Cordocentesis and IUT - History • 1963 - First intraperitoneal transfusion (Liley) • 1974 - Fetoscopy to obtain fetal samples (Hobbins, et al) • 1981 - Fetoscopic transfusion (Rodeck, et al) • 1982 - First ultrasound guided IUT (Bang, Bock & Troll) • 1983 - First large study of IUT - 66 cases (Daffos, et al)
Why Cordocentesis? • Identify genetic disorders if amniocentesis or Chorionic Villi Sampling unsuccessful or inconclusive. • Detect fetal blood disorders such as hemophilia, anemia, and blood oxygen levels. • Detect viral infections (rubella, toxoplasmosis, cytomegalovirus). • Recommended for mothers known to be sensitized to Rh factor .
Procedure • Usually performed as outpatient. • Mother provided a sedative to reduce her and fetus movement. • Fetus may be injected with medicine to stop movement. • Mother may be given antibiotics to prevent infection or preterm labor. • Local anesthetic is injected into abdomen. • Ultrasound is used to locate placental cord insertion. • Ultrasound imaging guides needle insertion into umbilical vein. • Small amount of blood is withdrawn.
Risks/Complications of Cordocentesis • Fetal Loss - risk variable depending on condition of fetus, overall 1-2%, range <1% - 50%. • Bradycardia - common but usually transient(3-12%). • Bleeding - usually transient and mild(50%) • Preterm Labor
Risks/Complications • Preterm Rupture of Membranes • Infection – lower than 1% • Cord Hematoma - rare, much more common with infusions. • Maternal Alloimmunization - largely preventable with Rhogam. • Failed Procedure- 5 – 9 %