GYNAECOLOGIE 2 2025-2026
0. Vrouwspecifieke aandoeningen..............................................................................................................13
1a. Zwangerschap en bevalling (herhaling)...............................................................................................14
Verloop van de zwangerschap................................................................................................................. 15
Zwangerschapsbegeleiding & prenatale zorg.......................................................................................... 17
De normale bevalling................................................................................................................................22
Verloop van baring in hoofdligging........................................................................................................... 25
Ontsluitingsfase..................................................................................................................................26
Uitdrijvingsfase................................................................................................................................... 26
Nageboortetijdperk............................................................................................................................. 27
Afnavelen................................................................................................................................................. 27
Begeleiding van de normale baring..........................................................................................................27
Ontsluitingsfase..................................................................................................................................27
Bewaking van de foetus..................................................................................................................... 28
Uitdrijvingsfase................................................................................................................................... 30
Nageboortetijdperk............................................................................................................................. 30
Het ongestoorde kraambed......................................................................................................................31
1b. Gynaecologische infecties (herhaling)................................................................................................ 32
Lage genitale infecties = vulvovaginitis.................................................................................................... 32
Bacteriële vaginose (BV)....................................................................................................................32
Candidiasis (moniliasis)......................................................................................................................33
Trichomoniasis................................................................................................................................... 33
Chlamydia cervicitis............................................................................................................................33
Gonococcen cervicitis/vaginitis.......................................................................................................... 34
Genitale wratten = condyloma acuminatum....................................................................................... 34
Genitale herpes.................................................................................................................................. 35
Syfilis (lues)........................................................................................................................................ 35
Aërobe vaginitis..................................................................................................................................36
Andere infecties..................................................................................................................................36
Pelvic inflammatory disease (PID)..................................................................................................... 38
1c. Contraceptie (herhaling)........................................................................................................................39
De combinatiepil.......................................................................................................................................39
Parenterale oestroprogestatieven............................................................................................................ 43
Progesteron only methoden (POP).......................................................................................................... 44
Intrauterine contraceptive device (IUCD) = spiraaltje...............................................................................45
Barrièremethoden.....................................................................................................................................46
Sterilisatie.................................................................................................................................................46
Noodanticonceptie....................................................................................................................................47
Abortuspil................................................................................................................................................. 48
1d. Seksuologie (herhaling)........................................................................................................................ 49
2a. Oligo- en polyhydramnios.....................................................................................................................54
Oligohydramnios...................................................................................................................................... 54
Polyhydramnios........................................................................................................................................55
2b. Groeiproblematiek tijdens de zwangerschap......................................................................................57
Foetale groeirestrictie (FGR)....................................................................................................................57
Macrosomie..............................................................................................................................................64
2c. Intra-uteriene vruchtdood en zwangerschapsterminatie................................................................... 66
1
, Intra-uteriene vruchtdood (IUVD)............................................................................................................. 66
Technische procedure bij zwangerschapsterminatie (TOP/IUVD)........................................................... 67
Laattijdige zwangerschapsafbreking........................................................................................................ 68
3. Meerlingzwangerschappen.................................................................................................................... 72
Zwangerschapscomplicaties.................................................................................................................... 74
Specifieke foetale complicaties................................................................................................................ 75
Monoamniotische tweelingen............................................................................................................. 75
Twin-to-twin transfusie syndroom (TTTS).......................................................................................... 76
Twin anemia-polycythemia sequence (TAPS).................................................................................... 76
Twin reversed arterial perfusion (TRAP)............................................................................................ 77
Abnormale tweelingen........................................................................................................................77
Discordante tweelingen (sIUGR)..............................................................................................................78
Foetale sterfte.......................................................................................................................................... 78
4. Problemen tijdens arbeid & verlossen, sectio, traumatische ervaringen...........................................82
Problemen tijdens arbeid & verlossen......................................................................................................82
Langdurige ontsluiting........................................................................................................................ 82
Langdurige uitdrijving......................................................................................................................... 82
Schouderdystocie...............................................................................................................................83
Liggingsafwijkingen............................................................................................................................ 83
Foetale nood = distress............................................................................................................................85
Problemen tijdens verlossen.................................................................................................................... 87
Traumatische bevallingservaringen..........................................................................................................90
5a. Hypertensieve aandoeningen in de zwangerschap............................................................................ 91
Behandeling hypertensie in de zwangerschap.........................................................................................94
Postpartum zorgen................................................................................................................................... 96
Advies ivm herhalingsrisico...................................................................................................................... 97
Preventie pre-eclampsie...........................................................................................................................97
5b. hartaandoeningen in de zwangerschap...............................................................................................98
Onderverdeling hartafwijkingen................................................................................................................98
Mitralisklepstenose.............................................................................................................................99
Syndroom van Marfan........................................................................................................................ 99
Pulmonale arteriële hypertensie (PAH).............................................................................................. 99
Complexe congenitale hartaandoeningen........................................................................................100
Mechanische hartkleppen................................................................................................................ 100
Peripartum cardiomyopathie.................................................................................................................. 100
6. Diabetes, obesitas en zwangerschap...................................................................................................101
Diabetes................................................................................................................................................. 101
Obesitas................................................................................................................................................. 109
7. Preterme arbeid & inductie....................................................................................................................112
Preterme arbeid......................................................................................................................................112
PPROM.................................................................................................................................................. 117
PROM.....................................................................................................................................................118
Serotiniteit = postdatisme....................................................................................................................... 118
Inductie................................................................................................................................................... 118
8. Infecties tijdens/na zwangerschap....................................................................................................... 121
Virale infecties........................................................................................................................................ 122
Rubella = rode hond......................................................................................................................... 122
CMV................................................................................................................................................. 123
Hepatitis........................................................................................................................................... 125
2
, HIV................................................................................................................................................... 127
Parvovirus........................................................................................................................................ 127
Herpes..............................................................................................................................................128
Bacteriële infecties................................................................................................................................. 129
Groep B streptococcen (GBS)..........................................................................................................129
Chorioamnionitis...............................................................................................................................130
Urineweginfecties............................................................................................................................. 131
Parasitaire infecties................................................................................................................................ 132
Toxoplasmose.................................................................................................................................. 132
Trichomonas.....................................................................................................................................133
Vaginale infecties................................................................................................................................... 133
Trichomonas.....................................................................................................................................133
Candida............................................................................................................................................ 133
Bacteriële vaginose.......................................................................................................................... 134
Listeria monocytogenes................................................................................................................... 134
Seksueel overdraagbare aandoeningen (SOA)..................................................................................... 134
Gonorroe.......................................................................................................................................... 134
Chlamydia........................................................................................................................................ 134
Syfilis................................................................................................................................................ 135
Vaccinatie & zwangerschap................................................................................................................... 135
Tetanus.............................................................................................................................................135
Influenza...........................................................................................................................................135
Kinkhoest = pertussis....................................................................................................................... 136
COVID.............................................................................................................................................. 136
RSV.................................................................................................................................................. 136
Antimicrobiële therapie tijdens zwangerschap....................................................................................... 137
Koorts in het kraambed = postpartum pyrexie....................................................................................... 138
Puerperale sepsis - endomyometritis............................................................................................... 138
Mastitis & andere borstproblemen postpartum.................................................................................139
9. Bloedingen..............................................................................................................................................141
Vaginaal bloedverlies tijdens de zwangerschap - eerste trimester.........................................................141
Miskraam = abortus..........................................................................................................................141
Herhaalde miskraam........................................................................................................................ 144
Buitenbaarmoederlijke zwangerschap = extra-uteriene graviditeit (EUG)....................................... 144
Mola zwangerschap......................................................................................................................... 146
Vaginaal bloedverlies tijdens de zwangerschap - tweede & derde trimester......................................... 146
Solutio placentae = placentaloslating............................................................................................... 147
Placenta previa.................................................................................................................................148
Vasa previa.......................................................................................................................................149
Placenta circumvallata..................................................................................................................... 149
Postpartum bloedverlies → abnormal placenta..................................................................................... 150
Fluxus postpartum............................................................................................................................150
Secundaire fluxus/hemorrhagie........................................................................................................152
10. Stolling & zwangerschap.....................................................................................................................153
Stolling & zwangerschap........................................................................................................................ 153
Trombose............................................................................................................................................... 153
Diep veneuze trombose................................................................................................................... 154
Longembool......................................................................................................................................154
Vena ovarica trombose.....................................................................................................................155
3
, Trombofilie..............................................................................................................................................155
Antifosfolipiden syndroom................................................................................................................ 155
DIC vructhwaterembool..........................................................................................................................156
Tromboseprofylaxe & zwangerschap..................................................................................................... 156
Anticoagulantia & zwangerschap/borstvoeding..................................................................................... 157
11. Bloedgroepantagonisme & maternele anemie.................................................................................. 158
Bloedgroepantagonisme........................................................................................................................ 158
Maternele anemie...................................................................................................................................162
12. Vruchtbaarheidsproblemen.................................................................................................................168
Ovulatiestoornissen................................................................................................................................168
PCOS (type IV).......................................................................................................................................168
Fertiliteitspreservatie.............................................................................................................................. 170
13. Endometriose en chronische pelviene buikpijn................................................................................175
Endometriose......................................................................................................................................... 175
Chronische pelviene buikpijn (CPP).......................................................................................................180
14a. Cervix pathologie............................................................................................................................... 182
Premaligne cervixletsels (CIN / HSIL en AIS)........................................................................................ 188
Invasief cervixcarcinoom........................................................................................................................ 190
14b. Vagina pathologie.............................................................................................................................. 193
Classificatie van vaginapathologie......................................................................................................... 194
Benigne vaginapathologie................................................................................................................ 194
Premaligne vaginale aandoeningen................................................................................................. 194
Malgine vaginapathologie.................................................................................................................194
14c. Vulva pathologie.................................................................................................................................200
Classificatie van vulvaire aandoeningen................................................................................................ 201
Benigne vulvaire aandoeningen....................................................................................................... 201
Premaligne vulvaire aandoeningen.................................................................................................. 202
Maligne vulvaire aandoeningen........................................................................................................202
Klinische presentatie.............................................................................................................................. 202
Jeuk (pruritus vulvae)....................................................................................................................... 202
Pijn en branderigheid....................................................................................................................... 203
Zichtbaar of palpabel vulvair letsel................................................................................................... 203
Bloeding, ulceratie en alarmsignalen............................................................................................... 203
Premaligne aandoeningen..................................................................................................................... 205
Lichen sclerosus (LS).......................................................................................................................205
Vulvaire intra-epitheliale neoplasie (VIN)......................................................................................... 205
Maligne tumoren van de vulva - vulvacarcinoom................................................................................... 206
15a. Pathologie van uterus, tubae, ovarium (benigne)...........................................................................210
Uterus - pathologie................................................................................................................................. 211
Myoma uteria.................................................................................................................................... 211
Adenomyosis....................................................................................................................................217
Endometriosis...................................................................................................................................218
Intra-uteriene poliepen..................................................................................................................... 218
Endometriumhyperplasie..................................................................................................................219
Tubae - pathologie................................................................................................................................. 220
Endosalpingiosis.............................................................................................................................. 220
Hydrosalpinx.....................................................................................................................................220
Salpingitis isthmica nodosa (SIN).....................................................................................................221
Peritubaire cysten.............................................................................................................................221
4
0. Vrouwspecifieke aandoeningen..............................................................................................................13
1a. Zwangerschap en bevalling (herhaling)...............................................................................................14
Verloop van de zwangerschap................................................................................................................. 15
Zwangerschapsbegeleiding & prenatale zorg.......................................................................................... 17
De normale bevalling................................................................................................................................22
Verloop van baring in hoofdligging........................................................................................................... 25
Ontsluitingsfase..................................................................................................................................26
Uitdrijvingsfase................................................................................................................................... 26
Nageboortetijdperk............................................................................................................................. 27
Afnavelen................................................................................................................................................. 27
Begeleiding van de normale baring..........................................................................................................27
Ontsluitingsfase..................................................................................................................................27
Bewaking van de foetus..................................................................................................................... 28
Uitdrijvingsfase................................................................................................................................... 30
Nageboortetijdperk............................................................................................................................. 30
Het ongestoorde kraambed......................................................................................................................31
1b. Gynaecologische infecties (herhaling)................................................................................................ 32
Lage genitale infecties = vulvovaginitis.................................................................................................... 32
Bacteriële vaginose (BV)....................................................................................................................32
Candidiasis (moniliasis)......................................................................................................................33
Trichomoniasis................................................................................................................................... 33
Chlamydia cervicitis............................................................................................................................33
Gonococcen cervicitis/vaginitis.......................................................................................................... 34
Genitale wratten = condyloma acuminatum....................................................................................... 34
Genitale herpes.................................................................................................................................. 35
Syfilis (lues)........................................................................................................................................ 35
Aërobe vaginitis..................................................................................................................................36
Andere infecties..................................................................................................................................36
Pelvic inflammatory disease (PID)..................................................................................................... 38
1c. Contraceptie (herhaling)........................................................................................................................39
De combinatiepil.......................................................................................................................................39
Parenterale oestroprogestatieven............................................................................................................ 43
Progesteron only methoden (POP).......................................................................................................... 44
Intrauterine contraceptive device (IUCD) = spiraaltje...............................................................................45
Barrièremethoden.....................................................................................................................................46
Sterilisatie.................................................................................................................................................46
Noodanticonceptie....................................................................................................................................47
Abortuspil................................................................................................................................................. 48
1d. Seksuologie (herhaling)........................................................................................................................ 49
2a. Oligo- en polyhydramnios.....................................................................................................................54
Oligohydramnios...................................................................................................................................... 54
Polyhydramnios........................................................................................................................................55
2b. Groeiproblematiek tijdens de zwangerschap......................................................................................57
Foetale groeirestrictie (FGR)....................................................................................................................57
Macrosomie..............................................................................................................................................64
2c. Intra-uteriene vruchtdood en zwangerschapsterminatie................................................................... 66
1
, Intra-uteriene vruchtdood (IUVD)............................................................................................................. 66
Technische procedure bij zwangerschapsterminatie (TOP/IUVD)........................................................... 67
Laattijdige zwangerschapsafbreking........................................................................................................ 68
3. Meerlingzwangerschappen.................................................................................................................... 72
Zwangerschapscomplicaties.................................................................................................................... 74
Specifieke foetale complicaties................................................................................................................ 75
Monoamniotische tweelingen............................................................................................................. 75
Twin-to-twin transfusie syndroom (TTTS).......................................................................................... 76
Twin anemia-polycythemia sequence (TAPS).................................................................................... 76
Twin reversed arterial perfusion (TRAP)............................................................................................ 77
Abnormale tweelingen........................................................................................................................77
Discordante tweelingen (sIUGR)..............................................................................................................78
Foetale sterfte.......................................................................................................................................... 78
4. Problemen tijdens arbeid & verlossen, sectio, traumatische ervaringen...........................................82
Problemen tijdens arbeid & verlossen......................................................................................................82
Langdurige ontsluiting........................................................................................................................ 82
Langdurige uitdrijving......................................................................................................................... 82
Schouderdystocie...............................................................................................................................83
Liggingsafwijkingen............................................................................................................................ 83
Foetale nood = distress............................................................................................................................85
Problemen tijdens verlossen.................................................................................................................... 87
Traumatische bevallingservaringen..........................................................................................................90
5a. Hypertensieve aandoeningen in de zwangerschap............................................................................ 91
Behandeling hypertensie in de zwangerschap.........................................................................................94
Postpartum zorgen................................................................................................................................... 96
Advies ivm herhalingsrisico...................................................................................................................... 97
Preventie pre-eclampsie...........................................................................................................................97
5b. hartaandoeningen in de zwangerschap...............................................................................................98
Onderverdeling hartafwijkingen................................................................................................................98
Mitralisklepstenose.............................................................................................................................99
Syndroom van Marfan........................................................................................................................ 99
Pulmonale arteriële hypertensie (PAH).............................................................................................. 99
Complexe congenitale hartaandoeningen........................................................................................100
Mechanische hartkleppen................................................................................................................ 100
Peripartum cardiomyopathie.................................................................................................................. 100
6. Diabetes, obesitas en zwangerschap...................................................................................................101
Diabetes................................................................................................................................................. 101
Obesitas................................................................................................................................................. 109
7. Preterme arbeid & inductie....................................................................................................................112
Preterme arbeid......................................................................................................................................112
PPROM.................................................................................................................................................. 117
PROM.....................................................................................................................................................118
Serotiniteit = postdatisme....................................................................................................................... 118
Inductie................................................................................................................................................... 118
8. Infecties tijdens/na zwangerschap....................................................................................................... 121
Virale infecties........................................................................................................................................ 122
Rubella = rode hond......................................................................................................................... 122
CMV................................................................................................................................................. 123
Hepatitis........................................................................................................................................... 125
2
, HIV................................................................................................................................................... 127
Parvovirus........................................................................................................................................ 127
Herpes..............................................................................................................................................128
Bacteriële infecties................................................................................................................................. 129
Groep B streptococcen (GBS)..........................................................................................................129
Chorioamnionitis...............................................................................................................................130
Urineweginfecties............................................................................................................................. 131
Parasitaire infecties................................................................................................................................ 132
Toxoplasmose.................................................................................................................................. 132
Trichomonas.....................................................................................................................................133
Vaginale infecties................................................................................................................................... 133
Trichomonas.....................................................................................................................................133
Candida............................................................................................................................................ 133
Bacteriële vaginose.......................................................................................................................... 134
Listeria monocytogenes................................................................................................................... 134
Seksueel overdraagbare aandoeningen (SOA)..................................................................................... 134
Gonorroe.......................................................................................................................................... 134
Chlamydia........................................................................................................................................ 134
Syfilis................................................................................................................................................ 135
Vaccinatie & zwangerschap................................................................................................................... 135
Tetanus.............................................................................................................................................135
Influenza...........................................................................................................................................135
Kinkhoest = pertussis....................................................................................................................... 136
COVID.............................................................................................................................................. 136
RSV.................................................................................................................................................. 136
Antimicrobiële therapie tijdens zwangerschap....................................................................................... 137
Koorts in het kraambed = postpartum pyrexie....................................................................................... 138
Puerperale sepsis - endomyometritis............................................................................................... 138
Mastitis & andere borstproblemen postpartum.................................................................................139
9. Bloedingen..............................................................................................................................................141
Vaginaal bloedverlies tijdens de zwangerschap - eerste trimester.........................................................141
Miskraam = abortus..........................................................................................................................141
Herhaalde miskraam........................................................................................................................ 144
Buitenbaarmoederlijke zwangerschap = extra-uteriene graviditeit (EUG)....................................... 144
Mola zwangerschap......................................................................................................................... 146
Vaginaal bloedverlies tijdens de zwangerschap - tweede & derde trimester......................................... 146
Solutio placentae = placentaloslating............................................................................................... 147
Placenta previa.................................................................................................................................148
Vasa previa.......................................................................................................................................149
Placenta circumvallata..................................................................................................................... 149
Postpartum bloedverlies → abnormal placenta..................................................................................... 150
Fluxus postpartum............................................................................................................................150
Secundaire fluxus/hemorrhagie........................................................................................................152
10. Stolling & zwangerschap.....................................................................................................................153
Stolling & zwangerschap........................................................................................................................ 153
Trombose............................................................................................................................................... 153
Diep veneuze trombose................................................................................................................... 154
Longembool......................................................................................................................................154
Vena ovarica trombose.....................................................................................................................155
3
, Trombofilie..............................................................................................................................................155
Antifosfolipiden syndroom................................................................................................................ 155
DIC vructhwaterembool..........................................................................................................................156
Tromboseprofylaxe & zwangerschap..................................................................................................... 156
Anticoagulantia & zwangerschap/borstvoeding..................................................................................... 157
11. Bloedgroepantagonisme & maternele anemie.................................................................................. 158
Bloedgroepantagonisme........................................................................................................................ 158
Maternele anemie...................................................................................................................................162
12. Vruchtbaarheidsproblemen.................................................................................................................168
Ovulatiestoornissen................................................................................................................................168
PCOS (type IV).......................................................................................................................................168
Fertiliteitspreservatie.............................................................................................................................. 170
13. Endometriose en chronische pelviene buikpijn................................................................................175
Endometriose......................................................................................................................................... 175
Chronische pelviene buikpijn (CPP).......................................................................................................180
14a. Cervix pathologie............................................................................................................................... 182
Premaligne cervixletsels (CIN / HSIL en AIS)........................................................................................ 188
Invasief cervixcarcinoom........................................................................................................................ 190
14b. Vagina pathologie.............................................................................................................................. 193
Classificatie van vaginapathologie......................................................................................................... 194
Benigne vaginapathologie................................................................................................................ 194
Premaligne vaginale aandoeningen................................................................................................. 194
Malgine vaginapathologie.................................................................................................................194
14c. Vulva pathologie.................................................................................................................................200
Classificatie van vulvaire aandoeningen................................................................................................ 201
Benigne vulvaire aandoeningen....................................................................................................... 201
Premaligne vulvaire aandoeningen.................................................................................................. 202
Maligne vulvaire aandoeningen........................................................................................................202
Klinische presentatie.............................................................................................................................. 202
Jeuk (pruritus vulvae)....................................................................................................................... 202
Pijn en branderigheid....................................................................................................................... 203
Zichtbaar of palpabel vulvair letsel................................................................................................... 203
Bloeding, ulceratie en alarmsignalen............................................................................................... 203
Premaligne aandoeningen..................................................................................................................... 205
Lichen sclerosus (LS).......................................................................................................................205
Vulvaire intra-epitheliale neoplasie (VIN)......................................................................................... 205
Maligne tumoren van de vulva - vulvacarcinoom................................................................................... 206
15a. Pathologie van uterus, tubae, ovarium (benigne)...........................................................................210
Uterus - pathologie................................................................................................................................. 211
Myoma uteria.................................................................................................................................... 211
Adenomyosis....................................................................................................................................217
Endometriosis...................................................................................................................................218
Intra-uteriene poliepen..................................................................................................................... 218
Endometriumhyperplasie..................................................................................................................219
Tubae - pathologie................................................................................................................................. 220
Endosalpingiosis.............................................................................................................................. 220
Hydrosalpinx.....................................................................................................................................220
Salpingitis isthmica nodosa (SIN).....................................................................................................221
Peritubaire cysten.............................................................................................................................221
4
