Fetal blood sampling
- Alessandro Ghidini, MD
Alessandro Ghidini, MD
- Professor of Obstetrics and Gynecology
- Georgetown University Medical Center
- Section Editors
- Louise Wilkins-Haug, MD, PhD
Louise Wilkins-Haug, MD, PhD
- Section Editor — Prenatal Diagnosis and Genetics
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
Fetal blood sampling (FBS) refers to three techniques used to gain access to fetal blood: cordocentesis (also known as percutaneous umbilical blood sampling), intrahepatic blood sampling, and cardiocentesis. FBS is riskier than postnatal venipuncture and interpretation of results can be difficult because of the limited availability of normative fetal laboratory values across gestation.
The techniques for FBS can also be used for intravenous administration of medication or blood products (eg, platelets, red blood cells) to the fetus. (See "Intrauterine fetal transfusion of red cells" and "Overview of the general approach to diagnosis and treatment of fetal arrhythmias".)
Fetal blood is sampled to aid in the diagnostic evaluation of fetal disorders. A major difference between FBS and venipuncture in children and adults is the relatively high degree of procedure-related risk: FBS can have lethal complications. Since evaluation of amniocytes, chorionic villi, or maternal blood can often provide similar information as fetal blood, FBS should be limited to clinical situations in which use of lower risk diagnostic procedures (amniocentesis, chorionic villous sampling, maternal blood sampling) does not provide adequate or sufficiently timely diagnostic information .
The maternal abdomen is cleaned with an antibacterial solution and draped. Aseptic technique should be used.
Location — Prior to fetal viability, FBS can be performed in a room used for sonographic examinations or in a labor room. After viability, the procedure should be performed in proximity to an operating room since an emergency cesarean delivery may be required if nonreassuring fetal heart rate patterns develop during or after the procedure.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Society for Maternal-Fetal Medicine (SMFM), Berry SM, Stone J, et al. Fetal blood sampling. Am J Obstet Gynecol 2013; 209:170.
- Mouw RJ, Klumper F, Hermans J, et al. Effect of atracurium or pancuronium on the anemic fetus during and directly after intravascular intrauterine transfusion. A double blind randomized study. Acta Obstet Gynecol Scand 1999; 78:763.
- Weiner CP, Okamura K. Diagnostic fetal blood sampling-technique related losses. Fetal Diagn Ther 1996; 11:169.
- Bovicelli L, Orsini LF, Grannum PA, et al. A new funipuncture technique: two-needle ultrasound- and needle biopsy-guided procedure. Obstet Gynecol 1989; 73:428.
- Welch CR, Talbert DG, Warwick RM, et al. Needle modifications for invasive fetal procedures. Obstet Gynecol 1995; 85:113.
- Boupaijit K, Wanapirak C, Piyamongkol W, et al. Effect of placenta penetration during cordocentesis at mid-pregnancy on fetal outcomes. Prenat Diagn 2012; 32:83.
- Weiner CP. Cordocentesis for diagnostic indications: two years' experience. Obstet Gynecol 1987; 70:664.
- Weiner CP, Wenstrom KD, Sipes SL, Williamson RA. Risk factors for cordocentesis and fetal intravascular transfusion. Am J Obstet Gynecol 1991; 165:1020.
- Nicolini U, Nicolaidis P, Fisk NM, et al. Fetal blood sampling from the intrahepatic vein: analysis of safety and clinical experience with 214 procedures. Obstet Gynecol 1990; 76:47.
- Aina-Mumuney AJ, Holcroft CJ, Blakemore KJ, et al. Intrahepatic vein for fetal blood sampling: one center's experience. Am J Obstet Gynecol 2008; 198:387.e1.
- Chinnaiya A, Venkat A, Dawn C, et al. Intrahepatic vein fetal blood sampling: current role in prenatal diagnosis. J Obstet Gynaecol Res 1998; 24:239.
- Antsaklis AI, Papantoniou NE, Mesogitis SA, et al. Cardiocentesis: an alternative method of fetal blood sampling for the prenatal diagnosis of hemoglobinopathies. Obstet Gynecol 1992; 79:630.
- Westgren M, Selbing A, Stangenberg M. Fetal intracardiac transfusions in patients with severe rhesus isoimmunisation. Br Med J (Clin Res Ed) 1988; 296:885.
- Nicolaides KH, Clewell WH, Rodeck CH. Measurement of human fetoplacental blood volume in erythroblastosis fetalis. Am J Obstet Gynecol 1987; 157:50.
- Sipes SL, Weiner CP, Wenstrom KD, et al. The association between fetal karyotype and mean corpuscular volume. Am J Obstet Gynecol 1991; 165:1371.
- Forestier F, Cox WL, Daffos F, Rainaut M. The assessment of fetal blood samples. Am J Obstet Gynecol 1988; 158:1184.
- Ogur G, Gül D, Ozen S, et al. Application of the 'Apt test' in prenatal diagnosis to evaluate the fetal origin of blood obtained by cordocentesis: results of 30 pregnancies. Prenat Diagn 1997; 17:879.
- Sepulveda W, Be C, Youlton R, et al. Accuracy of the haemoglobin alkaline denaturation test for detecting maternal blood contamination of fetal blood samples for prenatal karyotyping. Prenat Diagn 1999; 19:927.
- Lazebnik N, Hendrix PV, Ashmead GG, et al. Detection of fetal blood contamination by amniotic fluid obtained during cordocentesis. Am J Obstet Gynecol 1990; 163:78.
- Chao A, Herd JP, Tabsh KM. The ferning test for detection of amniotic fluid contamination in umbilical blood samples. Am J Obstet Gynecol 1990; 162:1207.
- Orlandi F, Damiani G, Jakil C, et al. The risks of early cordocentesis (12-21 weeks): analysis of 500 procedures. Prenat Diagn 1990; 10:425.
- Daffos F, Forestier F, Kaplan C, Cox W. Prenatal diagnosis and management of bleeding disorders with fetal blood sampling. Am J Obstet Gynecol 1988; 158:939.
- Paidas MJ, Berkowitz RL, Lynch L, et al. Alloimmune thrombocytopenia: fetal and neonatal losses related to cordocentesis. Am J Obstet Gynecol 1995; 172:475.
- Gruel Y, Boizard B, Daffos F, et al. Determination of platelet antigens and glycoproteins in the human fetus. Blood 1986; 68:488.
- Takashima T, Maeda H, Koyanagi T, et al. Prenatal diagnosis and obstetrical management of May-Hegglin anomaly: a case report. Fetal Diagn Ther 1992; 7:186.
- Lorenz P, Bollmann R, Hinkel GK, et al. False-negative prenatal exclusion of Wiskott-Aldrich syndrome by measurement of fetal platelet count and size. Prenat Diagn 1991; 11:819.
- Ash KM, Mibashan RS, Nicolaides KH. Diagnosis and treatment of feto-maternal hemorrhage in a fetus with homozygous von Willebrand's disease. Fetal Ther 1988; 3:189.
- Bussel, J. Minutes of the Neonatal Subcommittee of the International Committee of Thrombosis and Hemostasis Working Party on Neonatal Alloimmune Thrombocytopenia, Brussels, Belgium, 1987.
- Hogge WA, Thiagarajah S, Brenbridge AN, Harbert GM. Fetal evaluation by percutaneous blood sampling. Am J Obstet Gynecol 1988; 158:132.
- Jauniaux E, Donner C, Simon P, et al. Pathologic aspects of the umbilical cord after percutaneous umbilical blood sampling. Obstet Gynecol 1989; 73:215.
- Chénard E, Bastide A, Fraser WD. Umbilical cord hematoma following diagnostic funipuncture. Obstet Gynecol 1990; 76:994.
- Nicolini U, Kochenour NK, Greco P, et al. Consequences of fetomaternal haemorrhage after intrauterine transfusion. BMJ 1988; 297:1379.
- Weiner C, Grant S, Hudson J, et al. Effect of diagnostic and therapeutic cordocentesis on maternal serum alpha-fetoprotein concentration. Am J Obstet Gynecol 1989; 161:706.
- Chitrit Y, Caubel P, Lusina D, et al. Detection and measurement of fetomaternal hemorrhage following diagnostic cordocentesis. Fetal Diagn Ther 1998; 13:253.
- Boulot P, Deschamps F, Lefort G, et al. Pure fetal blood samples obtained by cordocentesis: technical aspects of 322 cases. Prenat Diagn 1990; 10:93.
- Ludomirsky A, Weiner S, Ashmead GG, et al. Percutaneous fetal umbilical blood sampling: procedure safety and normal fetal hematologic indices. Am J Perinatol 1988; 5:264.
- Maxwell DJ, Johnson P, Hurley P, et al. Fetal blood sampling and pregnancy loss in relation to indication. Br J Obstet Gynaecol 1991; 98:892.
- Ghidini A, Sepulveda W, Lockwood CJ, Romero R. Complications of fetal blood sampling. Am J Obstet Gynecol 1993; 168:1339.
- Tongsong T, Wanapirak C, Kunavikatikul C, et al. Fetal loss rate associated with cordocentesis at midgestation. Am J Obstet Gynecol 2001; 184:719.
- Tongsong T, Wanapirak C, Piyamongkol W, et al. Second-trimester cordocentesis and the risk of small for gestational age and preterm birth. Obstet Gynecol 2014; 124:919.
- Antsaklis A, Daskalakis G, Papantoniou N, Michalas S. Fetal blood sampling--indication-related losses. Prenat Diagn 1998; 18:934.
- Bigelow CA, Cinelli CM, Little SE, et al. Percutaneous umbilical blood sampling: current trends and outcomes. Eur J Obstet Gynecol Reprod Biol 2016; 200:98.
- Liao C, Wei J, Li Q, et al. Efficacy and safety of cordocentesis for prenatal diagnosis. Int J Gynaecol Obstet 2006; 93:13.
- Srisupundit K, Wanapirak C, Piyamongkol W, et al. Comparisons of outcomes after cordocentesis at mid-pregnancy between singleton and twin pregnancies. Prenat Diagn 2011; 31:1066.
- Antsaklis A, Daskalakis G, Souka AP, et al. Fetal blood sampling in twin pregnancies. Ultrasound Obstet Gynecol 2003; 22:377.
- Cox WL, Forestier F, Capella-Pavlovsky M, Daffos F. Fetal blood sampling in twin pregnancies. Prenatal diagnosis and management of 19 cases. Fetal Ther 1987; 2:101.
- Patriarco MS, Viechnicki BM, Hutchinson TA, et al. A study on intrauterine fetal resuscitation with terbutaline. Am J Obstet Gynecol 1987; 157:384.
- Afschar P, Schöll W, Bader A, et al. A prospective randomised trial of atosiban versus hexoprenaline for acute tocolysis and intrauterine resuscitation. BJOG 2004; 111:316.
- Shalev E, Peleg D. Fetal cardiac resuscitation. Lancet 1993; 341:305.
- Antenatal glucocorticoids
- Intravenous access
- Antibiotic prophylaxis
- Maternal local anesthesia and sedation
- Fetal paralytic drugs
- Needle guide
- SAMPLING SITE
- Umbilical cord blood sampling
- Intrahepatic vein fetal blood sampling
- BLOOD SPECIMEN
- Confirmation of fetal blood
- NORMAL VALUES
- Cord hematoma
- Fetomaternal bleeding
- Failure rate
- Fetal loss
- Vertical transmission of infection
- Fetal anomalies
- Small for gestational age, preterm birth, and other complications
- MULTIPLE GESTATIONS
- IN-UTERO FETAL RESUSCITATION
- SUMMARY AND RECOMMENDATIONS