
Figo- Stadia ................................................................................................................................ 85
8. RECIDIEF .................................................................................................................................... 86
9. OPVOLGING ............................................................................................................................... 86
10. VERSCHIL CIN EN INVASIEF CARCINOOM ............................................................................................. 86
LES 7: INCONTINENTIE EN PROLAPS.............................................................................................87
1. DEFINITIE VAN PELVIC FLOOR DYSFUNCTION........................................................................................... 87
2. DEFINITIE VAN POP ......................................................................................................................... 88
3. EPIDEMIOLOGIE EN MAGNITUDE .......................................................................................................... 89
, 4. ANATOMIE VAN DE BEKKENBODEM ....................................................................................................... 90
5. PATHOFYSIOLOGIE .......................................................................................................................... 90
6. COMPARTIMENTEN VAN PROLAPS ........................................................................................................ 91
7. SYMPTOMEN VAN POP ..................................................................................................................... 91
8. CLASSIFICATIE VAN POP................................................................................................................... 92
9. DIAGNOSE ..................................................................................................................................... 92
10. BEHANDELING.............................................................................................................................. 93
Conservatieve behandeling ......................................................................................................... 93
11. RELATIE PROLAPS EN INCONTINENTIE ................................................................................................. 95
LES 8: ENDOMETRIUMCARCINOOM, SARCOMA EN TROBOLASTTUMOREN .....................................96
1. ENDOMETRIUMCARCINOOM ...................................................................................................... 96
1.1 Epidemiologie ....................................................................................................................... 96
1.2 Risicofactoren ....................................................................................................................... 96
1.3 Pathogenese en types ............................................................................................................ 98
1.4 Kliniek ................................................................................................................................. 100
1.5 Diagnose............................................................................................................................. 100
1.6 FIGO-stadiëring, histologie, pre-op/ bilan, metastasering ....................................................... 101
1.7 Behandeling ........................................................................................................................ 103
1.8 Prognose ............................................................................................................................ 105
2. UTERUSSARCOMEN ................................................................................................................. 106
2.1 Types .................................................................................................................................. 106
2.2 Kliniek ................................................................................................................................. 106
2.3 Diagnose............................................................................................................................. 106
2.4 Behandeling ........................................................................................................................ 106
2.5 Prognose ............................................................................................................................ 106
3. TROFOBLASTTUMOREN ............................................................................................................ 107
3.1 Mola hydatidiformis (goedaardig) .......................................................................................... 107
3.2 Kliniek ................................................................................................................................. 108
3.3 Behandeling ........................................................................................................................ 109
3.4 hCG-opvolging .................................................................................................................... 109
3.5 Maligne trofoblastziekten ..................................................................................................... 109
4. OVERZICHT VERGELIJKING ........................................................................................................ 111
LES 9: VROEGE ZWANGERSCHAP (MISKRAAM, EXTRA-UTERIENE ZWANGERSCHAP) .................... 112
INLEIDING: TRANSVAGINALE ECHO ........................................................................................................ 112
1. MISKRAAM (SPONTANE ABORTUS)................................................................................................... 113
1.1 Definitie .............................................................................................................................. 113
1.2 Oorzaken van spontaan miskraam ........................................................................................ 113
1.3 Klinische vormen van miskraam ........................................................................................... 113
1.4 laattijdig Miskraam .............................................................................................................. 117
2. HERHAALD MISKRAAM .............................................................................................................. 118
2.1 Definitie en prevalentie ........................................................................................................ 118
2.2 Oorzaken ............................................................................................................................ 119
2.3 Diagnose............................................................................................................................. 120
2.4 Behandeling ........................................................................................................................ 121
3. ECTOPISCHE ZWANGERSCHAP................................................................................................. 121
3.1 Definitie .............................................................................................................................. 121
3.2 Prevalentie ..................................................................................................................... 121
3.3 Lokalisatie .......................................................................................................................... 122
PROF. TIMMERMAN, VAN GORP, FROYMAN, DEPREST, VAN DER MEWE
INHOUDSOPGAVE
LES 1: INTRODUCTIE ....................................................................................................................10
1. INLEIDING TOT HET VAK ..................................................................................................................... 10
2. ANATOMIE VAN DE UITWENDIGE GENITALIA (KLINISCH!) ............................................................................. 10
3. BASIS GYNAECOLOGISCHE INGREPEN ................................................................................................... 11
4. HYSTERECTOMIE – TYPES (EXAMEN!) .................................................................................................. 13
5. NIEUWE TECHNIEKEN ....................................................................................................................... 13
6. OVERZICHT PATHOLOGIE PER COMPARTIMENT ........................................................................................ 14
7. ABNORMAAL UTERIEN BLOEDVERLIES (AUB) .......................................................................................... 14
Definities .................................................................................................................................... 14
Methodologie bij AUB .................................................................................................................. 15
Oorzaken van AUB – FIGO ........................................................................................................... 17
Behandeling AUB ........................................................................................................................ 18
8. ENDOMETRIUMPATHOLOGIE .............................................................................................................. 19
12. ENDOMETRIUMHYPERPLASIE ............................................................................................................ 20
13. MYOMETRIUMPATHOLOGIE – FIBROMEN .............................................................................................. 21
14. EXAMENKAPSTOK AUB ................................................................................................................... 24
VOORBEELD EXAMENVRAAG .............................................................................................................. 24
LES 2: BORSTPATHOLOGIE ...........................................................................................................25
LES 3: ENDOMETRIOSE EN ADENOMYOSE ....................................................................................25
H9: ENDOMETRIOSE............................................................................................................................ 25
1. Definitie .................................................................................................................................. 25
2. Pathogenese ........................................................................................................................... 25
3. Prevalentie.............................................................................................................................. 26
4. Symptomen ............................................................................................................................ 26
5. Klinisch onderzoek .................................................................................................................. 26
6. Vormen ................................................................................................................................... 27
7. Diagnostiek ............................................................................................................................. 28
8. Behandeling ............................................................................................................................ 29
H4: ADENOMYOSE .............................................................................................................................. 30
1. Definitie .................................................................................................................................. 30
2. Echografische kenmerken ....................................................................................................... 30
3. Symptomen ............................................................................................................................ 30
4. Behandeling ............................................................................................................................ 31
H12: ONDERZOEK EN BEHANDELING VAN VERMINDERDE VRUCHTBAARHEID ....................................................... 31
1. Definities ................................................................................................................................ 31
, 2. De normale fertiliteit ................................................................................................................ 31
3. Leeftijd en ovariële reserve....................................................................................................... 31
4. Factoren van normale fertiliteit................................................................................................. 32
5. Oorzaken ................................................................................................................................ 33
6. Diagnostiek ............................................................................................................................. 33
7. BEHANDELING VAN INFERTILITEIT ........................................................................................... 34
5. Pre-implantatie genetische diagnostiek (PGD) .......................................................................... 39
6. Fertility preservation ................................................................................................................ 39
VOORBEELDVRAAG ............................................................................................................................. 39
LES 4: ANTICONCEPTIE ................................................................................................................41
10.1. DE ANTICONCEPTIEVE NOOD ......................................................................................................... 42
10.1.1. Epidemiologische cijfers (wereldbevolking als achtergrond) ............................................... 42
10.1.2. Oorzaken van anticonceptieve nood ................................................................................. 42
10.2. OVERZICHT VAN METHODEN .......................................................................................................... 43
10.3. ANTICONCEPTIEVE WERKZAAMHEID – METHODOLOGIE ......................................................................... 43
TABEL 10.4: PERFECT VS TYPICAL USE PI (SELECTIE) .................................................................................... 44
10.4. NATUURLIJKE FAMILIEPLANNING (NFP) ............................................................................................ 45
10.5. COÏTUSGEBONDEN METHODEN ...................................................................................................... 46
10.5.1. Coïtus interruptus (withdrawal)......................................................................................... 46
10.5.2. Condooms ...................................................................................................................... 47
10.5.3. Vaginale middelen ........................................................................................................... 48
10.6. INTRA-UTERIENE APPARATEN (IUCD)............................................................................................... 49
10.6.1. Types .............................................................................................................................. 49
10.6.2. Werkingsmechanisme ..................................................................................................... 49
10.6.4. Nadelen, nevenwerkingen, complicaties (heel examengericht) ........................................... 50
10.7. HORMONALE ANTICONCEPTIE ........................................................................................................ 53
10.7.1. Gecombineerde oestroprogestagenen (PPR-methoden) .................................................... 53
10.7.2. Progestagenen alleen ...................................................................................................... 55
10.8. DEFINITIEVE ANTICONCEPTIE (STERILISATIE) ....................................................................................... 56
10.9. NOODANTICONCEPTIE (EC) .......................................................................................................... 56
10.9.1. Orale EC.......................................................................................................................... 56
10.9.2. IUCD als EC ..................................................................................................................... 57
10.9.3. Counseling na EC ............................................................................................................ 57
10.10. ABORTUS ARTE PROVOCATUS (AAP) – CONCEPTUEEL OVERZICHT .......................................................... 57
10.10.1. Methoden ...................................................................................................................... 57
10.10.2. Nadelen/complicaties .................................................................................................... 58
10.10.4. Opvolging ...................................................................................................................... 58
SAMENVATTENDE TABELLEN ................................................................................................................... 59
LES 5: ABNORMAAL VAGINAAL BLOEDVERLIES .............................................................................60
CASUSSEN .................................................................................................................................... 60
Casus 1 ...................................................................................................................................... 60
Casus 2 ...................................................................................................................................... 61
Casus 3 ...................................................................................................................................... 62
1. DEFINITIE EN KLINISCHE INDELING ....................................................................................................... 63
2. POSTMENOPAUZAAL BLOEDVERLIES (PMB)............................................................................................ 63
3. DIFFERENTIËLE DIAGNOSE ................................................................................................................. 64
4. DIAGNOSTISCH STAPPENPLAN BIJ AUB ................................................................................................. 64
5. TRANSVAGINALE ECHOGRAFIE (TVS) .................................................................................................... 65
, 6. MORFOLOGISCHE EVALUATIE OP ECHOGRAFIE ........................................................................................ 65
6.1. Cyclische veranderingen ....................................................................................................... 65
6.2. Myomen (fibromen) .............................................................................................................. 65
6.3. Endometriale/endocervicale poliep ....................................................................................... 66
6.4. Endometriumcarcinoom ....................................................................................................... 66
6.5. Adenomyose ........................................................................................................................ 66
6.6. hematometrium ................................................................................................................... 67
7. SIS (SALINE INFUSION SONOGRAPHY) .................................................................................................. 69
8. IETA-CLASSIFICATIE ........................................................................................................................ 69
9. NIET-UTERIENE OORZAKEN VAN “UTERIEN” BLOEDVERLIES ......................................................................... 69
10. COMPLICATIES VAN AUB ................................................................................................................ 70
11. BEHANDELING.............................................................................................................................. 70
12. OVERZICHT .................................................................................................................................. 70
13. VOORBEELDVRAAG ........................................................................................................................ 71
LES 6: CERVIX PREMALIGNE LETSELS + SCREENING CERVIXCARCINOOM ......................................72
1. GOEDAARDIGE AANDOENINGEN VAN DE CERVIX ........................................................................ 72
1.1 anatomie en fysiologie van de cervix ....................................................................................... 72
1.2 transformatiezone (TZ) en metaplasie ..................................................................................... 72
1.2 Cervicale ectopie (ectropion) ............................................................................................ 73
1.3 Naboth-cyste ........................................................................................................................ 73
1.4 Cervicale erosie .................................................................................................................... 73
1.5 Cervicale wratten .................................................................................................................. 73
1.6 Cervicale poliep .................................................................................................................... 74
2. PREMALIGNE LETSELS (CIN/SIL) .................................................................................................. 74
2.1 Pathogenese ......................................................................................................................... 74
2.2 HPV ...................................................................................................................................... 74
2.3 Cervicale intra-epitheliale neoplasie (CIN) .............................................................................. 76
2.4 Risicofactoren cervixcarcinoom ............................................................................................. 77
3. PREVENTIE ................................................................................................................................. 77
3.1 Primaire preventie: HPV-vaccinatie ........................................................................................ 77
3.2 Secundaire preventie ............................................................................................................. 79
4. DIAGNOSTIEK: COLPOSCOPIE .................................................................................................... 82
5. BEHANDELING PREMALIGNE LETSELS ......................................................................................... 82
6. CERVIXCARCINOOM ................................................................................................................... 83
6.1 Epidemiologie ....................................................................................................................... 83
6.2 symptomen ........................................................................................................................... 83
6.3 Verspreiding .......................................................................................................................... 84
6.4 Prognosefactoren .................................................................................................................. 84
7. BEHANDELING INVASIEF CARCINOOM ........................................................................................ 84
Bilan .......................................................................................................................................... 84
Figo- Stadia ................................................................................................................................ 85
8. RECIDIEF .................................................................................................................................... 86
9. OPVOLGING ............................................................................................................................... 86
10. VERSCHIL CIN EN INVASIEF CARCINOOM ............................................................................................. 86
LES 7: INCONTINENTIE EN PROLAPS.............................................................................................87
1. DEFINITIE VAN PELVIC FLOOR DYSFUNCTION........................................................................................... 87
2. DEFINITIE VAN POP ......................................................................................................................... 88
3. EPIDEMIOLOGIE EN MAGNITUDE .......................................................................................................... 89
, 4. ANATOMIE VAN DE BEKKENBODEM ....................................................................................................... 90
5. PATHOFYSIOLOGIE .......................................................................................................................... 90
6. COMPARTIMENTEN VAN PROLAPS ........................................................................................................ 91
7. SYMPTOMEN VAN POP ..................................................................................................................... 91
8. CLASSIFICATIE VAN POP................................................................................................................... 92
9. DIAGNOSE ..................................................................................................................................... 92
10. BEHANDELING.............................................................................................................................. 93
Conservatieve behandeling ......................................................................................................... 93
11. RELATIE PROLAPS EN INCONTINENTIE ................................................................................................. 95
LES 8: ENDOMETRIUMCARCINOOM, SARCOMA EN TROBOLASTTUMOREN .....................................96
1. ENDOMETRIUMCARCINOOM ...................................................................................................... 96
1.1 Epidemiologie ....................................................................................................................... 96
1.2 Risicofactoren ....................................................................................................................... 96
1.3 Pathogenese en types ............................................................................................................ 98
1.4 Kliniek ................................................................................................................................. 100
1.5 Diagnose............................................................................................................................. 100
1.6 FIGO-stadiëring, histologie, pre-op/ bilan, metastasering ....................................................... 101
1.7 Behandeling ........................................................................................................................ 103
1.8 Prognose ............................................................................................................................ 105
2. UTERUSSARCOMEN ................................................................................................................. 106
2.1 Types .................................................................................................................................. 106
2.2 Kliniek ................................................................................................................................. 106
2.3 Diagnose............................................................................................................................. 106
2.4 Behandeling ........................................................................................................................ 106
2.5 Prognose ............................................................................................................................ 106
3. TROFOBLASTTUMOREN ............................................................................................................ 107
3.1 Mola hydatidiformis (goedaardig) .......................................................................................... 107
3.2 Kliniek ................................................................................................................................. 108
3.3 Behandeling ........................................................................................................................ 109
3.4 hCG-opvolging .................................................................................................................... 109
3.5 Maligne trofoblastziekten ..................................................................................................... 109
4. OVERZICHT VERGELIJKING ........................................................................................................ 111
LES 9: VROEGE ZWANGERSCHAP (MISKRAAM, EXTRA-UTERIENE ZWANGERSCHAP) .................... 112
INLEIDING: TRANSVAGINALE ECHO ........................................................................................................ 112
1. MISKRAAM (SPONTANE ABORTUS)................................................................................................... 113
1.1 Definitie .............................................................................................................................. 113
1.2 Oorzaken van spontaan miskraam ........................................................................................ 113
1.3 Klinische vormen van miskraam ........................................................................................... 113
1.4 laattijdig Miskraam .............................................................................................................. 117
2. HERHAALD MISKRAAM .............................................................................................................. 118
2.1 Definitie en prevalentie ........................................................................................................ 118
2.2 Oorzaken ............................................................................................................................ 119
2.3 Diagnose............................................................................................................................. 120
2.4 Behandeling ........................................................................................................................ 121
3. ECTOPISCHE ZWANGERSCHAP................................................................................................. 121
3.1 Definitie .............................................................................................................................. 121
3.2 Prevalentie ..................................................................................................................... 121
3.3 Lokalisatie .......................................................................................................................... 122
