به نام خدا

1. به نام خدا

3. CVS Dr. Minoo Movahedi

4. CVS Prenatal diagnosis Chromosome & DNA Ten weeks TC & TA

5. TC – CVS Culture Needle Sterile Speculum Metal sond Syring 20 cc Media Tenaculom

6. TA - CVS Sterile Gel Sterile Probe Needle Syringe Media Holder P&D Long axis placenta

9. Multiple Gestations Monochromic Twins : single sample Dechorionic Twins : Separate placentas Ant : TA – CVS Post : TC – CVS Fused Placenta : Placental Margin insertion of Cord Follow up Amniocenteses : 6 %

10. CVS Indications DNA Karyotyping Mendelian disorder Increased maternal Age Screen down syndrome Family history Paternity Infections

11. Contraindications TC – CVS Vaginismus Cervical stenosis Cervical Myomas Cervical infection Lower segment myoma Sever antiflextion Retrofelxtion of Uterus

12. Contraindication of TA – CVS Sever uterine retroflextion With intestinal Loop Fetal position posterior Placenta

13. All type of CVS Maternal isoimmunization Fetomaternal Hemorrhage Erythroblustosis fetalis

14. CVS complications Damage or fetal loss < 28 w : 2.8 – 3.9 % >28 w : 3.9 – 4.2 % TC – CVS increased TA – CVS = Amniocentesis Prenatal mortality rate = 6-7% Rupture of membering 0.5 % Bleeding = 1/3 cases - 6% increased VB – 4% Hematoma Infection = 0.5 % chorioamnionitis , septic shock peritonitis

15. Placental Mosaicism Direct method (Trophoblasts ) Long term cultures (Mesechymal cells ) Specificity 99.9 % Sensitivity 99.6 % Increased IUGR

16. Limb reduction Defects and Oromandibular hypogenesis GA < 9 weeks Needle Experience

17. CVS failure obtained TC – CVS > TA – CVS Multiple insertion TC – CVS > TA – CV

18. Ob complications Controversy PIH Long term Out come No differences

19. TA & TC CVS TA CVS is preferable: Fetal loss decreased Bleeding decreased Infections decreased Multiple insertions decreased Success rate increased

20. CVS is safer than early Amniocentesis < 15 weeks

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