OPVOLGING ARBEID DOOR DE VROEDVROUW
Inhoudsopgave
1. Foetale monitoring.......................................................................................................... 3
1.1 Inleiding..................................................................................................................... 3
1.1.1 Begrippen............................................................................................................ 4
1.2 Observaties en technieken........................................................................................4
1.3 Foetale bewaking door cardiotocogram.....................................................................4
1.3.1 Medicolegale aspecten........................................................................................4
1.3.2 Analyse van het CTG........................................................................................... 5
2. Inductie arbeid en amniotomie.......................................................................................6
2.1 Begrippen.................................................................................................................. 6
2.2 Niet-medische inductie.............................................................................................. 6
2.3 Medische inductie...................................................................................................... 7
2.4 Induceerbaarheid....................................................................................................... 7
2.5 Middelen en technieken.............................................................................................8
2.5.1 Onrijpe cervix...................................................................................................... 8
2.5.2 Rijpe cervix.......................................................................................................... 8
2.6 Besluit........................................................................................................................ 8
3. Achterste plaatsing......................................................................................................... 9
3.1 Begrippen.................................................................................................................. 9
3.2 Afwijkende ligging van de foetus...............................................................................9
3.3 Achterhoofdsligging achterhoofd achter....................................................................9
3.3.1 Kenmerken.......................................................................................................... 9
3.3.2 Oorzaken............................................................................................................. 9
3.3.3 Diagnose............................................................................................................. 9
3.3.4 Baringsmechanisme.......................................................................................... 10
3.3.5 Complicaties...................................................................................................... 10
3.3.6 Taak vroedvrouw............................................................................................... 10
4. Navelstrengprolaps....................................................................................................... 11
4.1 Begrippen................................................................................................................ 11
4.2 Incidentie................................................................................................................. 11
4.3 Soorten navelstrengprolaps.....................................................................................11
4.4 Predisponerende factoren........................................................................................ 11
4.5 Diagnose.................................................................................................................. 12
4.6 Preventie................................................................................................................. 12
4.7 Management............................................................................................................ 12
4.8 Prognose.................................................................................................................. 12
5. Preterme arbeid, postterme arbeid & GBS....................................................................13
1
Stefanie Marcelis
,OPVOLGING ARBEID DOOR DE VROEDVROUW
5.1 Preterme partus....................................................................................................... 13
5.1.1 Begrippen.......................................................................................................... 13
5.1.2 Incidentie........................................................................................................... 13
5.1.3 Risicofactoren.................................................................................................... 13
5.1.4 Diagnose........................................................................................................... 13
5.1.5 Beleid & vroedkundige aandachtspunten..........................................................13
5.2 Postterme partus..................................................................................................... 14
5.2.1 Begrippen.......................................................................................................... 14
5.2.2 Incidentie........................................................................................................... 14
5.2.3 Oorzaken........................................................................................................... 14
5.2.4 Gevolgen........................................................................................................... 14
5.2.5 Beleid & vroedkundige aandachtspunten..........................................................14
5.3 Groep B-Streptokokken............................................................................................ 14
5.3.1 Begrippen.......................................................................................................... 15
5.3.2 Incidentie........................................................................................................... 15
5.3.3 Gevolgen........................................................................................................... 15
5.3.4 Klinische tekens neonatale GBS.........................................................................15
5.3.5 Lange termijn gevolgen neonatale GBS.............................................................15
5.3.6 Risicofactoren.................................................................................................... 15
5.3.7 Preventiebeleid.................................................................................................. 15
6. Pijnverdoving................................................................................................................ 15
6.1 Pijnintensiteit........................................................................................................... 15
6.2 Pijnstilling................................................................................................................ 16
6.3 Lokaal regionale analgesie......................................................................................16
6.3.1 Klassieke epidurale............................................................................................ 16
6.3.2 Combined spinal epidural..................................................................................16
6.4 Complicaties............................................................................................................ 16
6.5 Rol van de vroedvrouw............................................................................................ 17
6.5.1 Voorbereiding.................................................................................................... 17
6.5.2 Uitvoering.......................................................................................................... 17
6.5.3 Nazorg............................................................................................................... 17
7. Partogram..................................................................................................................... 17
7.1 WHO Labour care guide........................................................................................... 17
7.2 Section 1: admission................................................................................................ 18
7.3 Section 2: supportive care.......................................................................................18
7.4 Section 3: baby........................................................................................................ 18
7.5 Section 4: women.................................................................................................... 19
7.6 Section 5: labour progress.......................................................................................19
2
Stefanie Marcelis
, OPVOLGING ARBEID DOOR DE VROEDVROUW
7.7 Section 6: medication.............................................................................................. 19
7.8 Section 7: shared decision-making..........................................................................19
8. PPH, uterus inversie, hypovolemische shock & placenta retentie.................................19
8.1 PPH.......................................................................................................................... 19
8.1.1 Atonie................................................................................................................ 19
8.1.2 Trauma.............................................................................................................. 20
8.1.3 Tissue................................................................................................................ 20
8.1.4 Trombin............................................................................................................. 20
8.1.5 Preventie........................................................................................................... 20
8.1.6 Behandeling....................................................................................................... 21
8.2 Hypovolemische shock............................................................................................ 21
8.2.1 Risicofactoren.................................................................................................... 21
8.2.2 Preventie........................................................................................................... 21
8.2.3 Klinische symptomen......................................................................................... 21
8.2.4 Behandeling....................................................................................................... 21
8.3 Manuele placentaverwijdering.................................................................................22
8.3.1 Definitie............................................................................................................. 22
8.3.2 Incidentie........................................................................................................... 22
8.3.3 Risicofactoren.................................................................................................... 22
8.3.4 Indicaties........................................................................................................... 22
8.3.5 Techniek............................................................................................................ 22
8.3.6 Alternatieve techniek......................................................................................... 22
8.3.7 Complicaties...................................................................................................... 22
8.4 Uterus inversie......................................................................................................... 23
8.4.1 Incidentie & risicofactoren.................................................................................23
8.4.2 Preventie........................................................................................................... 23
8.4.3 Klinische symptomen......................................................................................... 23
8.4.4 Classificatie....................................................................................................... 23
8.4.5 Behandeling....................................................................................................... 23
1. FOETALE MONITORING
1.1 INLEIDING
Placenta: zuurstofrijk bloed via Aorta > A. Iliacae > A. Uterinae > spiraalarteriën >
intervilleuze ruimte
3
Stefanie Marcelis
Inhoudsopgave
1. Foetale monitoring.......................................................................................................... 3
1.1 Inleiding..................................................................................................................... 3
1.1.1 Begrippen............................................................................................................ 4
1.2 Observaties en technieken........................................................................................4
1.3 Foetale bewaking door cardiotocogram.....................................................................4
1.3.1 Medicolegale aspecten........................................................................................4
1.3.2 Analyse van het CTG........................................................................................... 5
2. Inductie arbeid en amniotomie.......................................................................................6
2.1 Begrippen.................................................................................................................. 6
2.2 Niet-medische inductie.............................................................................................. 6
2.3 Medische inductie...................................................................................................... 7
2.4 Induceerbaarheid....................................................................................................... 7
2.5 Middelen en technieken.............................................................................................8
2.5.1 Onrijpe cervix...................................................................................................... 8
2.5.2 Rijpe cervix.......................................................................................................... 8
2.6 Besluit........................................................................................................................ 8
3. Achterste plaatsing......................................................................................................... 9
3.1 Begrippen.................................................................................................................. 9
3.2 Afwijkende ligging van de foetus...............................................................................9
3.3 Achterhoofdsligging achterhoofd achter....................................................................9
3.3.1 Kenmerken.......................................................................................................... 9
3.3.2 Oorzaken............................................................................................................. 9
3.3.3 Diagnose............................................................................................................. 9
3.3.4 Baringsmechanisme.......................................................................................... 10
3.3.5 Complicaties...................................................................................................... 10
3.3.6 Taak vroedvrouw............................................................................................... 10
4. Navelstrengprolaps....................................................................................................... 11
4.1 Begrippen................................................................................................................ 11
4.2 Incidentie................................................................................................................. 11
4.3 Soorten navelstrengprolaps.....................................................................................11
4.4 Predisponerende factoren........................................................................................ 11
4.5 Diagnose.................................................................................................................. 12
4.6 Preventie................................................................................................................. 12
4.7 Management............................................................................................................ 12
4.8 Prognose.................................................................................................................. 12
5. Preterme arbeid, postterme arbeid & GBS....................................................................13
1
Stefanie Marcelis
,OPVOLGING ARBEID DOOR DE VROEDVROUW
5.1 Preterme partus....................................................................................................... 13
5.1.1 Begrippen.......................................................................................................... 13
5.1.2 Incidentie........................................................................................................... 13
5.1.3 Risicofactoren.................................................................................................... 13
5.1.4 Diagnose........................................................................................................... 13
5.1.5 Beleid & vroedkundige aandachtspunten..........................................................13
5.2 Postterme partus..................................................................................................... 14
5.2.1 Begrippen.......................................................................................................... 14
5.2.2 Incidentie........................................................................................................... 14
5.2.3 Oorzaken........................................................................................................... 14
5.2.4 Gevolgen........................................................................................................... 14
5.2.5 Beleid & vroedkundige aandachtspunten..........................................................14
5.3 Groep B-Streptokokken............................................................................................ 14
5.3.1 Begrippen.......................................................................................................... 15
5.3.2 Incidentie........................................................................................................... 15
5.3.3 Gevolgen........................................................................................................... 15
5.3.4 Klinische tekens neonatale GBS.........................................................................15
5.3.5 Lange termijn gevolgen neonatale GBS.............................................................15
5.3.6 Risicofactoren.................................................................................................... 15
5.3.7 Preventiebeleid.................................................................................................. 15
6. Pijnverdoving................................................................................................................ 15
6.1 Pijnintensiteit........................................................................................................... 15
6.2 Pijnstilling................................................................................................................ 16
6.3 Lokaal regionale analgesie......................................................................................16
6.3.1 Klassieke epidurale............................................................................................ 16
6.3.2 Combined spinal epidural..................................................................................16
6.4 Complicaties............................................................................................................ 16
6.5 Rol van de vroedvrouw............................................................................................ 17
6.5.1 Voorbereiding.................................................................................................... 17
6.5.2 Uitvoering.......................................................................................................... 17
6.5.3 Nazorg............................................................................................................... 17
7. Partogram..................................................................................................................... 17
7.1 WHO Labour care guide........................................................................................... 17
7.2 Section 1: admission................................................................................................ 18
7.3 Section 2: supportive care.......................................................................................18
7.4 Section 3: baby........................................................................................................ 18
7.5 Section 4: women.................................................................................................... 19
7.6 Section 5: labour progress.......................................................................................19
2
Stefanie Marcelis
, OPVOLGING ARBEID DOOR DE VROEDVROUW
7.7 Section 6: medication.............................................................................................. 19
7.8 Section 7: shared decision-making..........................................................................19
8. PPH, uterus inversie, hypovolemische shock & placenta retentie.................................19
8.1 PPH.......................................................................................................................... 19
8.1.1 Atonie................................................................................................................ 19
8.1.2 Trauma.............................................................................................................. 20
8.1.3 Tissue................................................................................................................ 20
8.1.4 Trombin............................................................................................................. 20
8.1.5 Preventie........................................................................................................... 20
8.1.6 Behandeling....................................................................................................... 21
8.2 Hypovolemische shock............................................................................................ 21
8.2.1 Risicofactoren.................................................................................................... 21
8.2.2 Preventie........................................................................................................... 21
8.2.3 Klinische symptomen......................................................................................... 21
8.2.4 Behandeling....................................................................................................... 21
8.3 Manuele placentaverwijdering.................................................................................22
8.3.1 Definitie............................................................................................................. 22
8.3.2 Incidentie........................................................................................................... 22
8.3.3 Risicofactoren.................................................................................................... 22
8.3.4 Indicaties........................................................................................................... 22
8.3.5 Techniek............................................................................................................ 22
8.3.6 Alternatieve techniek......................................................................................... 22
8.3.7 Complicaties...................................................................................................... 22
8.4 Uterus inversie......................................................................................................... 23
8.4.1 Incidentie & risicofactoren.................................................................................23
8.4.2 Preventie........................................................................................................... 23
8.4.3 Klinische symptomen......................................................................................... 23
8.4.4 Classificatie....................................................................................................... 23
8.4.5 Behandeling....................................................................................................... 23
1. FOETALE MONITORING
1.1 INLEIDING
Placenta: zuurstofrijk bloed via Aorta > A. Iliacae > A. Uterinae > spiraalarteriën >
intervilleuze ruimte
3
Stefanie Marcelis
