ZWANGERSCHAP, ARBEID & BEVALLING 2
INHOUD
1. Prenatale testen in het tweede en derde trimester ..............................................................................5
1.1 Introductie..................................................................................................................................5
1.2 Prenatale screening ....................................................................................................................5
1.3 Prenatale diagnostiek ..................................................................................................................5
2. Niet invasieve prenatale testen .........................................................................................................6
2.1 Beeldvorming .............................................................................................................................6
2.1.1 Echografie ............................................................................................................................6
2.1.2 MRI ......................................................................................................................................8
2.1.3 CT ........................................................................................................................................8
2.2 Rol van de vroedvrouw ................................................................................................................8
2.3 Genetische testen .......................................................................................................................9
2.3.1 NIPT (Niet-Invasieve Prenatale Test) ......................................................................................9
2.3.2 NIPD (Niet- invasieve Prenatale Diagnose) .............................................................................9
3. Invasieve testen ............................................................................................................................. 10
3.1 Chorionvillibiopsie .................................................................................................................... 10
3.2 Amniocentese .......................................................................................................................... 10
3.3 Cordocentese ........................................................................................................................... 11
3.4 Fetoscopie ............................................................................................................................... 11
3.4 Rol van de vroedvrouw .............................................................................................................. 12
4. Fetale autopsie .............................................................................................................................. 13
4.1 Wat? ........................................................................................................................................ 13
4.2 Wanneer? ................................................................................................................................. 13
4.3 Hoe? ........................................................................................................................................ 13
4.4 Waarom?.................................................................................................................................. 13
4.5 Minimaal invasieve fetale autopsie ............................................................................................ 13
4.6 Beeldvorming ........................................................................................................................... 14
4.6.1 Postmortem MRI ................................................................................................................. 14
4.6.2 Postmortem CT .................................................................................................................. 14
4.6.3 Postmortem echo ............................................................................................................... 14
4.7 Placenta ................................................................................................................................... 14
4.7.1 Indicaties voor onderzoek ................................................................................................... 14
4.7.2 Technieken voor onderzoek ................................................................................................. 15
5. Prenatale therapie .......................................................................................................................... 15
5.1 Introductie................................................................................................................................ 15
5.2 Transplacentaire behandeling ................................................................................................... 15
1
Medische aspecten
,ZWANGERSCHAP, ARBEID & BEVALLING 2
5.3 Intra-uteriene transfusie ............................................................................................................ 15
5.4 Intra-uteriene chirurgie voor spina bifida .................................................................................... 16
5.5 Intra-uteriene chirurgie voor congenitale hernia diafragmatica .................................................... 16
5.6 Intra-uteriene chirurgie: shunt ................................................................................................... 16
5.7 Intra-uteriene chirurgie: laser TTS............................................................................................... 16
6. Feticide – Selectieve reductie .......................................................................................................... 16
6.1 Introductie................................................................................................................................ 16
6.2 Etische & juridische overwegingen ............................................................................................. 16
6.3 Intra-uteriene chirurgie: cordocclusie ........................................................................................ 16
7. Abnormaal vruchtwater .................................................................................................................. 17
7.1 Ontstaan vruchtwater ............................................................................................................... 17
7.2 Productie van vruchtwater ......................................................................................................... 17
7.3 Rol van vruchtwater .................................................................................................................. 17
7.4 Vruchtwater meten ................................................................................................................... 17
7.5 Oligohydramnion ...................................................................................................................... 18
7.5.1 Placenta-insufficiëntie ........................................................................................................ 18
7.5.2 PPROm .............................................................................................................................. 18
7.5.3 Structureel ......................................................................................................................... 18
7.5.4 Maternaal........................................................................................................................... 18
7.5.5 Risico’s .............................................................................................................................. 18
7.6 Polyhydramnion ........................................................................................................................ 19
7.6.1Idiopathisch ........................................................................................................................ 19
7.6.2 Diabetes ............................................................................................................................ 19
7.6.3 Te weinig slikken ................................................................................................................. 19
7.6.4 Te veel plassen ................................................................................................................... 19
7.6.5 Risico’s .............................................................................................................................. 20
7.7 Conclusie ................................................................................................................................. 20
8. Foetale groei .................................................................................................................................. 21
8.1 foetale groeirestrictie ................................................................................................................ 21
8.1.1 Diagnose ............................................................................................................................ 21
8.1.2 Management ...................................................................................................................... 21
8.1.3 Hoe verlossen met IUGR ..................................................................................................... 23
8.2 Macrosomie ............................................................................................................................. 23
9. Operatieve verloskunde .................................................................................................................. 25
9.1 Incidentie & indicatie voor operatieve verlossing ......................................................................... 25
9.2 Kunstverlossing: vacuum – forceps ............................................................................................ 25
9.2.1 Vacuum ............................................................................................................................. 25
2
Medische aspecten
,ZWANGERSCHAP, ARBEID & BEVALLING 2
9.2.2 Forceps.............................................................................................................................. 27
9.3 Keizersnede .............................................................................................................................. 28
9.3.1 Indicatie ............................................................................................................................. 28
9.3.2 Techniek ............................................................................................................................ 28
9.3.3 Complicaties ...................................................................................................................... 29
9.3.4 Nazorg ............................................................................................................................... 29
9.4 Zeldzame complicaties ............................................................................................................. 29
9.4.1 Uterusruptuur .................................................................................................................... 29
9.4.2 Inversie .............................................................................................................................. 30
10. DIABETES en zwangerschap .......................................................................................................... 31
10.1 Diabetes ................................................................................................................................. 31
10.1.1 Definitie ........................................................................................................................... 31
10.1.2 Symptomen van diabetes .................................................................................................. 31
10.1.3 Soorten (4) ....................................................................................................................... 31
10.1.4 Verstoorde glucose tolerantie en nuchter glycemie ............................................................. 31
10.1.5 Voorafbestaande diabetes en zwangerschap ..................................................................... 31
10.1.6 Macrosomie ..................................................................................................................... 32
10.1.7 Polyhydramnion................................................................................................................ 32
10.1.8 Partus .............................................................................................................................. 32
10.1.9 Neonaat ........................................................................................................................... 32
10.1.10 Cave: maternale (diabetische) keto-acidose ..................................................................... 33
10.2 Zwangerschapsdiabetes.......................................................................................................... 33
10.2.1 Glucosemetabolisme ....................................................................................................... 33
10.2.2 Risicofactoren & gevolgen ................................................................................................. 34
10.2.3 Wat als je zwdiabetes niet behandelt? ............................................................................... 34
10.2.4 Diagnose .......................................................................................................................... 35
10.2.5 Zwangerschapsdiabetes wat nu? ....................................................................................... 36
10.2.6 Behandeling ..................................................................................................................... 36
10.2.7 Meten van de glycemie ...................................................................................................... 36
10.2.8 Medische aanpak van diabetes en zwangerschap ............................................................... 37
10.2.9 Verloskundige aanpak van diabetes en zwangerschap ........................................................ 37
10.2.10 Partus ............................................................................................................................ 37
10.2.11 Postpartum .................................................................................................................... 37
10.2.12 Borstvoeding .................................................................................................................. 37
10.3 Diabetes insipidus .................................................................................................................. 38
10.3.1 Symptomen ...................................................................................................................... 38
10.3.2 Oorzaak ........................................................................................................................... 38
3
Medische aspecten
, ZWANGERSCHAP, ARBEID & BEVALLING 2
10.3.3 Diagnose .......................................................................................................................... 38
4
Medische aspecten
INHOUD
1. Prenatale testen in het tweede en derde trimester ..............................................................................5
1.1 Introductie..................................................................................................................................5
1.2 Prenatale screening ....................................................................................................................5
1.3 Prenatale diagnostiek ..................................................................................................................5
2. Niet invasieve prenatale testen .........................................................................................................6
2.1 Beeldvorming .............................................................................................................................6
2.1.1 Echografie ............................................................................................................................6
2.1.2 MRI ......................................................................................................................................8
2.1.3 CT ........................................................................................................................................8
2.2 Rol van de vroedvrouw ................................................................................................................8
2.3 Genetische testen .......................................................................................................................9
2.3.1 NIPT (Niet-Invasieve Prenatale Test) ......................................................................................9
2.3.2 NIPD (Niet- invasieve Prenatale Diagnose) .............................................................................9
3. Invasieve testen ............................................................................................................................. 10
3.1 Chorionvillibiopsie .................................................................................................................... 10
3.2 Amniocentese .......................................................................................................................... 10
3.3 Cordocentese ........................................................................................................................... 11
3.4 Fetoscopie ............................................................................................................................... 11
3.4 Rol van de vroedvrouw .............................................................................................................. 12
4. Fetale autopsie .............................................................................................................................. 13
4.1 Wat? ........................................................................................................................................ 13
4.2 Wanneer? ................................................................................................................................. 13
4.3 Hoe? ........................................................................................................................................ 13
4.4 Waarom?.................................................................................................................................. 13
4.5 Minimaal invasieve fetale autopsie ............................................................................................ 13
4.6 Beeldvorming ........................................................................................................................... 14
4.6.1 Postmortem MRI ................................................................................................................. 14
4.6.2 Postmortem CT .................................................................................................................. 14
4.6.3 Postmortem echo ............................................................................................................... 14
4.7 Placenta ................................................................................................................................... 14
4.7.1 Indicaties voor onderzoek ................................................................................................... 14
4.7.2 Technieken voor onderzoek ................................................................................................. 15
5. Prenatale therapie .......................................................................................................................... 15
5.1 Introductie................................................................................................................................ 15
5.2 Transplacentaire behandeling ................................................................................................... 15
1
Medische aspecten
,ZWANGERSCHAP, ARBEID & BEVALLING 2
5.3 Intra-uteriene transfusie ............................................................................................................ 15
5.4 Intra-uteriene chirurgie voor spina bifida .................................................................................... 16
5.5 Intra-uteriene chirurgie voor congenitale hernia diafragmatica .................................................... 16
5.6 Intra-uteriene chirurgie: shunt ................................................................................................... 16
5.7 Intra-uteriene chirurgie: laser TTS............................................................................................... 16
6. Feticide – Selectieve reductie .......................................................................................................... 16
6.1 Introductie................................................................................................................................ 16
6.2 Etische & juridische overwegingen ............................................................................................. 16
6.3 Intra-uteriene chirurgie: cordocclusie ........................................................................................ 16
7. Abnormaal vruchtwater .................................................................................................................. 17
7.1 Ontstaan vruchtwater ............................................................................................................... 17
7.2 Productie van vruchtwater ......................................................................................................... 17
7.3 Rol van vruchtwater .................................................................................................................. 17
7.4 Vruchtwater meten ................................................................................................................... 17
7.5 Oligohydramnion ...................................................................................................................... 18
7.5.1 Placenta-insufficiëntie ........................................................................................................ 18
7.5.2 PPROm .............................................................................................................................. 18
7.5.3 Structureel ......................................................................................................................... 18
7.5.4 Maternaal........................................................................................................................... 18
7.5.5 Risico’s .............................................................................................................................. 18
7.6 Polyhydramnion ........................................................................................................................ 19
7.6.1Idiopathisch ........................................................................................................................ 19
7.6.2 Diabetes ............................................................................................................................ 19
7.6.3 Te weinig slikken ................................................................................................................. 19
7.6.4 Te veel plassen ................................................................................................................... 19
7.6.5 Risico’s .............................................................................................................................. 20
7.7 Conclusie ................................................................................................................................. 20
8. Foetale groei .................................................................................................................................. 21
8.1 foetale groeirestrictie ................................................................................................................ 21
8.1.1 Diagnose ............................................................................................................................ 21
8.1.2 Management ...................................................................................................................... 21
8.1.3 Hoe verlossen met IUGR ..................................................................................................... 23
8.2 Macrosomie ............................................................................................................................. 23
9. Operatieve verloskunde .................................................................................................................. 25
9.1 Incidentie & indicatie voor operatieve verlossing ......................................................................... 25
9.2 Kunstverlossing: vacuum – forceps ............................................................................................ 25
9.2.1 Vacuum ............................................................................................................................. 25
2
Medische aspecten
,ZWANGERSCHAP, ARBEID & BEVALLING 2
9.2.2 Forceps.............................................................................................................................. 27
9.3 Keizersnede .............................................................................................................................. 28
9.3.1 Indicatie ............................................................................................................................. 28
9.3.2 Techniek ............................................................................................................................ 28
9.3.3 Complicaties ...................................................................................................................... 29
9.3.4 Nazorg ............................................................................................................................... 29
9.4 Zeldzame complicaties ............................................................................................................. 29
9.4.1 Uterusruptuur .................................................................................................................... 29
9.4.2 Inversie .............................................................................................................................. 30
10. DIABETES en zwangerschap .......................................................................................................... 31
10.1 Diabetes ................................................................................................................................. 31
10.1.1 Definitie ........................................................................................................................... 31
10.1.2 Symptomen van diabetes .................................................................................................. 31
10.1.3 Soorten (4) ....................................................................................................................... 31
10.1.4 Verstoorde glucose tolerantie en nuchter glycemie ............................................................. 31
10.1.5 Voorafbestaande diabetes en zwangerschap ..................................................................... 31
10.1.6 Macrosomie ..................................................................................................................... 32
10.1.7 Polyhydramnion................................................................................................................ 32
10.1.8 Partus .............................................................................................................................. 32
10.1.9 Neonaat ........................................................................................................................... 32
10.1.10 Cave: maternale (diabetische) keto-acidose ..................................................................... 33
10.2 Zwangerschapsdiabetes.......................................................................................................... 33
10.2.1 Glucosemetabolisme ....................................................................................................... 33
10.2.2 Risicofactoren & gevolgen ................................................................................................. 34
10.2.3 Wat als je zwdiabetes niet behandelt? ............................................................................... 34
10.2.4 Diagnose .......................................................................................................................... 35
10.2.5 Zwangerschapsdiabetes wat nu? ....................................................................................... 36
10.2.6 Behandeling ..................................................................................................................... 36
10.2.7 Meten van de glycemie ...................................................................................................... 36
10.2.8 Medische aanpak van diabetes en zwangerschap ............................................................... 37
10.2.9 Verloskundige aanpak van diabetes en zwangerschap ........................................................ 37
10.2.10 Partus ............................................................................................................................ 37
10.2.11 Postpartum .................................................................................................................... 37
10.2.12 Borstvoeding .................................................................................................................. 37
10.3 Diabetes insipidus .................................................................................................................. 38
10.3.1 Symptomen ...................................................................................................................... 38
10.3.2 Oorzaak ........................................................................................................................... 38
3
Medische aspecten
, ZWANGERSCHAP, ARBEID & BEVALLING 2
10.3.3 Diagnose .......................................................................................................................... 38
4
Medische aspecten
