IN THE NAME OF GOD

Cordocentesis

Cordocentesis and IUT - History First intraperitoneal transfusion (Liley) Fetoscopy to obtain fetal samples (Hobbins, et al) Fetoscopic transfusion (Rodeck, et al) First ultrasound guided IUT (Bang, Bock & Troll) First large study of IUT - 66 cases (Daffos, et al)

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.

Training

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 Small amount of blood is withdrawn.

Procedure

Sonographic Appearance

Risks/Complications of Cordocentesis Fetal Loss - risk variable depending on condition of fetus, overall 1-2%, range <1% - 50%. Bradycardia - common but usually transient(3-12%). Bleeding - usually transient and mild(50%) Preterm Labor

Risks/Complications Preterm Rupture of Membranes Infection – lower than 1% Cord Hematoma - rare, much more common with infusions. Maternal Alloimmunization - largely preventable with Rhogam. Failed Procedure- 5 – 9 %