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Samenvatting verloskunde blok 5: Bloed en infecties
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Deze samenvatting is geschreven door een student van de Academie Verloskunde Maastricht en omvat alle globale leerdoelen van blok 5.
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Samenvatting blok 5Bloed en infecties
Inhoudsopgave
1 Bloedgroepen -en resussysteem ...................................................................................................................4
1.1 Erytrocytenimmunisatie ................................................................................................................................ 5
1.2 Screening erytrocytenimmunisatie ................................................................................................................ 6
1.3 Preventie erytrocytenimmunisatie en beleid erytrocytenimmunisatie .......................................................... 7
Beleid en preventie anti-D .............................................................................................................................. 7
Beleid overige irregulaire antistoffen ............................................................................................................. 8
2 Anemie en hemoglobinopathieën ................................................................................................................9
2.1 Rode bloedcellen (erytrocyten) ...................................................................................................................... 9
2.2 Hemoglobine ............................................................................................................................................... 10
2.3 Fysiologische anemie ................................................................................................................................... 11
2.4 Anemie ........................................................................................................................................................ 11
Ijzergebreksanemie....................................................................................................................................... 12
Megaloblastaire anemie ............................................................................................................................... 12
Hemoglobinopathieën (HbP) ........................................................................................................................ 13
MCV .............................................................................................................................................................. 15
3 Bloedverlies in het eerste trimester ........................................................................................................... 16
3.1 Miskraam .................................................................................................................................................... 16
Herhaalde miskraam ..................................................................................................................................... 17
3.2 Gestational Trophoblastic Disease (GTD). Mola hydatidosa ....................................................................... 17
3.3 Extra-uteriene graviditeit ............................................................................................................................ 18
3.4 Gynaecologische oorzaken .......................................................................................................................... 19
Vaginitis ........................................................................................................................................................ 19
Cervicitis........................................................................................................................................................ 19
3.5 Het beleid bij bloedverlies ........................................................................................................................... 19
Diagnose en behandeling EUG ...................................................................................................................... 22
Behandeling mola zwangerschap ................................................................................................................. 22
4 Bloedverlies in het tweede en derde trimester ........................................................................................... 24
4.1 Abruptio (solutio) placentae ........................................................................................................................ 24
4.2 Placenta preavia .......................................................................................................................................... 26
4.3 Vasa preavia ................................................................................................................................................ 29
4.4 Overige oorzaken ........................................................................................................................................ 30
5 Bloedverlies post partum ........................................................................................................................... 31
6 Shock ......................................................................................................................................................... 42
6.1 Hypovolemische shock................................................................................................................................. 43
6.2 Distributieve shock ...................................................................................................................................... 44
, 6.3 Cardiogene shock ........................................................................................................................................ 47
6.4 Obstructieve shock ...................................................................................................................................... 47
7 Stollingsstoornissen ................................................................................................................................... 47
7.1 hemostase ................................................................................................................................................... 47
Hemostase in de zwangerschap.................................................................................................................... 49
7.2 Trombofilie .................................................................................................................................................. 49
Trombose in de zwangerschap ..................................................................................................................... 50
Protrombinemutatie ..................................................................................................................................... 51
Factor V Leiden ............................................................................................................................................. 51
Proteïne C deficiëntie ................................................................................................................................... 52
Proteïne S deficiëntie .................................................................................................................................... 52
Antitrombinedeficiëntie ............................................................................................................................... 52
Antifosfolipidensyndroom (APS) ................................................................................................................... 53
Beleid trombofilie ......................................................................................................................................... 53
7.3 Verhoogde bloedingsneiging ....................................................................................................................... 54
Defecten in de primaire hemostase.............................................................................................................. 54
Defecten in de secundaire hemostase .......................................................................................................... 58
7.4 Diagnostiek bij de hemostase ...................................................................................................................... 59
7.5 FNAIT ........................................................................................................................................................... 59
7.6 Vitamine-K-deficiëntie ................................................................................................................................. 61
8 Hypertensieve aandoeningen in de zwangerschap ..................................................................................... 62
8.1 De bloeddrukregulatie ................................................................................................................................. 62
...................................................................................................................................................................... 64
Bloeddrukregulatie tijdens de zwangerschap ............................................................................................... 64
8.2 Hypertensieve aandoeningen ...................................................................................................................... 65
Chronische hypertensie ................................................................................................................................ 65
Zwangerschapshypertensie .......................................................................................................................... 66
Pre-eclampsie ............................................................................................................................................... 66
HELLP ............................................................................................................................................................ 68
8.3 Beleid hypertensieve aandoeningen....................................................................................................... 69
9 Menstruatiestoornissen ............................................................................................................................. 72
9.1 De menstruatiecyclus .................................................................................................................................. 72
9.2 Cyclusstoornissen ........................................................................................................................................ 73
Ziektebeelden ............................................................................................................................................... 76
10 Buikpijn .................................................................................................................................................... 84
10.1 Fysiologische veranderingen in de buik en onderzoek tijdens de zwangerschap ...................................... 85
10.2 De anamnese en het onderzoek ................................................................................................................ 86
10.3 Oorzaken buikpijn...................................................................................................................................... 87
Gynaecologische oorzaken ........................................................................................................................... 88
Niet-gynaecologische oorzaken .................................................................................................................... 91
11 Koorts in het kraambed ............................................................................................................................ 98
11.1 Infectie van vulva en perineum ................................................................................................................. 98
11.2 Endometritis .............................................................................................................................................. 98
11.3 Salpingitis en pelveoperitonitis.................................................................................................................. 99
, 11.4 Parametritis ............................................................................................................................................... 99
11.5 Sepsis ....................................................................................................................................................... 100
11.6 Borstontsteking (mastitis puerperalis) .................................................................................................... 100
11.7 Mastitis abscedens .................................................................................................................................. 101
12 Ongeplande/ ongewenste zwangerschap en APLA.................................................................................. 102
12.1 De intake ................................................................................................................................................. 102
Medicamenteuze of instrumentele behandeling ....................................................................................... 103
Pijnstilling .................................................................................................................................................... 103
Risico’s ........................................................................................................................................................ 104
12.2 Medicamenteuze afbreking ..................................................................................................................... 104
12.3 Instrumentele afbreking .......................................................................................................................... 105
12.4 Foetale afwijkingen ................................................................................................................................. 106
Vruchtwaterpunctie .................................................................................................................................... 106
Vlokkentest ................................................................................................................................................. 106
12.5 Wet afbreking zwangerschap (WAZ) ....................................................................................................... 107
Bedenktijd, noodsituatie en rapportage ..................................................................................................... 107
Toegestane zwangerschapsduur................................................................................................................. 107
Begraven en cremeren................................................................................................................................ 108
Minderjarigen ............................................................................................................................................. 108
Kosten ......................................................................................................................................................... 108
12.6 Morning after pil ..................................................................................................................................... 108
12.7 De rol van een verloskundige bij een ongewenste zwangerschap........................................................... 108
12.8 Adoptie .................................................................................................................................................... 109
13 maternale sterfte ................................................................................................................................... 110
14 intercollegiale toetsing ........................................................................................................................... 111
14.1 Wetten rondom kwaliteit van zorg.......................................................................................................... 111
14.2 Continuïteit van zorg ............................................................................................................................... 114
14.3 Supervisie, intervisie en MIO ................................................................................................................... 115
14.4 De LVR ..................................................................................................................................................... 117
14.5 Perinatale audit ....................................................................................................................................... 119
14.6 Het verloop van een klacht ...................................................................................................................... 120
15 Bijlagen .................................................................................................................................................. 122
Bijlage 1, Beleid IEA ......................................................................................................................................... 122
Bijlage 2, beleid anemie .................................................................................................................................. 123
Bijlage 3, beleid hypertensieve aandoening .................................................................................................... 125
, 1 Bloedgroepen -en resussysteem
Er zijn heel veel verschillende bloedgroepstelsels. De bekendste zijn: AB0 en resus bloedgroepen.
Maar daarnaast heb je ook nog stelsels zoals Kell, Duffy, Kidd etc.
De aan- of afwezigheid van specifieke oppervlakteantigenen op de plasmamembranen van
erytrocyten bepaalt je bloedgroep. Antigenen zijn stoffen (meestal eiwitten) die een immuunreactie
kunnen veroorzaken. De membranen van alle cellen in het lichaam bevatten oppervlakteantigenen.
Oppervlakteantigenen worden ook wel agglutinogenen genoemd. Antistoffen worden agglutininen
genoemd.
Antistoffen reageren op antigenen van een andere bloedgroep. Het plasma van iemand met
bloedgroep A bevat antistoffen tegen antigeen B in het bloed en andersom. Iemand met bloedgroep
AB heeft geen antistoffen tegen antigenen van zowel A als B (universele ontvanger). Iemand met
bloedgroep O heeft zowel antistoffen tegen A als tegen B (universele donor).
Als iemand bloed krijgt van een andere bloedgroep, komen de antistoffen in het plasma van de
ontvanger en vindt er een kruisreactie plaats. De lichaamsvreemde erytrocyten gaan samenklonteren
als gevolg van de binding van antigenen en antistoffen, dit wordt agglutinatie genoemd. Vervolgens
worden de erytrocyten afgebroken of ondergaan hemolyse.
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