Ultrasound-guided Invasive

procedures in obstetrics

dr. Hariyasa Sanjaya, SpOG(K) MARS

Division of Maternal and Fetal

Department of Obstetrics and Gynecology
Sanglah Hospital
Diagnostic Procedures in the
1st Trimester
CVS : under continuous sonographic visualization of
the catheter in which chorionic villi are aspirated from the
developing placenta.
Early Amniocentesis : an aspiration needle is
guided into the amniotic fluid under continuous
sonographic guidance. It is sometimes difficult to
puncture both chorion and amnion in 13 16 W
pregnancies
Retrieval of tissue for karyotyping

(Arthur C. Fleischer, 2004)

 Chorionic Villous Sampling
Major Indications :
1. Maternal age : 35 years at delivery
2. Previous child with non-disjunction
chromosome abnormality
3. Parent is carrier of balanced translocation or
other chromosome disorder
4. Both parents are carriers of a sex-linked
disease
5. Positive 1st trimester screen for trisomy-21 or
18
 CVS : the procedure
Procedure related anatomy
Sampling technique
Transcervical sampling
Transabdominal CVS
Confirmation of adequate tissue
retrieval : visual inspection of the
syringe contents or by dissecting
microscope
 Risk Associated with CVS
Bleeding : 7-10% transcervically
Infection : 0.3% of pregnancy loss
Ruptured membranes : very rare
Elevated MSAFP : transient
Rh Isoimmunization : Rh (-) women should
receive Rho (D) immunoglobulin
Pregnancy loss : 2-3%
Risk of fetal abnormalities after CVS : limb
deformities
Perinatal risks and impact on long-term
development of the infant
Amniocentesis
Indications of amniocentesis
Late 1st and 2nd trimester diagnosis :
cytogenetic diagnosis, diagnosis of NTD, diagnosis
of metabolic disorders

Late 2nd and 3rd trimester : evaluation of the

severity of isoimmunization, fetal lung maturity,
diagnosis of intra amniotic infection, confirmation of
ruptured membranes

Therapeutic : drainage of polyhydramnios, medical

treatment of fetal disorders
 Technical aspects of the
procedure
Gestational age : 15 18 W
Needle selection : 20 22 G
Ultrasound
Operative technique : insertion of the
transducer into a sterile glove
Volume of amniotic fluid : 8 45 cc (20
25 cc)
 Intraoperative complications
Membrane tenting : separation of the
chorioamniotic membrane from the anterior
uterine wall during needle insertion
Multiple needle insertions
Bloody taps
Fetomaternal transfusion : Kleihauer-Betke
test
Discolored amniotic fliod : brown, green
FETAL BLOOD SAMPLING
 Indications of FBS
Cytogenetic diagnosis
Congenital infections : TORCH, parvovirus
Preterm labor and premature rupture of
membranes
Congenital immunodeficiency
Coagulopathy : hemophylia A and B
Platelet disorders
Hemoglobinopathies
IUGR
Fetal therapy
 Techniques of Fetal Blood
Sampling
Cordocentesis
Intrahepatic FBS
Cardiocentesis
Quality control of the specimen
Duration of the procedure
Training
Normal value for fetal blood :
erythroblast count
 Complications of FBS
Fetal losses : 1.4%
Hemorrhage : bleeding from the puncture site
: 41 53%, with a mean duration of 35 second
Cord hematoma : 17%
Bradicardia : transient (12%)
Fetomaternal hemorrhage
Abruptio placentae
Preterm delivery : 7%
Fetal resuscitation
 Ultrasound-Guided Fetal
Invasive Therapy
Fetal uropathy : obstructive uropathy
Fetal surgery : pulmonary hypoplasia,
diaphragmatic hernia
Evaluation of renal function
Hydrocephalus
Isolated pleural effusions : fetal
pleuroamniotic shunting
Bronchogenic cyst
Invasive therapy for NTD