CORDOCENTESIS

INTRODUCTION:-

 Cordocentesis is a technique by which fetal blood sampling is done through the maternal
abdomen under ultrasound guidance. It gives, rapid results within 24-48 hours.

CordocentesisOpen pop-up dialog box

  Cordocentesis — also known as percutaneous umbilical blood sampling — is a
diagnostic prenatal test in which a sample of the baby's blood is removed from the
umbilical cord for testing.
 Cordocentesis, which is usually done after week 18 of pregnancy, can be used to detect
certain genetic disorders, blood conditions and infections. Cordocentesis can also be used
to deliver blood and medication to a baby through the umbilical cord.
 Use of cordocentesis is becoming rare because diagnostic procedures such as
amniocentesis and chorionic villus sampling, which pose a lower risk of fetal death, can
be used instead for prenatal diagnosis of disease. Cordocentesis is most often done to test
for anemia in the baby.

PRENATAL DIAGNOSIS:-

1. Chromosomal abnormalities
2. Single gene defects. Hemoglobinopathies, coagulopathies, chronic granulomatous
disorders and some metabolic diseases.

FETAL ASSESSMENT:-

A. Red cell alloimmunization. Hematocrit and hemoglobin estimations.

B. Hydrops fetalis. Karyotyping, hematology, virology
C. Fetal infections like toxoplasmosis )TORCH, PCR, IgM, hematology).
D. Platelet alloimmunization. Hematology, transfusion
E. Monitoring of transplacental therapy and drug delivery like administration of
antiarrhythmic drugs for fetal arrhythmias.

THERAPEUTIC INDICATIONS:-

1. Intravascular transfusion
2. Intravascular drug administration
3. Platelet transfusion in thrombocytopenia

COMPLICATIONS:-

The complications can be fetal or maternal.

Fetal Complications Include:

a) Bleeding at the puncture site, hematoma formation and fetomaternal hemorrhage

b) Deceleration of FHS (as umbilical vessels go into spasm)
c) Chorioamnionitis
d) Premature rupture of membranes
 e) Abruptio placentae (Accidental hemorrhage)
f) Preterm labor
g) Miscarriage
h) Fetal morbidity and mortality depend on the condition of the fetus at the time of the
procedure, e.g. less with healthy fetus but more with severely compromised fetuses with
erythroblastosis or severe fetal growth restriction (FGR).
Procedure related fetal death rate is 1.4%

Maternal Complications Are:-

1. Isoimmunization.
2. Chorioamnionitis
3. Trauma to the intestines, vessels, etc.
4. May need emergency cesarean delivery.

Why it's done

 Cordocentesis is used primarily to detect and treat blood conditions, such as fetal anemia
— a low amount of healthy red blood cells in a developing baby.
 Cordocentesis is usually done when a diagnosis can't be made from
amniocentesis,chorionic villus sampling, ultrasound or other methods. Cordocentesis
carries a higher risk of complications to the baby, including death, than other procedures
do. Your health care provider will offer the procedure only if other options aren't
available or they won't produce results quickly enough.
 Rarely, cordocentesis might be used to check fetal chromosomes through chromosome
microarray or karyotype analysis. Blood obtained through cordocentesis can also
potentially be used for other types of genetic studies.

Risks

Cordocentesis carries potentially serious risks, including:

 Fetal bleeding. Bleeding from the area where the needle is inserted is the most common
complication. If life-threatening fetal bleeding occurs, your health care provider might
recommend replacement of blood products to the fetus.
  Cord hematoma. A collection of fetal blood within the cord might occur during or after a
cordocentesis. Most babies don't have signs or symptoms when this occurs. However, a few
might develop a low heart rate for a short period.

If the hematoma is stable, your health care provider will observe the baby. If the hematoma
isn't stable or if your baby's heart rate doesn't recover, your health care provider will
recommend an emergency cesarean delivery.

 Slowing of the baby's heart rate. The baby's heart rate might slow temporarily after
cordocentesis.

 Infection. Rarely, cordocentesis can lead to a uterine or fetal infection.

 Fetal-maternal bleeding. Fetal blood might enter maternal circulation in about 40 percent
of procedures. The amount of bleeding is usually small. This problem is more common
when the placenta lies in the front of the uterus.

 Passing maternal infection. If the mother has certain infections, such as hepatitis B,
hepatitis C or HIV, they might be passed to the baby.

 Pregnancy loss. Cordocentesis carries a higher risk of fetal death than do other prenatal
diagnostic tests, such as chorionic villus sampling and amniocentesis. The risk is about 1 to
2 percent for a fetus that appears normal and is being tested for genetic disorders.

However, since many babies are ill when the test is done, it's often difficult to determine
whether fetal death is related to the procedure or to the baby's health.

Ultimately, the decision to have cordocentesis is up to you. Your health care provider and a
genetic professional can help you weigh the risks and benefits.

How you prepare

If you are 23 or more weeks pregnant, you'll be asked to avoid eating or drinking after midnight
the night before cordocentesis. This is because certain complications caused by the procedure
might require an emergency cesarean section.

You might want to ask your partner or a friend to accompany you to the appointment for
emotional support or to drive you home afterward.

What you can expect

Before week 23 of pregnancy, cordocentesis is usually done in an outpatient facility or the health
care provider's office. After week 23 of pregnancy, cordocentesis is usually done in the hospital,
in case the baby develops complications that might require an emergency delivery.

A sample of your blood will be taken before the procedure for comparison with the fetal blood
samples.

During the procedure

 About 30 to 60 minutes before the procedure, you might be given antibiotics to reduce
the risk of a uterine infection. This is usually done through a tube inserted into a vein.
 Your health care provider will use ultrasound to determine the umbilical cord's location
in your uterus. You'll lie on your back on an exam table, and your health care provider
will apply a special gel to your belly. He or she will then use a small device known as an
ultrasound transducer to show your baby's position on a monitor.
 Next, your health care provider will clean your belly. Sometimes medication is given to
prevent discomfort during the procedure, but often it isn't needed.
 Guided by ultrasound, your health care provider will insert a thin, hollow needle through
your abdominal wall and into your uterus. A small amount of blood from the vein in the
umbilical cord will be withdrawn into a syringe, and the needle will be removed.
 You'll need to lie still while the needle is inserted and the blood is withdrawn. You might
notice a stinging sensation when the needle enters your skin, and you might feel
cramping when the needle enters your uterus.

After the procedure

 After the blood sample is taken, you might have cramping or a small amount of
discomfort.
 Your health care provider will use an ultrasound or an external labor monitor to track
your baby's heart rate after the procedure.
 When you go home, your health care provider might suggest resting for the remainder of
the day. You'll likely be able to resume normal activities the next day. Call your health
care provider if you experience vaginal bleeding or fluid leakage.
 The blood sample will be analyzed in a lab. Test results are typically available within
days.
Results

 Your health care provider or a genetic professional will help you understand the results of
your cordocentesis. If your test results are normal, your health care provider will discuss
the need for any follow-up appointments.
 If your baby has an infection, your health care provider will explain the treatment
options. If your baby has severe anemia, he or she might need a blood transfusion
through the umbilical cord.
 If your test results indicate that your baby has a condition that can't be treated, you might
be faced with wrenching decisions — such as whether to continue the pregnancy. Seek
support from your health care team, your loved ones and other close contacts during this
difficult time.

BIBLIOGRAPHY:-

Swain Dharitri. Obstetrics nursing procedure manual. Jaypee the health sciences
publisher:New Delhi;2017. Pg.No. 131-135.
Jacob Annamma, R Rekha. Clinical nursing procedures: The art of nursing practice. 2 nd edition.
Jaypee publisher: New Delhi; 2010.Pg. No. 212-218.