Current status of percutaneous umbilical cord blood sampling in Japan

Abstract

Aim: The aim of the survey is to investigate current practice and complications of percutaneous umbilical cord blood sampling (PUBS) in Japan. Methods: In this retrospective survey, data including perioperative information, indications, details of the procedure and procedure-related complications were collected for patients who underwent PUBS between 2012 and 2016 in Japanese perinatal care centers. Results: One hundred and fifty-three patients underwent PUBS and a total of 223 procedures were analyzed in this study. Fetal anemia was the most common indication for PUBS, representing greater than 70% of all cases. Anemia specific to monochorionic twins, such as acute feto-fetal hemorrhage subsequent to single intrauterine fetal death (IUFD) and twin anemia-polycythemia sequence, were the leading causes of suspected fetal anemia. Maternal anesthetics were given during the procedure in 70% of cases. The PTC needle (Hakko, Japan) was most commonly used in the procedure. The most frequent complication was bleeding from the umbilical cord puncture site; however, it did not require immediate delivery during or after the procedure in any case. IUFD occurred in 11 (4.9%) procedures, 7 of which appeared to be related to the underlying fetal disease. The overall completion rate of the procedure was 97%. Conclusion: Percutaneous umbilical cord blood sampling was most commonly performed for the evaluation of fetal anemia, usually due to complications of monochorionic twins, followed by the measurement of fetal thyroid function. The safety and the completion rate of the procedure in Japan appear satisfactory.

Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

“…The "no procedure" rate of miscarriage (with post 12-14 weeks of gestation viability) is reported at 0.65-0.70% [11-15, 20, 21]. The cordocentesis procedure risk in complex noninfected cohorts was variable and based on the fetal physiology at the time of the procedure (fetal anemia 2.0%, no hydrops 3.2%, immune fetal hydrops 9.1%, nonimmune fetal hydrops 31.7%) [23][24][25].…”

“…Cordocentesis for "at-risk" fetal anemia cohorts as the testing indication reported 223 procedures in 153 pregnancies, with fetal loss in 11 cases, but 7 losses were identified as disease-related (95% CI 1.4-2.7; 4/223 [1.7%]) [24]. A fetal hemoglobinopathy cohort (case-control) with 5,506 cordocentesis cases reported a fetal loss rate of 1.9 vs. 1.0% (RR 1.9, 95% CI 1.4-2.7) [25].…”

New challenges of fetal therapy in Japan

“…37 In addition, in 2020, IUT, which remains the oldest type of fetal therapy, was the fourth fetal therapy to be approved for coverage by Japan National Health Insurance based on the findings of recent studies. 38,39 In the past 20 years, we have been engaged in clinical research of existing fetal therapies in Japan to establish them as standard prenatal care with the approval of National Health Insurance coverage. As a result, FLS, TAS, RFA, and IUT have become standard prenatal treatments in Japan.…”

Nationwide survey of intrauterine blood transfusion for fetal anemia in Japan

“…Percutaneous umbilical blood sampling (PUBS) is the procedure performed just before IUT to assess fetal anemia. Recently, the current status of PUBS in Japan was revealed, 8 leading to the approval of PUBS and IUT for coverage by Japan National Health Insurance. IUT is now the fourth fetal treatment covered by National Health Insurance in Japan, following fetoscopic laser surgery for twin–twin transfusion syndrome, thoracoamniotic shunting for fetal hydrothorax, and radiofrequency ablation for twin reversed arterial perfusion 9 .…”