Diagnostic fetal blood sampling-technique related losses.
BACKGROUND
The applications of cordocentesis are limited by its safety. Cordocentesis is performed either freehand or with the aid of a fixed needle guide. Recent reports suggest a loss rate of 1-7% using the freehand technique. The potential influence of technique on the perinatal loss rate has not been examined.


METHODS
The procedure-related loss rates of two fetal diagnosis and treatment units, one in the United States (10 operators) and one in Japan (15 operators), who perform diagnostic cordocentesis with the aid of a fixed needle guide is calculated from a prospectively maintained database and compared to the published experience of large centers who use a freehand technique.


RESULTS
A total of 1,260 diagnostic cordocenteses were performed. The mean gestation at sampling was 29.1 +/- 5 weeks. The umbilical vein was punctured in 90%. There were 12 procedure-related losses yielding an overall perinatal loss rate of 0.9%. There was no relationship between the risk of a loss and the number of prior procedures the operator had performed. Losses were more often associated with puncture of the umbilical artery (41.7 vs. 9.2%, p = 0.002). Eleven of 12 losses were associated with a postprocedure bradycardia. Eight fetuses who died had either a trisomy or triploidy, 1 had renal agenesis, 2 had severe early-onset growth restriction and 1 had rhesus disease. For all diagnoses other than a chromosome abnormality and severe fetal growth restriction, the procedure-related loss rate from diagnostic cordocentesis was 0.2% (2/1,021).


CONCLUSIONS
This study suggests that technique is a variable in the loss rate for cordocentesis.
Weiner
C P
CP
Departments of Obstetrics and Gynecology, University of Iowa, College of Medicine, Iowa City.
Okamura
K
K
D001919:Bradycardia / Q000209:etiology; D002821:Chorioamnionitis / Q000150:complications; D002869:Chromosome Aberrations; D017218:Cordocentesis / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D005317:Fetal Growth Retardation; D005865:Gestational Age; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D011247:Pregnancy