University of Groningen
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1 University of Groningen Het inleiden van de baring : Een literatuuroverzicht en een exploratieve studie betreffende de simultane amniotomie en oxytocine-infusie Visser, Gerard Hille Adriaan IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 1978 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Visser, G. H. A. (1978). Het inleiden van de baring : Een literatuuroverzicht en een exploratieve studie betreffende de simultane amniotomie en oxytocine-infusie [S.n.] Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date:
2 STELLINGEN 1) In het derde trimester van de raviditeit vormen amniotomie en oxytocine-infusie (of prostaglandines), wanneer simultaan toegepast, de meest effectieve methode ter induktie van de baring. Oxytocine prevaleert vooralsnog boven prostaglandines. 2) Daar de foetale en ook de maternale morbiditeit stiigt wanneer de inleiding van de baring door amniotomie e oxytocine-infusie langer dan 12 uur geduurd heeft, zou een inleiding in principe binnen deze termiin beëindigd moeten zijn. Door gebruik te maken van een geschikte portio-score zijn met een redelijke zekerheid de patiënten aan te geven bij wie een langdurige inleiding te verwachten is. 3) Wanneer 18 uur na het begin van een inleiding door simultane amniotomie en oxytocine-infusie de actieve fase van de baring nog niet bereikt is, dient tot sectio Caesarea besloten te worden. 4) Bij de combinatie van foetale onderontwikkeling en een deceleratief ante partum cardiotocogram, verdient een primaire sectio Caesarea voorkeur boven een inleiding van de baring door simultane amniotomie en oxytocine-infusie. 5) Bij iedere potentieel zwangere dient zo vroeg mogelijk een zwangerschapstest verricht te worden, zonder dat daaraan voor haar financiële consequenties verbonden zijn. 6) Het verdient voorkeur om in het kader van de opleiding tot obstetricus/gynaecoloog, het B-opleidingsjaar gesplitst in twee verschillende ziekenhuizen te doorlopen. 7) Amniocentese dient door de echoscoop of op geleide van een direkt voor de punctie verricht echoscopisch onderzoek te geschieden.
3 8) Dat het aantal in 1977 in Nederland geïsoleerde woningen 40% lager lag dan in 1975 en 1976, nadat in 1976 de overheidssubsidie voor woningisolatie aanzienlijk verlaagd werd, vormt het duidelijkste bewijs van het feit dat de Engelse diagnose van de 'Hollandse ziekte' althans ten dele juist is en dat de Nederlandse regering het energiebesparingsbeleid tot nu toe zwaar verziekt heeft. 9) Nu meer en meer kinderen met cystische fibrose de volwassen leeftijd bereiken, dient men er zich van bewust te zijn dat vrouwelijke patiënten, in tegenstelling tot de mannelijke, in principe fertiel zijn. Adequate anticonce tie en zorgvuldige afweging van de risico's van een graviditeit zijn een vereiste en bij een vitale capaciteit van minder dan 50% en/of pulmonale hypertensie moet een zwangerschap met klem worden afgeraden. G.H.A. Visser et al. Europ.J.Obstet.Gynecol.Reproèi.Biol., 7:109, ) Het beluisteren van de foetale hartactie bij iedere prenatale controle, middels een stethoscoop, is van weinig meer dan psychologische betekenis. 11) Bij een postoperatieve urineretentie is het meer zinvol een alpha-adrenerge blokker (als phenoxybenzamine) toe te dienen dan een parasympaticomimetrium (als carbachol) ; een adrenerge blokker verdient in het algemeen de voorkeur boven een catheterisatie. 12) Het is te overwegen om bij een planocellulair vulvacarcinoom met een diameter van minder dan twee cm een excisiebiopsie te verrichten en bij een invasie van vijf mm of minder en ontbreken van celanaplasie en/of vasculaire infiltratie, de verdere behandeling te beperken tot een radicale vulvectomie, zonder dat daarbij een bilaterale lymfadenectomie verricht wordt. R.T. Parker et al. Am.J.Obstet.Gynecol., 123:349, ) De enige exponentiële groei die milieu- en energiebewuste Nederlanders weinig zorgen hoeft te baren, is die van het ledental van D'66.
4 14) Het zou goed zijn wanneer tij dens het a. s. wereldkampioenschap voetbal de rode kaarten vooral aan de bezoekers van de eretribune zouden worden uitgedeeld. Stellingen behorend bij het proefschrift 'Het inleiden van de baring' - G. H. A. Visser, 7 juni 1978.
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