CORDOCENTESIS
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.
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.
