Fetal cardiocentesis: A review of indications, risks, applications and technique
ABSTRACT To review the indications, applications and technique of fetal cardiocentesis.
Review of published case reports and case series of fetal cardiocentesis utilizing the PubMed search engine of the National Library of Medicine.
Case reports and case series demonstrate that fetal cardiocentesis may be an alternative method by which to facilitate prenatal diagnosis, intravascular therapy, multifetal and selective fetal reduction and in utero therapy of congenital heart disease. However, procedure-associated risk is higher than with cordocentesis and may limit use of this procedure.
Fetal cardiocentesis may be a reasonable option to obtain fetal intravascular access and facilitate therapeutic interventions when cordocentesis fails or is not feasible. However, expected benefit must clearly outweigh the procedure-associated risk.
Article: Fetal blood sampling[Show abstract] [Hide abstract]
ABSTRACT: We sought to review indications, technical aspects, risks, and recommendations for fetal blood sampling (FBS). A systematic review was performed using MEDLINE, PubMed, EMBASE, and Cochrane Library using the terms "fetal blood sampling," "percutaneous umbilical blood sampling," and "cordocentesis." The search was restricted to English-language articles published from 1966 through July 2012. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Evidence reports and guidelines published by organizations or institutions such as the National Institutes of Health, Agency for Health Research and Quality, American Congress of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. Grade (Grading of Recommendations Assessment, Development, and Evaluation) methodology was employed for defining strength of recommendations and rating quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. Ultrasound-guided FBS is the only procedure that provides direct access to the fetal circulation. When invasive testing is planned for suspected severe fetal anemia or thrombocytopenia, we recommend FBS as the procedure of choice, with availability of immediate transfusion if confirmed. We recommend against the use of FBS for indications in which other less invasive, and therefore lower risk, alternatives are available. The overall success rate of FBS is high, and blood samples can be obtained in >98% of patients. We suggest that counseling for FBS include discussion about the potential risk of FBS that may include, but may not be limited to: bleeding from puncture site (20-30%); fetal bradycardia (5-10%); pregnancy loss (≥1.3%, depending on indication, gestational age, and placental penetration); and vertical transmission of hepatitis or human immunodeficiency virus. We recommend that FBS be performed by experienced operators at centers with expertise in invasive fetal procedures when feasible.American journal of obstetrics and gynecology 09/2013; 209(3):170-80. DOI:10.1016/j.ajog.2013.07.014 · 3.97 Impact Factor
International journal of obstetric anesthesia 10/2010; 19(4):464-5. DOI:10.1016/j.ijoa.2010.06.003 · 1.83 Impact Factor
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ABSTRACT: The aim of this study was to perform fetal magnetic resonance angiography (MRA) in utero in a sheep model. Images of the great vessels, the heart, and the tracheal tree were performed on four pregnant ewes with a 1.5-T scanner (Philips Medical Systems, Best, The Netherlands). MRA was achieved in utero using a nontriggered free-breathing three-dimensional balanced fast field echo (FFE) technique. All obtained MRA images were evaluated in consensus on a three-point scale by two radiologists with 9 and 4 years of experience in fetal MRI, respectively. The fetal heart frequencies were between 130 and 160 bpm. The aorta from the aortic bulb to the bifurcation as well as some of the main aortic branches could be depicted. The pulmonary trunk and arteries, the superior and inferior caval veins, and the subsegmental branches of the trachea could also be visualized. The nontriggered MRA of the fetal great vessels with images of the tracheal tree allowed an excellent evaluation of anatomical structures.Japanese journal of radiology 12/2010; 28(10):720-6. DOI:10.1007/s11604-010-0498-x · 0.74 Impact Factor