The risks of early cordocentesis (12–21 weeks): Analysis of 500 procedures

Abstract

Five hundred cordocenteses were performed between 12 and 21 weeks. The indications were thalassaemia (386), rapid karyotyping (97), feto-maternal allo-immunization (10), rubella (6), and toxoplasmosis (1). One hundred and ten pregnancies underwent termination on the basis of the result, while 20 of the 370 pregnancies intended to continue were lost to follow-up. Amongst these were 16 fetal losses (4.3 per cent) and 22 premature deliveries (5.9 per cent); no other complications were reported. Four adverse prognostic factors were identified: (a) cord bleeding; (b) fetal bradycardia; (c) prolonged procedure time; and (d) anterior insertion of the placenta. There was no 'obvious' difference in fetal loss rate with advancing gestation until 19-21 weeks, when the risk of fetal loss decreased to 2.5 per cent.

Identification of mesenchymal stem/progenitor cells in human first-trimester fetal blood, liver, and bone marrow

“…First-trimester fetal blood represents a potentially harvestable source of autologous MSCs amenable to genetic manipulation and reinfusion in ongoing pregnancies. Indeed, fetal blood has been sampled in ongoing pregnancies from as early as 12 weeks, 41 and, with advances in embryofetoscopic cannulation techniques, 42 may become obtainable even earlier. We are currently assessing the possible use of fetal blood MSCs for in utero gene therapy for genetic disorders.…”

High transduction efficiency of circulating first trimester fetal mesenchymal stem cells: potential targets for in utero ex vivo gene therapy

“…Fetal interventional techniques under high resolution ultrasound have already developed to the extent that fetal blood sampling can be performed in ongoing pregnancies as early as 12 weeks with less than a 5% loss 6 . Advances in imaging and thin gauge fetoscopic cannulation should render mesenchymal stem cells harvest and intraperitoneal reinfusion feasible in the late first/early second trimester.…”

Cordocentesis: Overall Pregnancy Loss Rate as Important as Procedure Loss Rate

“…Reported success rates for cordocentesis range from 93.7 to 98.5% [2][3][4][5], An ultrasound-guided freehand technique with a 22-gauge needle is the most common technique, but use of a needle guide attached to the ultra sound transducer is reported [6], Cordocenteses are usually performed at a gestational age of greater than 18 weeks, but Orlandi et al [7] discuss earlier cordocentesis on 95 cases between 12 and 16 weeks gesta tion. Fetal losses at earlier gestational ages of 12-14, 15-16 and 17-18 weeks was 4.8, 5.7 and 5.2%, respectively, compared with 2.5% at 19-21 weeks.…”