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Taken van de huisarts bij zwangerschap
In het eerste trimester moet uitgevraagd worden of de zwangerschap gewenst is of niet, of de zwangerschapsduur ingeschat kan worden, gebruik van medicatie en voorlichting. Foliumzuur moet gesuppleerd worden, alcohol en drugs moet vermeden worden, roken moet gestopt worden en groente moet goed gewassen worden. Rauw vlees wordt afgeraden en er moeten handschoenen gebruikt worden bij het tuinieren. Ongepasteuriseerde melkproducten moeten vermeden worden en er moeten geen geneesmiddelen gestart of gestopt worden zonder overleg van de arts. De verloskundige indicatielijst moet ingevuld en besproken worden en aan de hand daarvan moet besloten worden welke begeleiding vereist is. Er kan gescreend worden op trisomie 21, 13 en 18. Er wordt ook een bloedonderzoek gedaan tijdens het eerste trimester van de zwangerschap. Bij vrouwen met een Hb onder de grenswaarde moet de MCV bepaald worden. Foliumzuursuppletie wordt aanbevolen bij vrouwen met anemie. Verdere bijkomende ziektebeelden bij de zwangerschap kunnen een urineweginfectie, of endometritis zijn, misselijkheid en braken, schildklierfunctiestoornis. Wanneer sprake is van een te geringe inname van borstvoeding, een verminderde gewichtstoename en afvallen, een weinig geconcentreerde urine, lage spierspanning, verlaagde turgor en ingezonken fontanel moet geadviseerd worden om het kind vaker aan te leggen, te kolven en extra (kunst)voeding te geven. Wanneer sprake is van mastitis moet in de eerste 24 uur zo veel mogelijk gevoed worden om melkstase tegen te gaan. Er kan pijnstilling plaatsvinden in de vorm van kompressen na de voeding, paracetamol en NSAID. Er moet gestart worden met antibiotica wanneer er onvoldoende effect is.
NHG-standaarden - Geneeskunde - Thema: Zwangerschap, anticonceptie, geslachtsorganen
NHG-standaarden - Geneeskunde - Thema: Zwangerschap, anticonceptie, geslachtsorganen
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