By

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Cordocentesis
By Leigh Giles-Brown MS113 Project
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History

• 1954 First attempts at fetoscopy (precursor to
  cordocentesis).
• Hysteroscope Endoamnioscope Needlescopes
• 1983 Fernand Daffos pioneers ultrasound-guided
  cordocentesis.
• First case of Hemophilia A diagnosed in utero.
• 1985 Hobbins group at Yale University describes
  their technique as percutaneous umbilical blood
  sampling. This replaces blood sampling via
  fetoscopy in U.S.
• - Kypros Nicolaides at Kings College Hospital
  in England develops single operator
  two-hands method.
• Late 1980s Cordocentesis becomes more
  available and accepted as a quick confirmation
  of abnormal karyotype when ultrasound suggests
  a chromosomal abnormality.

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Why Cordocentesis?

• Identify genetic disorders if amniocentesis or
  Chorionic Villi Sampling unsuccessful or
  inconclusive.
• Detect fetal blood disorders such as hemophilia,
  anemia, and blood oxygen levels.
• Detect viral infections (rubella, toxoplasmosis,
  cytomegalovirus)
• Recommended for mothers known to be sensitized to
  Rh factor if
• Fetus has hydrops.
• Bilirubin levels from amniocentesis show moderate
  or severe damage.
• Bilirubin levels are rising quickly.
• Fetus signs of severe anemia during 2nd
  trimester.
• Doppler ultrasound of middle cerebral artery
  shows anemia.

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Technology
Cordocentesis Trainer simulates gravid abdomen

• Used with any ultrasound equipment.
• Contains a fetal cord, filled with mock blood,
  suspended in gel (does not include fetus).
• Includes 2 placentas (anterior and posterior),
  enabling both direct and transplacental
  approaches to the cord.
• The mock blood in the foetal cord can be
  replenished.
• Used for needle insertion and placement however,
  no fluid can be withdrawn from the amniotic sac.
• Self-sealing abdomen and cord can be pierced
  repeatedly.

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Training
http//www.limbsandthings.com/usa/products.php?pa
rtno60203
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Procedure

• Usually performed as outpatient.
• Mother provided a sedative to reduce her and
  fetus movement.
• Fetus may be injected with medicine to stop
  movement.
• Mother may be given antibiotics to prevent
  infection or preterm labor.
• Local anesthetic is injected into abdomen.
• Ultrasound is used to locate placental cord
  insertion.
• Ultrasound imaging guides needle insertion into
  umbilical vein.
• Small amount of blood is withdrawn.

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Procedure
http//www.shands.org/health/pregnancy/stayhealthy
/articles/pubs.html
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Procedure
http//www.shands.org/health/pregnancy/stayhealthy
/articles/pubs.html
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Sonographic Appearance
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Sonographic Appearance
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Results and Treatment

• Monitoring
• if Rh sensitization effects mild to moderate
• AND
• no severe anemia in fetus.
• Fetal Blood Transfusion
• if Rh sensitization effects are severe
• AND
• severe fetal anemia
• Subsequent fetal blood transfusions may be
  required until it can be delivered safely

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What are the Benefits?

• Early intervention and treatment are possible
  (early as 17th week).
• Usually performed after an amniocentesis or
  Doppler ultrasound when more specific results are
  required.
• Cordocentesis gives a more direct and reliable
  estimate of the fetal condition.
• Enables parental decisionmaking (termination,
  planning for child with special needs, medical
  intervention).

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Worth the Risks?

• Miscarriage rate of 1-2.
• Fetal bleeding and blood mixing risk is higher
  than amniocentesis.
• Possible vaginal bleeding (rare).
• Small risk of infection.
• Possible drop in fetal heart rate (constantly
  monitored during procedure). If performed after
  26 weeks, could require emergency ceasarean if
  baby too distressed (rare).
• Leaking amniotic fluid with possible premature
  rupture of membranes.

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REFERENCES
American Pregnancy Association. Cordocentesis
Also Known as Fetal Blood Sampling, Percutaneous
Umbilical Blood Sampling, and Umbilical Vein
Sampling. 2/5/2004. http//www.americanpregnancy
.org/prenataltesting/cordocentesis.html Birth.co
m. Cordocentesis. 2004. http//www.birth.com.au
/class.asp?class6602page7 WebMDHealth.
Fetal Blood Sampling (FBS) for Rh Sensitization
During Pregnancy. 9/2003. http//my.webmd.com/hw
/being_pregnant/hw141283.asp WebMDHealth.
Hydrops Fetalis. 5/30/2004. http//my.webmd.com
/hw/health_guide_atoz/hw141264.asp?navbarhw135945
Woo, Joseph, M.D. A Short History of the
Development of Ultrasound in Obstetrics and
Gynecology. http//www.ob-ultrasound.net/history3
.html Woo, Joseph, M.D. A Short History of
Amniocentesis, Fetoscopy and Chorionic Villus
Sampling. 9/18/2004. http//www.ob-ultrasound.net
/amniocentesis.html