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PubMed2003

[Correlation between cordocentesis performed during pregnancy and premature delivery].

OBJECTIVES: Cordocentesis is a procedure used to obtain fetal blood sample or to perform an intrauterine therapy. The cordocentesis is performed to determine the blood group, blood cell counts, fetus karyotype, intrauterine infection, level of 17-OH progesterone and fetus renal secretion. Access to the umbilical vein is possible from the 16-18th week of gestation. DESIGN: The aim of our study was to determine the impact of cordocentesis on the premature delivery. MATERIAL AND METHODS: Authors have analysed the course of gestation and delivery in all the cases with at least one cordocentesis carried out in the Department of Obstetrics in Gdańsk in 1991-2002. The group of 145 pregnant women was analysed. In this group 199 cordocenteses were performed. In 31 cases there was a premature delivery which was not a complication of cordocentesis. The duration of pregnancies in each group was compared to the control group--a total of 1657 patients who gave births in the Institute of Obstetrics and Gynecology in 1998. For statistical analysis of the results the T-Student test was used with the significance level p = 0.05. RESULTS: The mean duration of pregnancy in the control group was 40 +/- 2.47 weeks (from 23 to 45), in the group of patients after cordocentesis--33.97 +/- 4.68 weeks (from 23 to 42)--no statistical difference was found. In the group of patients with lethal malformation of foetus the induction of delivery was performed in the 30.97 +/- 4.66 week of gestation (from 23rd to 41st)--statistical difference to the group of all patients after cordocentesis. In cases with only diagnostic cordocentesis the delivery took place in 36.85 +/- 2.60 weeks of gestation and in the group with fetal blood transfusions the mean duration of pregnancy was 35.36 +/- 3.72 weeks. The incidence of the premature deliveries in the control group was 7.18% and in the group of patients after cordocentesis--72.46%--there is significant difference between these two groups. The cesarean section was performed in the control group in 23.60% and in 36.23% in the group of patients with performed cordocentesis. CONCLUSIONS: The intrauterine transfusions during cordocentesis do not influence the term of delivery. The term of delivery after the diagnostic and therapeutic cordocenteses does not statistically differ from the term of delivery in the control group. The cordocentesis (the result of blood tests) allows to determine the need of induction of delivery. It gives better prognosis for the newborn.

Cordocentesis↗

PubMed2005

Fetal heart rate response to cordocentesis and pregnancy outcome: a prospective cohort.

OBJECTIVE: To evaluate fetal cardiac response to cordocentesis and whether such changes may affect pregnancy outcome. METHODS: 117 singleton pregnant women requiring percutaneous trans-abdominal cordocentesis were prospectively included. Fetal heart rate was continuously evaluated by ultrasound for 1 min after completion of cordocentesis and intermittently for 20 min more. Fetal and pregnancy outcomes were analyzed by grouping fetal cardiac response to cordocentesis into bradycardia, normal heart rate and tachycardia groups. RESULTS: Women included in the study were 30.5+/-4.0 years old and had a gestational age of 23.7+/-2.0 weeks. Fetal blood sample obtained by cordocentesis was 3.1+/-0.8 ml. Fetal heart rate before cordocentesis was 149+/-8 beats per minute (bpm), ranging from 130 to 169 bpm. Fetal heart rate post-cordocentesis was 145+/-30 bpm (from 32 to 175 bpm). The incidence of bradycardia and tachycardia was 10.3% (n=12) and 6.0% (n=7), respectively. Fetal heart rate returned to normal levels in all cases at <or=5 minutes post-cordocentesis. In the tachycardia group, 6 cases had normal pregnancy outcome and one patient was lost to follow-up. In the bradycardia group, we observed two pregnancy terminations, one patient was lost to follow-up and nine were normal outcomes. In the group with normal heart rate (n=98), we observed one intrauterine fetal death, nine adverse fetal outcomes, eight pregnancy terminations and nine patients were lost to follow-up. CONCLUSIONS: Transient fetal tachycardia and bradycardia were uncommon and were not associated with adverse fetal or pregnancy outcomes.

Adult↗

PubMed1993

The effect of cordocentesis on umbilical and middle cerebral artery blood flow velocity waveforms.

OBJECTIVE: To investigate the effect of cordocentesis on the umbilical and fetal cerebral circulation. DESIGN: Cross sectional study. SETTING: Department of Obstetrics and Gynaecology, Regional Referral Centre for Fetal Medicine, Klagenfurt Hospital, Austria. SUBJECTS: Thirty pregnant women undergoing diagnostic cordocentesis at 18 to 38 weeks' gestation. INTERVENTIONS: The pulsatility index (PI) in the umbilical artery and fetal middle cerebral artery was measured by pulsed Doppler ultrasound before and immediately after cordocentesis. MAIN OUTCOME MEASURES: Change in umbilical artery PI and middle cerebral artery PI. RESULTS: Cordocentesis was associated with a significant decrease in both umbilical artery PI (median -0.18, range -2.21 to 1.5, P < 0.004) and middle cerebral artery PI (mean -0.15, SD 0.32, P < 0.03) and the decrease in umbilical artery PI was most marked when cordocentesis was performed transplacentally. In four cases, there were absent or reversed frequencies at the end of diastole (EDF) in the umbilical artery before cordocentesis, and in all cases there were positive EDF after the procedure. In contrast, one of the 26 cases with positive EDF developed reversed EDF following the procedure. CONCLUSIONS: Acute alterations in the waveforms from both the umbilical and fetal cerebral circulation can be induced by cordocentesis. The decrease in resistance in the fetoplacental circulation could be attributed to the release of vasodilators, and the increase in resistance observed in some cases could be secondary to arterial vasospasm. Better understanding of the underlying mechanisms might help in making cordocentesis a safer procedure.

Blood Flow Velocity↗

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↗

PubMed2006

Efficacy and safety of cordocentesis for prenatal diagnosis.

OBJECTIVE: To assess the efficacy and safety of diagnostic cordocentesis. METHODS: Between January 1991 and May 2004, 2,010 cordocentesis were performed in the outpatient setting in 2,010 women with singleton pregnancies. A fixed needle guide and a 22-gauge percutaneous needle were used and no more than 2 attempts were allowed at 1 visit. In most cases, the umbilical vein was the target vessel. The results of each procedure and pregnancy outcomes were recorded and analyzed. RESULTS: The most frequent indication for cordocentesis was risk of severe thalassemia (59.0%), followed by a need for rapid karyotyping (30.0%). Most of the procedures (97%) were performed in the free cord loop and the remaining at the cord insertion. The overall success rate was 98.4%, with 80.0% of the successful procedures performed at the first needle insertion and the remaining 20% at the second insertion. Transient bleeding was observed at the puncture site in 19.8% of cases and transient fetal bradycardia in 4.9% of cases. The total fetal loss and cordocentesis-related loss rates within 2 weeks of cordocentesis were 2.7% and 1.0%, respectively, before 24 weeks of gestation and 1.9% and 0.8% after 24 weeks. The other obstetric complications were unremarkable. CONCLUSIONS: Cordocentesis is a simple, safe, and reliable procedure for prenatal diagnosis.

Adult↗

PubMed1996

Release of vasoactive agents during cordocentesis: differences between normally grown and growth-restricted fetuses.

OBJECTIVE: The purpose of this study was to evaluate whether cordocentesis is associated with the release of vasoactive substances and whether there are differences between normally grown and growth-restricted fetuses. STUDY DESIGN: 6-Keto-prostaglandin F1 alpha (the stable metabolite of prostacyclin), endothelin-1, and cyclic guanosine monophosphate were measured in fetal blood at the beginning and closing of cordocentesis in 30 normally grown fetuses and 25 growth-restricted fetuses. This latter group was characterized by abnormal Doppler index values in umbilical artery and middle cerebral artery, suggestive of chronic hypoxemia as the causative factor of the impaired growth. In six growth-restricted fetuses bradycardia occurred at the end of the procedure. Umbilical artery pulsatility index was measured by Doppler ultrasonography immediately before and after the procedure. RESULTS: The median interval between the two blood samples obtained by cordocentesis was 90 seconds (range 60 to 320 seconds). During this interval a significant rise of 6-keto-prostaglandin F1 alpha (p < or = 0.0001) and endothelin-1 (p = 0.03) was evidenced in normally grown fetuses. The increase in 6-keto-prostaglandin F1 alpha was significantly related (r = 0.52, p = 0.002) to the fall of umbilical artery pulsatility index occurring after the procedure. In growth-restricted fetuses cordocentesis induced a marked increase of endothelin-1 (p = 0.0002), which was significantly related to the severity of acidosis (r = 0.52, p = 0.018), whereas no modifications were evidenced for the other agents tested. The increase of endothelin-1 was higher in those growth-restricted fetuses showing bradycardia at the end of the procedure than in growth-restricted fetuses that did not (p = 0.04). The variations of the vasoactive substances assayed were not significantly related to the type of procedure (transamniotic or transplacental), the amount of blood aspirated during the procedure, the interval elapsing between the first and second samples, the gestational age at which the procedure was performed, and the degree of fetal smallness. CONCLUSION: Cordocentesis induces the rapid release of vasoactive substances and the effect differs between normally grown and growth-restricted fetuses. This may explain the different hemodynamic response and the higher rate of complications occurring in the latter group after cordocentesis.

6-Ketoprostaglandin F1 alpha↗

PubMedDate not supplied

Detection and measurement of fetomaternal hemorrhage following diagnostic cordocentesis.

OBJECTIVE: The aim of this study was to investigate the effect of cordocentesis on fetomaternal hemorrhage (FMH). METHODS: One hundred and three diagnostic cordocenteses, without any other associated procedure, were performed at 23-40 weeks' gestation. FMH was detected using the Kleihauer-Betke staining of maternal blood taken immediately before and after cordocentesis. RESULTS: Significant FMH occurred after 40 (38.8%) of the 103 procedures. An increased risk of fetal bleeding was associated with both an anterior placenta (odds ratio (OR) 5.89; 95% confidence interval (CI) 2.27-15.3; p < 0. 001) and a transplacental cordocentesis (OR 37.0; 95% CI 2.15-636; p < 0.001). The volume of FMH was greater after cordocentesis with an anterior placenta (90th percentile 6.20 ml) than after cordocentesis with a lateral (90th percentile 4.58 ml) or posterior placenta (90th percentile 1.35 ml) (p < 0.001). After fetal blood sampling, significant FMH occurred more frequently with a procedure duration of 3 min or more (OR 4.45; 95% CI 1.70-11.7; p = 0.002) and with two or more needle insertions (OR 4.65; 95% CI 1.80-12.1; p = 0.001). CONCLUSION: FMH following cordocentesis may be related to placental injuries. This event is influenced by placental location, procedure duration and the number of needle insertions.

Cordocentesis↗

PubMedDate not supplied

Fetomaternal transfusion and pregnancy outcome after cordocentesis.

OBJECTIVE: To study the extent of fetomaternal transfusion and the outcome of pregnancy after cordocentesis. MATERIAL AND METHODS: 268 women underwent percutaneous fetal umbilical cord blood sampling for fetal karyotyping between 15 and 26 gestations of weeks. Complete follow-up was available in 221 (82.5%) of the cases. Cordocentesis was performed under continuous real-time ultrasound guidance. The duration of the procedure and the post-procedural bleeding time was counted in seconds. Fetomaternal transfusion was calculated by using the measurements of the maternal serum levels of alpha-fetoprotein before and after the procedure. The data were analyzed by Student's t and multiple regression tests. RESULTS: The maximum and mean amounts of fetomaternal transfusion were 1.067 and 0.061 ml, respectively. Twenty percent or more alpha-fetoprotein elevation was in 35.4% of the cases. Positive correlation was found between bleeding time after cordocentesis and fetomaternal transfusion (r = 0.174, p < 0.0129) as well as between the duration of the procedure (r = 0.165, p < 0.0171) and the amount of fetomaternal transfusion. Comparing the cordocentesis at the placental insertion site and at the free cord loop, a smaller amount of fetomaternal transfusion was observed (p < 0.0123) in the latter. Transplacental passage was associated with a higher amount of fetomaternal transfusion (p < 0.0067). No association was found between the extent of fetomaternal transfusion and the outcome of pregnancy. The fetal loss related to the cordocentesis was 0.50%. CONCLUSIONS: The extent of fetomaternal transfusion was influenced by the subsequent four parameters: procedural time, bleeding time, puncture site and transplacental penetration. The lack of the association between the degree of fetomaternal transfusion and the outcome of pregnancy, along with the low (0.50%) post-procedural fetal loss rate, suggest that cordocentesis is clinically a safe procedure.

Abortion, Therapeutic↗

PubMed2004

[The risk of complications of diagnostic and therapeutic cordocentesis].

OBJECTIVES: Cordocentesis is one of the wide range of invasive diagnostic and therapeutic procedures used during pregnancy. Most common indications for is are suspicion of chromosomal abnormalities, Rh-immunisation or assessment of fetal renal function. Authors report the frequency of complications of this procedure as high as 1.5-5% with pregnancy loss rate up to 3%. DESIGN: The aim of our study was to determine the frequency of complications after cordocentesis. MATERIAL AND METHODS: We analyzed 145 pregnancies, during which 199 cordocentesis were performed. 124 of them were qualified as diagnostic with obtaining fetal blood (during 4 of them furosemidum was administered to the fetus), 22 diagnostic with furosemidum administration only and 53 therapeutic with blood transfusion (52) or pentaglobin administration (1). RESULTS: Complications of the cordocentesis were diagnosed in three cases--it was 1.5% of all of the procedures. Fetal bradycardia was reported in our material--in two cases it was isolated complication, in one case it appeared with retroplacental haematoma. In all three cases cesarean section was performed and alive babies were born. Data about the end of the pregnancy were obtained from 69 patients (47.5%). CONCLUSIONS: Cordocentesis in many case allows to establish proper diagnosis, make up decisions about treatment or termination of pregnancy and introduce management according to the needs and decisions of the patient. Complications are not very frequent and only in 1.5% were the reason of immediate caesarean section. Cordocentesis is safe and very useful tool of diagnosis in management of high risk pregnancies.

Adult↗

PubMed2004

[Studies on safety of cordocentesis guided by transabdominal ultrasound for prenatal diagnosis].

OBJECTIVE: To assess the safety and efficacy of diagnostic cordocentesis during pregnancy. METHODS: During March 1990 to June 2003, 2403 consecutive cordocenteses were performed under transabdominal ultrasound guidance at Guangzhou Women and Children's Hospital. The results of each procedure was prospectively collected and subsequently analysed in terms of operational complications and pregnancy outcomes. RESULTS: Success rate of cordocentesis: totally 2368 procedures (98.5%) were done successfully at the first attempt, and 35(1.5%) required repeated cordocentesis, 16 of which were performed successfully at second attempt. Duration of cordocentesis: In 75.5% cases, the procedure was completed in less than 5 min, and in 93.0% cases in less than 10 min. COMPLICATIONS: Transient bleeding at puncture site was observed in 315 cases (13.1%), transient fetal bradycardia in 125 cases (5.2%), and chorioamnionitis in 2 cases (0.1%). Pregnancy outcomes: The total fetal loss rate was 0.8% (18 cases of abortions). The rate of premature birth after cordocentesis was 0.2% (4 cases). CONCLUSION: Cordocentesis during pregnancy is a useful, relatively safe, and effective procedure for prenatal diagnosis.

Abortion, Spontaneous↗

PubMed2000

Prenatal diagnosis of haemoglobin Bart's disease by cordocentesis at 12-14 weeks--experience with the first 59 cases.

We have shown that fetuses affected by haemoglobin (Hb) Bart's disease can be reliably identified by their sonographic manifestation of cardiac enlargement at 12-14 weeks. Between 1995 and 1999, 282 couples were seen before 15 weeks. They were offered the options of chorionic villus sampling, or amniocentesis and DNA study, or ultrasound examination at 12-14 weeks, followed by cordocentesis and Hb study only when the ultrasound findings were abnormal. Two hundred and thirty-four at-risk pregnancies had ultrasound assessment at 12-14 weeks, 62 fetuses showed enlarged cardiothoracic ratio [mean (SD) 0.54 (0.02)] and four of them also had hydropic changes. Fifty-nine women agreed to undergo cordocentesis at 12-14 weeks and the procedure was successful in 57 cases (97%). Cordocentesis were performed by a freehand technique using a 26- or 24-gauge spinal needle with a 20-gauge introducer. Fifteen fetuses (25%) had bleeding from the cord and 12 fetuses (20%) had bradycardia following cordocentesis. The fetal loss rate was 8% (5/59). Hb Bart's disease was confirmed in all the 62 fetuses with cardiac enlargement. Their Hb concentration ranged between 3.1 to 8.4 g/dl. One hundred and seventy-two fetuses had normal ultrasound assessment and 148 of them were confirmed to be unaffected by Hb Bart's disease. Twenty-three pregnancies were ongoing and one miscarried at 15 weeks. We believe that sonographic assessment followed by selective cordocentesis at 12-14 weeks is a feasible prenatal diagnostic option for Hb Bart's disease.

Adult↗

PubMed2006

Intravenous immunoglobulins without initial and follow-up cordocentesis in alloimmune fetal and neonatal thrombocytopenia at high risk for intracranial hemorrhage.

OBJECTIVE: To report on a less invasive treatment strategy in alloimmune fetal and neonatal thrombocytopenia (FNAIT) at high risk for either in utero or neonatal intracranial hemorrhage (ICH). METHODS: In 7 pregnancies, with a history of ICH in the older sibling, weekly intravenous immunoglobulin (IVIG) therapy to the mother (1 g/kg) without initial cordocentesis was started at a median gestational age of 16 weeks. RESULTS: In 4 pregnancies cordocentesis was avoided. One predelivery cordocentesis with platelet transfusion was performed in 3 further cases. Although none of the cases had a platelet count of >50 x 10(9)/l at cordocentesis, predelivery or birth, no ICHs were observed. The neonatal periods of the infants were uncomplicated. CONCLUSION: IVIG treatment alone might be considered in patients with both severe platelet alloimmunization and an increased risk for morbidity and mortality at cordocentesis.

Antigens, Human Platelet↗

PubMed1996

Effects of cordocentesis on inferior vena cava velocity waveforms: differences between normally grown and growth-retarded fetuses.

The objective of this study was to analyze the effects of cordocentesis on velocity waveforms recorded from the inferior vena cava and to evaluate differences, if any, in the hemodynamic response between normally grown and growth-retarded fetuses. Twenty-five normally grown fetuses and 20 growth-retarded fetuses were considered for this study. This latter group was characterized by abnormal Doppler indices in the umbilical artery and the middle cerebral artery suggestive of uteroplacental insufficiency as the causative factor of the impaired growth. Flow velocity waveforms were measured from the inferior vena cava immediately before and after cordocentesis and the % reverse flow during atrial contraction calculated. In normally grown fetuses the % reverse flow values did not vary significantly after cordocentesis, while in growth-retarded fetuses this index increased significantly after the procedure (p < or = 0.001). Furthermore, the amplitude of this increase was inversely related to pH levels in umbilical vein (p = 0.004). In conclusion, in growth-retarded fetuses cordocentesis induces an increase of % reverse flow in the inferior vena cava, while no modifications occur in normally grown fetuses. This suggests the presence in growth-retarded fetuses of an impaired cardiac adaptive mechanism to cordocentesis that may explain the higher incidence of complications occurring in such fetuses.

Blood Flow Velocity↗

PubMed2005

Feto-maternal hemorrhage after cordocentesis at Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To evaluate the incidence and volume of feto-maternal hemorrhage following cordocentesis. STUDY DESIGN: Descriptive study. MATERIAL AND METHOD: One hundred and sixteen asymptomatic non-anemic pregnant women with an indication for cordocentesis at 18-22 weeks of gestation between January and June 2004 were recruited. Maternal blood samples were obtained immediately before and 30 minutes after cordocentesis. Fetal cells in the maternal blood were counted using Kleihauer Betke test. About 25,000 maternal cells per slide were scanned by the same examiner. Feto-maternal hemorrhage was considered significant if the fetal bleeding was more than 0.25 ml. RESULTS: There was a significant increase in fetal blood volume in maternal circulation after cordocentesis (Paired Students t test, p < 0.001). A significant hemorrhage (> 0.25 ml) occurred in 63 from 116 women (54. 7%). Only one had marked hemorrhage of more than 5.0 ml and none had massive hemorrhage (> 15 ml). CONCLUSION: Cordocentesis at 18-22 weeks of gestation can be associated with feto-maternal hemorrhage in more than half of the cases but nearly all cases had only minimal hemorrhage and none had massive hemorrhage.

Adolescent↗

PubMed1996

Cordocentesis: a useful method for prenatal diagnosis.

OBJECTIVE: To evaluate the efficacy and safety of cordocentesis for prenatal diagnosis of various fetal diseases. PATIENTS AND METHODS: Fetal blood sampling was performed in 30 pregnancies from gestational week 19 to 36 for various prenatal diagnoses. We used Aloka SSD-650 real-time ultrasound scanner with 3.5 mHz curvilinear transducer during the procedure. A regular 22-gauge spinal needle was used for fetal blood sampling. RESULTS: Twenty-five cordocentesis were successful at the first attempt. A second attempt of cordocentesis succeeded in three cases. In the remaining two cases, intrahepatic vein sampling and cardiocentesis were employed respectively. The duration of procedure was shorter than 15 minutes in 25 cases. 1-6 ml of fetal blood was obtained from each case. Fetal blood was diluted with amniotic fluid in four samples. Maternal blood contamination never happened. No lethal complication occurred in our series. CONCLUSION: It is believed that cordocentesis is a safe and useful method for prenatal diagnosis, and intrahepatic vein sampling is an alternative choice when cordocentesis has failed.

Cordocentesis↗

PubMed1997

Fetal bradycardia following cordocentesis.

Several clinical investigations on the course and outcome of pregnancies following cordocentesis have mentioned the occurrence of fetal bradycardia at the time of umbilical cord puncture. The prognostic impact of this common complication has remained controversial. Our purpose was to investigate the prevalence and the short-term and long-term consequences of fetal bradycardia associated with cordocentesis. This study included all 339 cordocenteses performed in 290 fetuses at the Division of Prenatal Diagnosis and Therapy, University of Vienna, between 1991 and 1994. Clinically significant bradycardia was defined as a drop in the heart rate to less than 100 beats/min for a period of > or = 60 s. Bradycardia during or immediately after cordocentesis was observed in 13 cases (3.8 per cent). The fetal/neonatal loss rate per procedure was 61.5 per cent (8/13) in cases with bradycardia and 3.1 per cent (10/326) in those without bradycardia (P < 0.001). Early gestational age and hydrops fetalis correlated significantly with the development of bradycardia at cordocentesis. The other risk groups, including fetuses with intrauterine growth retardation, the puncture site, and the number of puncture attempts did not correlate with fetal bradycardia. Our results indicate that prolonged fetal bradycardia during or after cordocentesis is characteristic of a group of fetuses with an especially unfavourable prognosis.

Bradycardia↗

PubMed1989

Prenatal diagnosis using sonographic guided cordocentesis.

Cordocentesis has been practiced as a diagnostical tool for prenatal diagnosis of intrauterine infections, hematological disorders, metabolic status of the fetus and rapid cytogenetic analysis. The performance of 198 cordocentesis is presented over 3 years of experience. A 21 gauge spinal needle is inserted via the optimal point on the maternal abdomen under real-time ultrasonic guidance into the insertion of the umbilical cord in the placenta. Successful cordocentesis were achieved in 98.5% of the cases. Termination of pregnancy was directly related to the procedure in only 1%. Hematoma surrounding the puncturing site was demonstrated in one case, but without damage to the fetus. In our series the main indication for performing cordocentesis was the need for rapid karyotyping. The use of fetal lymphocytes for chromosomal analysis offers a rapid and a reliable method for routine clinical demands. The availability of a rapid chromosomal analysis offers a considerable advantage in pregnancies of advanced gestational age. In those pregnancies it appears to be most important to have a rapid diagnosis where anatomical structural anomalies are associated with chromosomal malformations in up to 30%. The metabolic status of the fetus is considered in either acute distress or in cases of suspected sub-optimal metabolic hemostasis, where IUGR or oligohydramnios are demonstrated. Cordocentesis, even though is a new technique, turns to play a major role in modern perinatology. The possibility of a direct rout to fetal blood vessels early during the pregnancy bears the tremendous potential of early diagnosis and treatment.

Female↗

PubMed1990

[Cordocentesis: experience in 391 initial samples].

The first diagnostic cordocentesis was performed in our unit in october 1985. Our 4-year experience is reported: 391 cordocentesis were performed in 360 patients during gestational weeks 14 to 42. The first attempt was successful in 90% of the procedures, 4 samplings failed, there were 4 fetal deaths within one week after diagnostic cordocentesis, one of them appears to be directly linked to the punction. A transient fetal bradycardia was observed in 9.9% of the cases, bleeding occurred in 19% of the cases. The indications for cordocentesis were: risk of fetal infection, karyotyping, hemopathy, search for paternity, assessment of fetal acid-base status, biochemical dosage. Our data confirm that cordocentesis is a safe and reliable diagnostic procedure providing guidelines for management of the pregnancy.

Chromosome Aberrations↗