Name of the Procedure:

Cordocentesis (intrauterine), also known as Percutaneous Umbilical Cord Blood Sampling (PUBS).

Summary

Cordocentesis is a prenatal diagnostic procedure in which a sample of the baby's blood is taken from the umbilical cord while the baby is still in the uterus. This procedure helps diagnose certain fetal conditions and can be used to manage fetal health.

Purpose

Cordocentesis is used to diagnose and treat several genetic conditions, blood disorders, and infections in the fetus. The goals are to confirm a suspected diagnosis, determine the severity of a condition, and guide further medical management.

Indications

• Abnormalities detected in ultrasound or other prenatal tests.
• Suspected fetal anemia or other blood disorders.
• Genetic testing when chorionic villus sampling (CVS) or amniocentesis results are inconclusive.
• Suspected fetal infection (e.g., toxoplasmosis, cytomegalovirus).
• Isoimmunization (Rh disease).

Preparation

• The patient may be advised to eat lightly and drink fluids before the procedure.
• A complete blood count (CBC) and coagulation profile (to ensure normal blood clotting) might be required.
• An ultrasound is done to determine the position of the fetus and the umbilical cord.

Procedure Description

1. The patient lies on an exam table, and an ultrasound is performed to locate the umbilical cord.
2. The abdomen is cleaned with an antiseptic solution.
3. Local anesthesia is administered to numb the abdominal area.
4. Using ultrasound guidance, a thin needle is inserted through the abdomen and into the umbilical cord vein.
5. A small sample of the baby's blood is drawn and sent for analysis.
6. The needle is withdrawn, and the site is monitored for any bleeding or complications.

Duration

The procedure typically takes about 30-60 minutes.

Setting

Cordocentesis is performed in a hospital, often in a specialized prenatal diagnostic center.

Personnel

• Maternal-fetal medicine specialist (obstetrician specializing in high-risk pregnancies)
• Ultrasound technician
• Nurse
• Possibly an anesthesiologist if sedation is used.

Risks and Complications

• Bleeding at the puncture site.
• Infection.
• Fetal distress or bradycardia (slow heart rate).
• Premature rupture of membranes.
• Preterm labor.
• Fetal loss (though rare, the risk is present).

Benefits

• Provides critical information for diagnosing fetal conditions.
• Enables targeted interventions and treatments.
• Can improve outcomes by allowing early and appropriate management of fetal health issues.

Recovery

• The patient is monitored for a short period after the procedure for any immediate complications.
• Rest is usually advised for the remainder of the day.
• Follow-up ultrasound may be performed to ensure the fetus is not in distress.
• The patient should report any unusual symptoms such as severe pain, fluid leakage, or bleeding.

Alternatives

• Amniocentesis: Useful for genetic studies and detecting fetal infections but generally performed earlier in pregnancy.
• Chorionic Villus Sampling (CVS): Another prenatal test for genetic conditions but limited to early second trimester.
• Non-invasive prenatal testing (NIPT): A blood test from the mother that can detect certain genetic abnormalities without risk to the fetus.
• Each alternative has different levels of risk, accuracy, and timing considerations.

Patient Experience

• The patient may feel initial discomfort similar to a typical needle puncture, and some cramping during and after the procedure.
• Pain management typically involves local anesthesia, and over-the-counter pain relievers may be recommended post-procedure.
• Emotional support from healthcare providers and family is crucial due to the stressful nature of the procedure.

This markdown content provides a comprehensive overview of Cordocentesis (intrauterine), ensuring patients and healthcare providers have clear, accessible information.