Thema 7: Voortplanting. Een complete samenvatting van alle tentamenstof!
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Thema 7 Voortplanting
Établissement
Rijksuniversiteit Groningen (RuG)
Op aanraden van mijn medestudenten verkoop ik nu mijn samenvattingen! In deze samenvatting maak ik veel gebruik van afbeeldingen, tabellen en opsommingen. Hierdoor hoef je geen lange lappen saaie en ingewikkelde tekst te lezen. In deze samenvatting staat alle stof van de boeken, colleges en leerdoe...
,Content
Week 25: Sex ........................................................................................................................................... 6
“Doctor, we have a sexual problem” .................................................................................................. 6
Case 1 .............................................................................................................................................. 6
Case 2 .............................................................................................................................................. 7
How sex works: sexology..................................................................................................................... 9
Why do we have sex ........................................................................................................................ 9
Models of sexual response .............................................................................................................. 9
Genital vasocongestion ................................................................................................................. 11
Sexual dysfunction......................................................................................................................... 12
Ejaculation problems ..................................................................................................................... 13
Erection problems ......................................................................................................................... 13
Low desire ..................................................................................................................................... 13
Genito-pelvic pain penetration disorder ....................................................................................... 13
Ageing ............................................................................................................................................ 14
Sexually transmitted diseases ........................................................................................................... 15
Organisation of sexual health care and STDs .................................................................................... 19
Epidemiology ................................................................................................................................. 19
Sexual problems ............................................................................................................................ 19
Sexual violence: a hidden pandemic ............................................................................................. 20
Sexology in the first line .................................................................................................................... 21
SOA in the second line: STD care in the hospital............................................................................... 24
When to think about syphilis and HIV ........................................................................................... 24
HIV ................................................................................................................................................. 26
Endometriosis and hormones ........................................................................................................... 27
Gender dysphoria .............................................................................................................................. 30
Male-to-female.............................................................................................................................. 30
Female-to-male ............................................................................................................................. 31
Week 26: Pregnancy, childbirth and the postnatal period ................................................................... 32
Introduction....................................................................................................................................... 32
Organisation of maternity care in the Netherlands ...................................................................... 32
Early pregnancy ............................................................................................................................. 33
First appointment: at the midwife or GP ...................................................................................... 33
Information and preparation for labour ....................................................................................... 35
Introduction to reproductive health ................................................................................................. 37
Safe motherhood........................................................................................................................... 37
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, Maternal adaption............................................................................................................................. 38
Embryonic development and placentation ....................................................................................... 41
The placenta .................................................................................................................................. 41
Embryonic development ............................................................................................................... 43
Foetal monitoring .............................................................................................................................. 44
Ante partum (during pregnancy) ................................................................................................... 44
Foetal monitoring during labour ................................................................................................... 46
Complications during the first trimester ........................................................................................... 47
Miscarriage .................................................................................................................................... 47
Ectopic pregnancy ......................................................................................................................... 47
Trophoblast disease ...................................................................................................................... 48
Midwifery led care............................................................................................................................. 50
Pictures of birth ............................................................................................................................. 50
Normal labour and delivery............................................................................................................... 52
Anatomy ........................................................................................................................................ 52
Lie, presentation, attitude and position ........................................................................................ 53
The first stage of labour ................................................................................................................ 55
The second stage of labour ........................................................................................................... 57
The third stage of labour ............................................................................................................... 58
The fourth stage of labour............................................................................................................. 59
Induction and augmentation of labour ............................................................................................. 60
Induction of labour ........................................................................................................................ 60
Augmentation of labour ................................................................................................................ 60
Partogram: when to take action.................................................................................................... 61
Postnatal period and puerperium care ............................................................................................. 62
Lactation ........................................................................................................................................ 63
Postnatal care ................................................................................................................................ 63
Week 27: Foetal development: too small ............................................................................................. 65
Prenatal screening and diagnosis ...................................................................................................... 65
Screening for genetic disorders ..................................................................................................... 66
Gestational problems: Preterm birth ................................................................................................ 69
Foetal growth and monitoring .......................................................................................................... 71
Large for gestational age (LGA) ..................................................................................................... 71
Small for gestational age (SGA) ..................................................................................................... 71
Blood group antagonism and blood disorders .................................................................................. 75
Blood group ABO ........................................................................................................................... 75
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, Rhesus D ........................................................................................................................................ 75
Blood disorders: Sickle cell ............................................................................................................ 77
Blood disorders: Thalassemia ........................................................................................................ 77
Vaginal bleeding during second and third trimester......................................................................... 78
Placenta previa .............................................................................................................................. 78
Placental abruption ....................................................................................................................... 79
Vasa previa .................................................................................................................................... 80
Uterine rupture ............................................................................................................................. 81
Genital embryology ........................................................................................................................... 82
Primordia and timeline .................................................................................................................. 82
Cloaca and urogenital sinus........................................................................................................... 85
Gonads and ducts indifferent ........................................................................................................ 86
Gonads and ducts differentiation.................................................................................................. 87
External genitalia ........................................................................................................................... 88
Anatomy ............................................................................................................................................ 92
Week 28: Abnormal pregnancy and delivery, Caesarean Section ...................................................... 103
Complicated pregnancy ................................................................................................................... 103
Appendicitis ................................................................................................................................. 103
Placental problems ...................................................................................................................... 103
COVID-19 ..................................................................................................................................... 103
Obesity......................................................................................................................................... 103
Complicated delivery ................................................................................................................... 104
Postnatal depression ................................................................................................................... 106
Postnatal psychosis ..................................................................................................................... 106
Maternal mortality ...................................................................................................................... 106
Perinatal morbidity and mortality ............................................................................................... 107
Operative delivery and caesarean section ...................................................................................... 108
Vacuum ........................................................................................................................................ 108
Forceps ........................................................................................................................................ 109
Caesarean section ....................................................................................................................... 109
Hypertensive disorders of pregnancy ............................................................................................. 111
Pregnancy induced hypertension: PIH ........................................................................................ 111
Pre-eclampsia: PE ........................................................................................................................ 111
Hemolysis, elevated liver enzymes and low platelets: HELLP ..................................................... 113
Complications during third stage of labour ..................................................................................... 114
Postpartum haemorrhage: PPH .................................................................................................. 114
,Week 25: Sex
“Doctor, we have a sexual problem”
Case 1
Details:
• Male, 30 years
• Married for 4 years
• He and his wife want children, but he is not able to have intercourse with his wife.
Questions:
• How long has this been happening: since a couple a months
• Why are you not able to have intercourse: he doesn’t know. He tries, but it doesn’t
work.
• What doesn’t work: he cannot get an erection. Sometimes it gets hard but then it
goes away.
• Are you experiencing stress in your personal life: yes, he has a busy job. Also the
situation in the world.
• Any other complaints: he is constipated.
• Medical history: no previous problems.
• Do you get along with you partner: yes.
• Do you already have children: two.
• Current medication: no.
Additions:
• Erectile function is good upon awakening.
• Masturbation without any problems.
• No micturition problems
• Intimacy and sexual activity is less frequent.
• Difficulties to conceive in the past: put pressure on the relation with his wife and
family.
• The patient does not feel “sexy” at the moment, because he cannot “make it work”.
He feels like he fails as a man. He does not enjoy sex.
• No psychiatric diagnoses
• Personality: active, religious, serious, somewhat neurotic
• No negative sexual experiences or physical abuse
• Good contact with family
• Relationship: second partner. Shy, she has experienced trouble conceiving in the
past.
Differential diagnosis:
Erectile dysfunction = the inability to achieve or maintain an erection long enough to engage
in sexual intercourse
• Performance anxiety
• Limited erotic repertoire
• Spectators role
• Inadequate sexual stimulation
• Difference in desire
• Unrealistic expectations
In the absence of physical/organic problems: refer to sex therapy by sexologist
→ goal = reset the system
Case 2
Details :
• 29 year old female
• Married for 3 years
7
, • Wants to have children, but doesn’t get pregnant
Questions:
• How long have they been trying: since the beginning.
• Frequency: has dropped. At the beginning the tried a lot but it declined.
• Children already: no children.
• Have you already succeeded to have intercourse: no. It feels like there is a physical
wall. Each attempt is painful.
• Do you use tampons: yes. It is not pleasant, but she can insert the tampon.
• Have you every had intercourse with someone else: no.
• Do you have regular menstruations: yes.
• Are you on contraception: no.
• Medication: no.
• Sexual response = normal.
• Masturbation: yes. Masturbation is normal.
• Strong religion.
• The pain is superficial.
• Lubrication is normal.
• The patient is able to orgasm.
Additions:
• No psychiatric diagnosis
• Regular cycle
• Micturition: twice per hour, squeezes to void, cystitis
• Defection: twice a week, painful
• No negative sexual experiences or physical abuse
• Personality: perfectionist
• Family: both parents, one brother, good contact
• Relationship: first partner, 5 years, understanding partner
• No daily life troubles, works 32 hours a week as management secretary
Physical examination: only what is necessary
• Speculum examination
• Pelvic floor examination: overactive pelvic floor muscles
• External examination: positive touch test (redness at the perineum) + no anatomic
abnormalities
Differential diagnosis:
Vaginismus: it is nearly impossible to enter anything
Dyspareunia: persistent recurrent pain with vaginal entry = final diagnosis
→ due to overactive pelvic floor
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