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At least 19 recordsLinked to original sources
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↗
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↗
PubMed1989

The acute effect of cordocentesis with or without fetal curarization and of intravascular transfusion upon umbilical artery waveform indices.

The systolic/end-diastolic ratio (S/D) and pulsatility and resistance indices were calculated before and after diagnostic cordocentesis in 46 fetuses, after 19 intravascular transfusions in eight fetuses, and on two occasions 45 minutes apart in eight controls. The fetus was paralyzed with pancuronium (0.3 mg/kg sonographic estimate of fetal weight) for diagnostic cordocentesis on 19 occasions (intravascularly in 17 and intramuscularly [IM] in two). Pancuronium (intravascularly in 16; IM in three) and furosemide (4 mg/kg intravenously) were administered during each transfusion. There were no significant differences between the first and second measurements for any of the three indices in the control group. Significant reductions were documented in the S/D ratio (P less than .0001), the pulsatility index (P = .043), and the resistance index (P less than .0001) after diagnostic cordocentesis. Pancuronium administration did not alter the magnitude of the decline, nor was there an association between the decline and the volume of blood removed. Significant relationships were observed between the magnitude of the decline and several respiratory blood gas measurements. As in the diagnostic cordocentesis group, there were significant reductions in each Doppler index after transfusion (S/D ratio, P = .003; pulsatility index, P = .002; resistance index, P = .0001). In addition, there was a significant relationship between gestational age and S/D ratio (r = 0.70, P = .002) in fetuses undergoing intravascular transfusion. The S/D ratio was most sensitive to changes in fetal oxygenation. We conclude that both diagnostic cordocentesis and intravascular transfusion as performed at the University of Iowa acutely lower the studied Doppler waveform indices.

Blood Flow Velocity↗
PubMed1995

Alloimmune thrombocytopenia: fetal and neonatal losses related to cordocentesis.

OBJECTIVE: This report describes the increased risks of cordocentesis in fetuses affected with alloimmune thrombocytopenia. STUDY DESIGN: As part of a multicenter treatment study clinical and laboratory data from five pregnancies with alloimmune thrombocytopenia in which there was a fetal or neonatal loss associated with cordocentesis were reviewed. The fetal or neonatal deaths were all thought to be a result of exsanguination. These fetuses were compared with a group of 44 affected fetuses who underwent the same procedure but who survived. The data were analyzed by the Wilcoxon rank-sum test and the two-tailed Fisher's exact test. A p value < 0.05 was considered significant. RESULTS: The mean platelet count at cordocentesis was significantly lower in the cases than in the controls (5.8 vs 32.8 x 10(9)/L, p = 0.005). The incidence of antenatal intracranial hemorrhage in the untreated sibling of the prior affected pregnancy was significantly greater in the cases than in the controls (two of five vs one of 42, p = 0.02). CONCLUSION: Fetuses affected with alloimmune thrombocytopenia are at increased risk for fatal exsanguination associated with cordocentesis.

Antigens, Human Platelet↗
PubMed1995

Fetal oxygenation at cordocentesis, maternal smoking and childhood neuro-development.

OBJECTIVE: To assess the relationship between subsequent neuro-development and measurements in small for gestational age (SGA) fetuses, including oxygenation at cordocentesis. DESIGN: A longitudinal study of a cohort of SGA fetuses using those with normal oxygenation as controls. SUBJECTS: 65 chromosomally normal children aged 12-66 months who, as fetuses, had been small for gestational age, had undergone cordocentesis and had been delivered after 32 weeks' gestation. RESULTS: Griffiths' developmental quotient (DQ) was significantly associated with fetal blood pH (r = 0.41, P = 0.0008), PO2 (r = 0.25, P = 0.047) and PCO2 (r = -0.28, P = 0.027) at cordocentesis but not with the severity of growth retardation (r = 0.18, P = 0.17). However, the significant correlations between DQ and both PO2 and PCO2 were explained by their co-correlations with pH and neither remained significant after removing the effect of pH by analysis of variance. The association between DQ and pH was still significant after removing the effect of confounding variables. Maternal smoking during pregnancy was significantly associated with DQ (F to remove = 6.89, P = 0.011) even after allowing for the effects of possible confounding variables including fetal blood pH. CONCLUSIONS: Both fetal pH at cordocentesis and maternal smoking correlate significantly with subsequent neuro-development. Further investigation into the causes of these associations is required.

Child, Preschool↗
PubMed1989

Diagnostic cordocentesis: two years of experience.

The first diagnostic cordocentesis was performed in our unit in October 1985, our 2-year experience is reported. 144 samplings were performed in 137 patients (139 fetuses - 2 patients had twin pregnancies) during gestational weeks 14 to 42. The first attempt was successful in 80% of the procedures, 4 samplings failed. There were no fetal deaths within 3 days after diagnostic cordocentesis, a transient fetal bradycardia was observed in 12.2% of the cases, bleeding occurred in 13.6% of the cases. The indications for cordocentesis were: risk of fetal infection, karyotyping, hemophilia A, alloimmunisation, search for paternity, assessment of fetal acid-base status. Our data confirm that cordocentesis is a safe and reliable diagnostic procedure providing guidelines for management of the pregnancy.

Blood Specimen Collection↗
PubMed1991

Antepartum fetal blood sampling with cordocentesis. Comparison with chorionic villus sampling and amniocentesis in diagnosing karyotype anomalies.

Cordocentesis under ultrasound guidance, or percutaneous umbilical blood sampling, was first reported in 1983 by Daffos et al. Since then the method has gained importance in prenatal diagnosis. In 1,011 cases at a women's clinic in Bonn, Federal Republic of Germany, 35% of the cordocentesis cases were done for blood group incompatibilities plus intravascular transfusion in most of the cases. In the remaining 65% the indications for cordocentesis were a rapid karyotype analysis, diagnosis of fetal infections and determination of fetal acid-base status in severe intrauterine growth retardation. Chorionic villus sampling (CVS) and amniocentesis were also performed to detect karyotype anomalies. Amniocentesis constituted 78.8% of the procedures and detected 50% of the karyotype abnormalities. Cordocentesis and CVS constituted 17.3% and 3.9%, respectively, of all the procedures and diagnosed 39% and 11%, respectively, of the abnormalities. Different forms of trisomy were the most common karyotype anomaly. Translocation was noted in 22 cases. Turner's, Klinefelter and triple X syndromes and triploidy were the next major forms.

Adult↗
PubMed1994

[Monitoring and treatment of fetal maternal allo-immunization. Role of cordocentesis].

OBJECTIVE: Diagnosis and treatment of haemolytic disease of the fetus has considerably progressed since the introduction of Liley's diagram. Amniocentesis and cordocentesis have changed diagnostic and therapeutic options. Recently, some authors pleaded for restraint in diagnostic cordocentesis. In this context of relative controversy, we wanted to compare our results with those of the literature. SUBJECTS AND METHODS: Thirty-nine pregnancies complicated by antigen incompatibilities were referred to our unit. The haemolytic disease was evaluated by the measurement of antibody titers, by spectrophotometry in the amniotic fluid, by measurement of fetal haematocrit in cord blood samples and by ultrasound examination. Sixty-four amniocenteses, 85 cordocenteses and 25 in utero transfusions were performed. RESULTS: Alloimmunization anti-D represented 67% of the cases in our series of 39 pregnancies. Fifteen percent of the fetuses were antigen negative. One neonatal death after chorioamnionitis was observed after cordocentesis, the fetal loss rate related to the procedure was 1.2%, Six fetuses had a haematocrit below 30% at the first sampling; 9 other fetuses developed an anaemia later in pregnancy. Six fetuses underwent in utero transfusion. One of these fetuses had hydrops at the ultrasound before the procedure. Twenty-five in utero transfusions were uncomplicated in spite of the observation of one post-transfusional haematoma of the umbilical cord. The delta OD450 measurement did not predict the severity of fetal anaemia in all cases. CONCLUSION: In our experience, the fetal haematocrit measurement remains the most reliable method to evaluate the severity of the haemolytic disease.

Amniocentesis↗
PubMed1994

Cordocentesis: direct access to the fetal circulation for evaluating fetal wellbeing and thyroid function.

Cordocentesis has pioneered perinatal medicine in the last 10 years with the ability to obtain genetic information, to diagnose and to treat erythrocyte and platelet alloimmunization, to discover the presence of perinatal infections, and to determine the acid-base status of the fetus. Fetal blood sampling has also allowed the perinatologist a greater understanding of fetal physiology, such as thyroid-pituitary function. This review will concentrate on the role of cordocentesis in determining fetal physiology with acid-base status, compare noninvasive testing in its prediction of the hypoxic-acidemic state, and also how cordocentesis has enabled obstretricians to have a better understanding of fetal thyroid development and function.

Acidosis↗
PubMed1994

Role of cordocentesis in perinatal medicine.

Cordocentesis is a feasible, reliable, and safe method for fetal evaluation of a wide variety of disorders. It has allowed for in-utero treatment of fetal red cell isoimmunization and opened future routes for other fetal therapies. In this review, results of a multicenter intrauterine fetal blood sampling registry will be presented, outlining current indications, techniques, and complications of the procedure. In addition, current research in the assessment and treatment of fetal erythrocyte isoimmunization and infection, as well as the role of cordocentesis in rapid genetic karyotyping, work-up of non-immune hydrops, fetal platelet abnormalities, and fetal growth restriction will be reviewed. Recent work using cordocentesis to better understand fetal metabolism, endocrinology, and immunology will also be reviewed.

Cordocentesis↗
PubMed1988

Cordocentesis: an appraisal of risks.

Fetal blood sampling via cordocentesis is being used with increasing frequency. Between March 1986 and February 1988, we performed 58 intravascular transfusions (64 attempts) and 27 fetal blood samplings (28 attempts) guided by ultrasonography. The complication rates for intravascular transfusion and fetal blood sampling were 9.4% (6 of 64) and 7.1% (2 of 28), respectively. The procedure-related mortality rates were 4.7% (3 of 64) and 0%. We caution that the potential complications be seriously considered when appropriate patients are selected for cordocentesis. Additionally, we recommend that cordocentesis be performed only in tertiary care centers by personnel skilled in both ultrasonography and prenatal diagnosis.

Blood Specimen Collection↗
PubMed1989

Fetal blood gas analysis from cordocentesis for abnormal fetal heart rate patterns.

We present three cases with abnormal fetal heart rate patterns and cordocentesis umbilical venous blood gas analyses. Conflicting heart rate patterns and cordocentesis and postnatal blood gas analyses prompt questions with regard to abnormal fetal heart rate pattern interpretation and suggest that cordocentesis blood gas analysis aids perinatal management only as a reflection of fetal status at sampling time.

Adolescent↗
PubMed1991

The value of cordocentesis in management of patients with severe preeclampsia.

Severe preeclampsia affects placental function and causes fetal compromise. It is necessary to deliver the fetus at an appropriate time in order to minimize fetal mortality and morbidity. Cordocentesis was performed in 9 patients with severe preeclampsia (group 1) and 10 patients with other pregnancy complications (group 2). Intrauterine growth retardation occurred in 5 patients in group 1 and in only one patient in group 2. Blood gas parameters including pH, pO2 and O2 saturation were significantly lower for group 1, while pCO2 was significantly higher, as compared to group 2. For patients in group 1, non-invasive fetal surveillance successfully identified 5 patients with fetal compromise, who required immediate termination of pregnancy. All 5 of these patients had abnormal fetal blood gas analyses by cordocentesis. Fetal blood gas analysis was abnormal in 2 additional fetuses among the remaining 4 patients who exhibited normal findings by non-invasive methods of fetal surveillance. These results suggest that cordocentesis is useful in identifying fetal compromise (fetal hypoxia/acidosis) prior to the onset of labor in high-risk patients, such as preeclampsia associated with intrauterine growth retardation.

Acidosis↗
PubMed1990

Biochemical evaluation of fetus with hypoxia caused by severe preeclampsia using cordocentesis.

Biochemical evaluation of the fetus using cordocentesis was performed in sixteen pregnant women with severe preeclampsia. In addition, FHR monitoring and Doppler flow velocimetry of the umbilical artery were examined in these cases before the cordocentesis. Other than blood gas and routine hematologic and biochemical examinations, catecholamine and hypoxanthine concentrations were also evaluated in some cases. According to the results it is obvious that the fetus of mother with severe preeclampsia is exposed to hypoxemia with the delta pO2, the difference from the mean in each gestation, of -22 mmHg. Especially, the prognosis of the severely growth-retarded babies with pO2 below 10 mmHg, or delta pO2 30 mmHg lower than the mean standard value, is poor. Among 16 babies, 4 with severe hypoxia or acidosis and growth retardation died perinatally. In contrast, severely growth-retarded babies without hypoxia or acidosis were alive. Since neither FHR monitoring nor Doppler velocimetry always reflect biochemical values of the fetus of a severe preeclamptic mother, hence the precise evaluation of fetal condition using cordocentesis is indispensable to determine the timing of the delivery and to prevent the neurological sequelae caused by hypoxia, especially when the fetal growth is retarded.

Adult↗
PubMed1992

What can be learned from cordocentesis?

Cordocentesis is a well-accepted procedure that is widely practiced by experienced perinatologists. Its facile and safe access to the fetal circulation has broadened the spectrum of congenital disorders diagnosed prenatally. Some fetal disease states can now be identified and treated earlier, directly, more quickly, and more effectively than before, resulting in improved patient care. Although cordocentesis has been embraced by the perinatal community, it is, by definition, a technique of obtaining a fetal blood sample. A prerequisite for the procedure to exert its full impact on perinatal care is a highly capable clinical laboratory. The facility must be aware of the commonly requested fetal serologic, hematologic, and serum chemistry studies, as well as their normal values. Efforts must be made to perform fetal blood studies rapidly and reliably on small specimens. Laboratory personnel should be familiar with the indications and pitfalls of these tests and those that are best referred to a specialty laboratory. A general understanding of the perinatologist's needs and concerns will lead to a cooperative working relationship between clinician and laboratory. In this manner, we will truly discover what can be learned from cordocentesis.

Blood Specimen Collection↗
PubMed1990

Safety of cordocentesis under ultrasound guidance for fetal blood sampling.

In the present study, we attempted to assess the safety and the risk of cordocentesis under ultrasound guidance for fetal blood sampling. Forty-five cordocenteses in 43 cases were carried out. These forty-three cases included 23 nonimmunologic hydrops fetalis, 12 congenital fetal malformations, 3 chromosome aberrations, 3 Rh isoimmunization, and 2 idiopathic thrombocytopenic purpura. Gestational age when cordocentesis was performed ranged from 17 to 39 weeks of gestation. In 42 (93.3%) out of 45 procedures, pure fetal blood was obtained. Postpuncture bleeding was observed in 17 cases (37.8%). In 12 (70.6%) out of 17 cases, bleeding stopped within 2 minutes. In only one case, bleeding continued for 11 minutes and cesarean section was performed due to fetal distress. Cardiotocogram obtained after cordocentesis revealed no ominous signs in the other 44 procedures. The other complications, including premature rupture of the membranes, premature labor, and intrauterine infection, did not occur during or after this procedure. There were no cases in which any kind of injury to the placenta or umbilical cord was observed.

Blood Specimen Collection↗
PubMed1993

Relationship between the fetal biophysical profile score, umbilical artery Doppler velocimetry, and fetal blood acid-base status determined by cordocentesis.

OBJECTIVE: Fetal hypoxia-acidosis is part of the terminal pathway leading to intrauterine fetal death. A central premise of antepartum surveillance is that identification and timely delivery of the hypoxic or acidotic fetus will prevent intrauterine death and decrease long-term neurologic damage. The optimal method to identify fetal hypoxia-acidosis has not been determined. We attempted to compare the performance of the biophysical profile score and umbilical artery Doppler velocimetry in the identification of fetal acidemia, hypoxemia, and hypercarbia as determined by pH and gas analysis of fetal blood obtained by cordocentesis. STUDY DESIGN: Fetal biophysical profile and umbilical artery Doppler velocimetry studies were performed before cordocentesis in 24 patients (26 to 40 weeks). Umbilical vein pH and blood gas values were determined in all cases. The pulsatility index of the umbilical artery was obtained with pulsed Doppler equipment. Receiver-operator characteristic curve analysis and stepwise multiple logistic regression were performed to examine the relationship between biophysical profile score, umbilical artery Doppler velocimetry, and acid-base status. RESULTS: The prevalence of fetal acidemia (pH 2 SD below the mean for gestational age) was 41.7% (10/24). There was a significant relationship between the change in umbilical artery pulsatility index and fetal acidemia (chi 2 = 26.6, p < 0.001) and hypercarbia (chi 2 = 22.9, p < 0.001), but not hypoxemia (chi 2 = 1.0, p > 0.1), and between the biophysical profile score and fetal acidemia (chi 2 = 11.1, p < 0.001) and hypercarbia (chi 2 = 9.0, p < 0.005), but not hypoxemia (chi 2 = 2.3, p > 0.1). Stepwise multiple logistic regression demonstrated that umbilical artery Doppler velocimetry was a better explanatory variable for acidemia and hypercarbia than the biophysical profile score. CONCLUSION: A strong relationship between the degree of fetal acidemia and hypercarbia and the results of umbilical artery Doppler velocimetry and biophysical profile was found. However, umbilical artery Doppler velocimetry was a better explanatory variable for these outcome than the biophysical profile score.

Acid-Base Equilibrium↗