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Cordocentesis using the combined technique.

B Petrikovsky·E Schneider·J Wyse
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CordocentesisFemaleFetal DeathHumansPregnancyUltrasonography, Doppler, ColorLetter

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B Petrikovsky, E Schneider, J Wyse. 1997. Cordocentesis using the combined technique.. https://doi.org/10.1002/(sici)1097-0223(199708)17%3A8%3C788%3A%3Aaid-pd136%3E3.0.co%3B2-i

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The cost effectiveness of empiric intravenous immunoglobulin for the antepartum treatment of fetal and neonatal alloimmune thrombocytopenia.

OBJECTIVE: The purpose of this study was to compare the cost effectiveness of empiric intravenous immunoglobulin (IVIG) with that of fetal blood sampling-indicated treatment for the antepartum care of fetal and neonatal alloimmune thrombocytopenia. STUDY DESIGN: We developed a decision analysis model to compare the cost effectiveness of 2 strategies for treatment of pregnancies in women with a history of fetal and neonatal alloimmune thrombocytopenia and an at-risk fetus: 1) IVIG and corticosteroids as indicated by fetal platelet levels determined by fetal blood sampling (FBS); and 2) empiric IVIG. In the first strategy, FBS is used to measure fetal platelets at 24 weeks of gestation and repeated 6 weeks later to guide pharmacotherapy. In the second strategy, weekly IVIG is empirically administered from 24 weeks' to 37 weeks' gestation. The main outcome measure was the marginal cost per quality-adjusted life years (QALY) gained. RESULTS: For every 1000 women with a fetus at risk for recurrent alloimmune thrombocytopenia, empiric therapy, compared with FBS-indicated treatment, decreases perinatal deaths from 31.7 to 11.8 while increasing the number of infants with long-term neurologic deficits from 6.1 to 9.6. These health outcomes translate to 382 QALYs gained with empiric therapy and a cost effectiveness ratio of dollar 32,747 per QALY favoring empiric therapy. In the sensitivity analysis, empiric therapy was not cost effective when the rate of perinatal ICH exceeded 28%. CONCLUSION: Empiric IVIG therapy is a cost-effective strategy for the treatment of women at risk for fetal and neonatal alloimmune thrombocytopenia when the rate of perinatal ICH is less than 28%.

Cordocentesis↗
PubMed2005

Experience of the first 50 cases of cordocentesis after training with model.

OBJECTIVE: To describe the experience of the first 50 cases of cordocentesis after practicing with cordocentesis model. MATERIAL AND METHOD: Cordocentesis model consisted of a water-filled transparent glass box covered with a rubber latex sheet with or without piece of pork skin. A 30-cm umbilical cord filled with mercurochrome, hung inside the container, was the target for the puncture. As in real practice, the trainee had to try to aspirate the red mercurochrome from the umbilical cord using a spinal needle under ultrasonographic guidance. After practicing with the model for 300 procedures, the trainee was allowed to perform cordocentesis on pregnant women at gestational age of 18-22 weeks by herself under expert supervision with time limit of 30 minutes. The procedure not successful in 30 minutes was considered failure. Duration of procedures, placental site, puncture site, and related complications were recorded for subsequent analysis. RESULTS: After practicing with model for 300 procedures, real cordocentesis was performed by the trainee on 50 pregnant women. The success rate in obtaining fetal blood within 30 minutes was 100%. Most of them (92%) took less than 10 minutes to complete the procedure. Puncture site bleeding and fetal bradycardia were the most common immediate complications, found in 30% and 8% respectively, and spontaneously resolved within few minutes. CONCLUSION: Without any fetal and maternal jeopardy, cordocentesis model is simple, inexpensive but highly effective for the beginner to gain their experience, skill and prepare themselves for cordocentesis with confidence. However, the reduction of fetal loss rate with the training program remains to be further tested.

Cordocentesis↗
PubMed2004

Longitudinal data for intrauterine levels of fetal IGF-I and IGF-II.

OBJECTIVE: An increasing body of evidence supports a major role for the insulin-like growth factors (IGFs) in the control of human fetal growth. Individual data at various times of pregnancy suggest that IGF-I and IGF-II levels remain stable up to the 33rd week of pregnancy. Thereafter, both increase to reach values 2-3 times higher at term. In order to provide an accurate reflection of fetal IGFs in utero, we sampled fetal blood from the umbilical cord by cordocentesis. METHODS: We measured IGF-I and IGF-II in 12 fetuses longitudinally for up to 5 times between the 21st week of gestation and delivery. RESULTS: All patients showed a progressive increase in IGF-I and IGF-II levels. Data determined during different time intervals (before 29th, 29th to 32nd, after 32nd week) were compared and the main increase was found after the 32nd week. The median for IGF-I before the 29th week was 33.5 ng/ml (range 19-40.5) and increased to 41 ng/ml (32-59) between the 29th to 32nd and further to 54.1 ng/ml (range 17-70) thereafter. During the same time interval, the median for IGF-II increased from 217 ng/ml (86-326) to 349 ng/ml (227-467). In 7 patients, cord blood after delivery was available. For IGF-II a further increase was consistently found after birth (from 282 ng/ml (175-511) to 393 ng/ml (297-513)), whereas only 2 fetuses showed an increase in IGF-I. CONCLUSION: We conclude that in human fetuses, IGF-I and IGF-II levels increase longitudinally throughout pregnancy. Therefore, they may become important markers of healthy fetal development.

Cordocentesis↗