Percutaneous Umbilical Blood Sampling: Indication Changes and Procedure Loss Rate in a Nine Years’ Experience

Abstract

A 9 years’ experience with percutaneous umbilical blood sampling (PUBS) has been appraised. A total number of 1,272 procedures have been performed in our institution between 1986 and 1994; 861 before the 24th week of gestation and 411 after 24 weeks. The indications for PUBS changed throughout these years because of the rapid evolution of molecular biology and because of the fact that certain conditions can now be diagnosed at earlier stages of gestation by chorionic villi sampling and amniocentesis. Sampling at a later gestational age reflected changes in indications. PUBS loss rate has been calculated for 482 fetuses less than 24 weeks, retrospectively found to be negative for the suspected condition and has been related to gestational age, duration of the procedure and number of needle insertions. Total procedure-related loss rate was 2.3%: 1.6% intrauterine fetal deaths within 48 h of the procedure and 0.7% spontaneous abortions in the 2 weeks following the procedure. Gestational age at the time of the procedure and duration of the procedure were significantly related to fetal losses within 48 h.

Will it ever be possible to balance the risk of intracranial haemorrhage in fetal or neonatal alloimmune thrombocytopenia against the risk of treatment strategies to prevent it?

“…This search revealed five eligible articles [14,15,54–56], and seven more were added from the reference lists [57–60] or provided from our own database [7,61,62]. Complications of cordocentesis were divided into procedure‐related fetal/neonatal loss or procedure‐related fetal haemorrhage of the umbilical cord, persistent fetal bradycardia requiring emergency Caesarean section, premature rupture of membranes and/or intrauterine infection.…”

Effect of placenta penetration during cordocentesis at mid‐pregnancy on fetal outcomes

“…Therefore, it is one of the most important procedures in prenatal diagnosis and therapy. Although the procedure is relatively safe in experienced hands, it can be associated with a significant fetal risk, such as fetal loss (procedure‐related fetal loss) of about 0.2–3.2% . The factors affecting the safety of cordocentesis are yet to be investigated.…”

Developing recombinant HPA-1a–specific antibodies with abrogated Fcγ receptor binding for the treatment of fetomaternal alloimmune thrombocytopenia

“…There is no consensus on the most effective antenatal therapy for FMAIT (13). Intrauterine transfusions (IUTs) of HPA-1a -platelets are a logistical challenge (14), and the risk of fetal loss is up to 15% (15)(16)(17)(18). Several trials have shown the benefit of intravenous immunoglobulin (IVIG) therapy, but in 50% of patients with severe disease (ICH in the previous pregnancy or an initial fetal platelet count of fewer than 20 × 10 9 /l), IVIG therapy does not achieve a safe fetal platelet count (19)(20)(21)(22)(23).…”