Samenvatting - M7 pathologische arbeid: inductie

Pathologische arbeid




Inductie

Inhoudsopgave
HistorIek................................................................................................................................................................1
Mechanisme methoden....................................................................................................................................2
Chirurgische methoden.....................................................................................................................................2
Farmacologische methoden..............................................................................................................................2

KCE richtlijnen inductie..........................................................................................................................................2

Beoordelen inleiding & inleidingsmethodes.........................................................................................................2
Hoe beoordeelt men of cervix rijp is?...............................................................................................................2
Welke methode wordt gekozen?......................................................................................................................3

Inleidingsmethodes...............................................................................................................................................3
Cervixrijping, pre-inductie.................................................................................................................................4
Inductie met syntocinon....................................................................................................................................4
Sweeping of the membranes............................................................................................................................4
Misoprostol & cytotec.......................................................................................................................................5
AMNIOTOMIE....................................................................................................................................................5
Overige..............................................................................................................................................................5

Terminologie.........................................................................................................................................................5
inductie baring...................................................................................................................................................5
Contra indicaties................................................................................................................................................6
Montevideo-eenheden.....................................................................................................................................6
Theobaldmethode.............................................................................................................................................6
Extra-amniotisch................................................................................................................................................6
Intravaginaal......................................................................................................................................................6
Littekenuterus...................................................................................................................................................6

Wat mag een vroedvrouw wettelijk doen.............................................................................................................6

Inductie bij MIU.....................................................................................................................................................6
Actief beleid.......................................................................................................................................................6
Complicatiess prostaglandines..........................................................................................................................7
Mogelijke medicatie ter symptomatische behandeling....................................................................................7
Nazorg...............................................................................................................................................................7




HISTOR IEK




1

, Pathologische arbeid


MECHANISME METHODEN
 Dilatatiemethoden vroeger stiften van zeewier die zwellen door vocht
 Instilleren van vloeistoffen heet water --> glycerol --> gel
 Bougies & ballonnen geplaatst tussen vliezen & uterus




CHIRURGISCHE METHODEN
 Amniotomie = vliezen breken
o Hoge katheter van Drew Smyte
o Lage Pozzi


FARMACOLOGISCHE METHODEN
 Moederkoren uterus-contraherende eigenschappen
 Watson-kuren ricusolie, warm bad & kinine
 Oxytocine
 Prostaglandines
Aantal inductie daalt ivg met 10j geleden

KCE RICHTLIJNEN INDUCTIE

Voor 39w NIET
Tss 39w-41w NIET
Macrosomie NIET
Vanaf 41w AANVAARDBAAR

Enkel na toestemming van de zwangere!

BEOORDELEN INLEIDING & INLEIDINGSMETHODES
 Meer voordelen dan nadelen? Littekenuterus, zwangerschapsduur & toestand kind
 Vaginaal of abdominaal?
 Hoe kunnen we dit bereiken?

Risico’s inductie
 Preterme bevalling na foute duurberekening
 Failed induction
 Hypercontractiliteit of *tetanie uterus
 Foetale nood tgv tetanie
 40% inducties eindigt in kunstverlossing

*tetanie uterus
= krampen spier




HOE BEOORDEELT MEN OF CERVIX RIJP IS?

Bishop

2