Cordocentesis

Cordocentesis, [alternatively called as Percutaneous Umbilical Cord Blood Sampling (PUBS)], is a diagnostic procedure involving examining foetal blood to detect abnormalities. Cordocentesis is becoming unusual because diagnostic procedures like amniocentesis as well as chorionic villus sampling, which pose a lower risk of foetal mortality, can be utilised instead for prenatal diagnosis of disease.

Difference Between Amniocentesis and Cordocentesis

The key difference between amniocentesis and Cordocentesis is that amniocentesis utilises a sample of amniotic fluid, while Cordocentesis uses a blood sample of the umbilical cord.

What does Cordocentesis test for?

The test can aid in diagnosing certain conditions in a foetus:

Anaemia, a low number of healthy red blood cells.
Thrombocytopenia, a low number of platelets (blood particles that aid with clotting).
Blood disorders like foetal haemolytic disease when red blood cells break down rapidly.
Chromosomal abnormalities (inherited or random genetic mutations), like Down syndrome.
Infection, like toxoplasmosis or rubella.
Isoimmunization, when a pregnant mother's blood isn't compatible with the foetuses.

Who performs the cordocentesis procedure?

The procedure happens in an office or hospital, typically by an obstetrician, a specialist in pregnancy as well as childbirth.

Preparations before the Cordocentesis

Mother does not require a full bladder. An empty bladder is less uncomfortable.
Mother should bring someone along for moral support, and to drive home afterwards.
Mother can inform if she has any bleeding tendency, or if she is utilising any medicine (comprising low-dose aspirin or arnica).
Arrange to get sufficient relaxation.

How is Cordocentesis performed?

About half an hour to 1 hour prior to the procedure, mother might be given antibiotics to decrease the risk of a uterine infection. This is typically done through a tube inserted into a vein.

Health care provider will utilise ultrasound to determine the umbilical cord's location in uterus. Mother will lie on back on an exam table, and health care provider will put a special gel to belly. He or she will then utilise a tiny device called as an ultrasound transducer to depict baby's position on a monitor.

Thereafter, health care provider will clean belly. Sometimes medicine is given to prevent discomfort during the procedure, but usually it isn't required.

Guided by ultrasound, health care provider will insert a fine, hollow needle through abdominal wall and into mother's uterus. A small quantity of blood from the vein in the umbilical cord will be taken into a syringe, and the needle will be taken out.

Mother will require to lie still while the needle is put inside, and the blood is withdrawn. Mother might notice a stinging sensation when the needle enters skin, and mother might feel cramping when the needle enters uterus.

After the procedure

Post the blood sample is taken, mother might have cramping or a small amount of discomfort.
Health care provider will utilise an ultrasound or an external labour monitor to track baby's heart rate post the procedure.
While mother leaves for home, health care provider might advice resting for the remainder of the day. Mother will likely be able to commence routine activities the next day.
The sample of blood will undergo analysis in a laboratory. Test results are generally available within days.

When is Cordocentesis performed?

Cordocentesis is usually performed when other diagnostic methods such as amniocentesis, CVS, or ultrasound fail to provide sufficient information, or when their results are inconclusive. It is carried out after the 17th week of pregnancy.

Meaning of cordocentesis results

Cordocentesis is a precise diagnostic procedure capable of detecting chromosome abnormalities and specific blood disorders with a high level of accuracy. Although the chances of identification are high, this test does not estimate the severity of these disorders. This test also does not aid recognise neural tube defects.

Risks and side effects to the mother/baby

While Cordocentesis is regarded relatively safe, it is classified as an invasive diagnostic test associated with a greater risk of complications for the baby, including the possibility of death, compared to other procedures.

Cordocentesis carries potentially serious risks, comprising:

Foetal bleeding: The most predominant complication is bleeding from the site where the needle is inserted. If fatal foetal bleeding happens, healthcare provider may recommend the administration of blood products to the foetus.
Cord hematoma: An aggregation of foetal blood within the cord might happen during or post a cordocentesis. Majority of babies don't have signs or manifestations when this happens. However, some might develop a low heart rate for a short duration.
If the hematoma is stable, health care provider will keep an eye on the baby. If the hematoma isn't stable or if baby's heart rate doesn't recover, health care provider will advise an emergency caesarean delivery.
Decline of baby's heart rate: The baby's heart rate may for some duration decline succeeding Cordocentesis.
Infection: An uncommon occurrence following Cordocentesis, but it can potentially result in uterine or foetal infections.
Foetal-maternal bleeding: Foetal blood might move into maternal circulation in about 40 percent of procedures. The quantity of bleeding is usually small. This problem is more predominant when the placenta lies in the front of the uterus.
Transmission of maternal infection: If the mother is suffering from certain infections such as hepatitis B, hepatitis C, or HIV, they may be transmitted to the baby.
Death of an unborn baby: Cordocentesis poses a higher likelihood of foetal mortality compared to other prenatal diagnostic tests like chorionic villus sampling as well as amniocentesis. The probability is roughly 1 to 2 percent for a foetus that looks normal and is undergoing testing for genetic disorders.

Reasons to opt for Cordocentesis test or not!

The reasons to test or not differ from individual to individual, couple to couple, as well as physician to physician.

Conducting the tests and confirming the diagnosis provides mother with specific opportunities:

Pursue potent medical interventions that may exist.
Commence planning for a kid with special needs.
Commence addressing anticipated lifestyle alterations.
Identify support groups as well as resources.

To summarise, cordocentesis refers to an invasive prenatal procedure. It can get a sample of blood from a foetus's umbilical cord to determine blood disorders, infections, as well as genetic alterations. It can also be utilised to deliver medications or blood transfusions to a foetus. The procedure can cause complications, like early delivery by emergency C-section or miscarriage.

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