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.
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- 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