INTRODUCTION:The procedure may be conducted for diagnostic purpose or used as life saving therapeutic

measure. Te operator must have adequate skills and experience before undertaking the
procedure. Strict asepsis should be observed during all procedures. Except while performing
percutaneous vessel punctures and collecting capillary blood sample, sterile gown and gloves
must be worn.
MATERNAL PROCEDURE:Rapid advances in the field of perinatal medicine has led to introduction of several
procedures for antenatal diagnosis and fetal therapy . These procedure s are highly skill
oriented and must be performed by an experienced obstetrician. The availability of a real time
high precision ultrasound with a sector scanner is essential to guide these procedures. In all
diagnostic procedures, the benefit risk ratio must be carefully weighed and both mother and
fetus should not be exposed to unnecessary hazards.
AMNIOCENTESIS:Transabdominal amniocentesis is a relatively simple and safe procedure to collect a sample of
amniotic fluid.
Indication:1) Prenatal genetic diagnosis by estimation of alpha fetoproteins, chromosomal,
biochemical and molecular studies.
2) To assess the severity of Rh haemolytic disease.
3) To assess the maturity of the baby by estimation of creatinine content, orange staining
cells, lecithin to sphingomyelin ratio and phosphatidyl glycerol.
Procedure:

The procedure should preferably be avoided before 14 weeks of gestation due to the
high incidence of failure rate and greater chance of damage the fetus.
The procedure is best performed around 15-16 weeks of gestation. The placenta and
fetal parts must be localized by ultrasonography to minimize the risk of damage to the
placenta or fetus.
The procedure must be performed by a skilled operator, strict asepsis should be
ensured during the procedure.
Spinal needle with stylet is quite suitable, the puncture site should be determined by
palpating the fetal parts. The concavity or hollowness between the fetal head and
limbs on the ventral aspect of the fetus constitutes an ideal site if placenta does not
come in the way.
If uterus contracts while needle 1-2cm and wait until contractions subsides. In case
fresh blood is aspirated, it is better to abandon the procedure instead of manipulating
the needle. A discoloured fluid may indicate fetal death.

About 20ml of clear amniotic fluid should be withdrawn and collected in a sterile
bottle.

Complication:The procedure is quite safe, particularly when due care is exercised to avoid infection and
injury to the placenta. The recognized complication are listed below:1. Placenta bleeding an fetal death in 0.5-0.1% cases.
2. Feto-maternal haemorrhage with increased risk of Rh isoimmunisation. The risk can
be minimized by prophylactic administration of 50ug anti-D immunoglobulin before
the procedure in Rh- negative women.
3. Premature onset of labour
4. Amnionitis.
5. Rarely injury to the fetal parts may occur.
6. Postural deformities of limbs due to removal of amniotic fluid.

CHORIONIC VILLUS SAMPLING:Prenatal diagnosis by obtaining fetal tissue for chromosomal, biochemical and DNA studies
is being increasingly sought. In the past fetal cells were obtained by transabdominal
amniocentesis performed around 15-16 weeks of gestation. But now recently, chorionic villus
sampling(CVS) is gaining popularity especially for the study of those disorders which can be
diagnosed by DNA probes and restriction enzyme studies. Chromosomal and biochemical
analysis can be carried out directly on chorionic villus samples without the need for culture.
Indication:1) It is useful to screen the pregnancies of elderly mothers especially those with a
previous history of birth of a child with chromosomal and biochemical disorder.
2) The procedure is especially suitable for the internal diagnosis of thalassemia, sickle
cell disease, haemophilia, Duchennes muscular dystrophy and cystic fibrosis.
Procedure:It is a simple and relatively safe procedure which can be performed on an outpatient
basis. No operative preparation is required but mother should have to be full bladder
so that the gravid uterus is lifted up into the abdominal cavity.
The procedure is ideally performed between the narrow range of 10-12weeks of
gestation because risk of complications is much higher beyond these gestation.
The procedure must be performed by an experienced obstetrician who has mastered
the skill by practicing the procedure on women undergoing medical termination of
pregnancy.
The cervix is prepared with povidine-iodine . a polyethylene catheter of length 2128cm, diameter 0.1-2.0 mm fitted with a malleable wire obturator is inserted through
the cervix under continuous sonographic guidance.

The catheter tip is advanced till it lies within chorion frondosum, while the guide wire
is gently removed, the catheter is advanced by 0.5 cm to ensure that it stays within the
chorion.
A 20ml syringe filled with 5ml of tissue culture medium is attached to the catheter.
Gentle suction is applied and catheter is slowly withdrawn from the placental site till
catheter tip lies just above the internal os.
The patient is sent home shortly after the procedure and no antibiotics are prescribed.
The aspiration of 15-50 mg of trophoblastic tissue is considered as adequate. If the
aspirate is unsatisfactory or procedure is unsuccessful, upto three attempts may be
made by taking care each time a fresh sterile catheter is used.
Twin pregnancy is exclude and placental site is localized, and the other
contraindications include vaginitis, vaginal bleeding, severe ante or retro flexion of
uterus and rhesus iso-immunization.
Complications:1. The procedure is relatively safe in experienced hands especially when it is restricted
during 10-12 weeks of gestation.
2. The overall risk of abortion is around 1.0%. the other complications include
chorioamnionitis, sepsis and perforation of amniotic sac.

CORDOCENTESIS:The potentially dangerous techniques of fetal blood sampling (FBS) by placentocentesis and
fetoscopy has been replaced by cordocentesis or percutaneous umbilical blood sampling
(PUBS). Though technically difficult, it provides an uncontaminated sample of fetal blood
with acceptable risk of complications. The FBS can be obtained on several occasions after 17
weeks of gestation till delivery.
Indication:Fetal blood sample is required for prenatal diagnosis by undertaking rapid karyotyping and
DNA studies in a fetus showing an abnormality on ultrasound examination to establish
normal references values and indices of hematologic values, coagulation profile, biochemical,
immunologic, endocrinologic and acid base