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Cordocentesis and Fetal Transfusion
Introduction
Cordocentesis is a procedure that has both diagnostic and therapeutic value in fetal medicine, and is used for fetal blood sampling (FBS) and administration of fetal transfusions. Sir William Liley described the first successful intraperitoneal transfusion in 1963 with x-ray assistance. Almost 20 years later, Rodeck et al. reported using a fetoscopic approach to gain direct fetal vascular access. Ultrasound (US) guided percutaneous umbilical sampling (PUBS) was then described by Daffos et al. in 1983 and was subsequently used for testing karyotype, genetic disorders, blood/antigen typing, infectious testing, and to give direct intravascular fetal therapy. However, the development of less invasive diagnostic techniques has led to a decreased need for FBS. In a single center in Italy, the reported use of cordocentesis for prenatal diagnosis of karyotype analysis decreased from 26.4% (372 of 1408) during 1982–1985 to 2.2% (213 of 9341) during 2000–2004.
Procedure
Setting
Early cordocentesis is performed in a US unit because emergent cesarean delivery is not indicated for the previable fetus if there is evidence of fetal distress during or following the procedure. Once the fetus is viable, the procedure should be performed in a setting where an urgent cesarean delivery can take place if a complication occurs. It is useful to have the patient evaluated by the anesthesia team and prepared for a possible emergent delivery in that setting. Before the procedure, consideration should be given to administering prenatal steroids for fetal lung maturity.
Counseling
All cordocentesis procedures should be preceded by an extensive counseling session in which the indication, risks, benefits, and alternatives to the procedure are discussed.
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