Percutaneous umbilical blood sampling: Results from a multicenter collaborative registry Durtin E. Hickok, MD, MPH: Marlin Mills, MD: and the Western Collaborative Perinatal Group Seattle, Washington, and Phoenix, Arizona Percutaneous umbilical blood sampling has become an important diagnostic tool in the evaluation of fetal health. Although recent reports have established the safety of this procedure, most have arisen from single centers with extensive experience. The Western Perinatal Collaborative Group has maintained a continuous registry of percutaneous umbilical blood sampling performed at the 13 member institutions for the years 1986 through 1990. During this period 302 procedures were performed. Primary indications for percutaneous umbilical blood sampling included Rh and non-Rh isoimmunization, intrauterine growth retardation, nonimmune hydrops, fetal anomalies, immune thrombocytopenia purpura, and rapid fetal chromosome analysis. Percutaneous umbilical blood sampling was successfully performed in 93.7% of cases with a sample withdrawn by a single puncture in 80.5% of attempts. In the majority of cases a 22-gauge needle was used. Postprocedural fetal death resulted in six cases (2.1%) and was most often associated with fetal anomalies or an abnormal karyotype. In conclusion, evaluation of the fetal state by percutaneous umbilical blood sampling is a safe and easily performed procedure, as demonstrated by a collaborative multicenter study. (AM J DesTET GVNECOL 1992;166:1614-8.)
Key words: Percutaneous umbilical blood sampling, fetal anomalies, Rh isoimmunization
Material and methods
Percutaneous umbilical blood sampling has become an increasingly more important and frequently performed diagnostic procedure in evaluating fetal health. I -' This relatively new technology has also allowed more direct access to the fetus for treatment in conditions such as Rh isoimmunization" Although fetal bradycardia and uterine irritability are recognized transient side effects of percutaneous umbilical blood sampling; serious complications such as fetal death appear to be quite uncommon. The safety of the procedure, however, has largely been established from studies originating from single centers with extensive experience of only a few operators. As tertiary level perinatal centers in the United States have greatly increased over the last decade, invasive obstetric procedures are now performed at a large number of locations, quite in contrast to the more centralized experience reported in other countries. 6 -s We conducted a multicenter investigation to assess the safety of the procedure.
The Western Perinatal Collaborative Group is a nonprofit research organization that maintains a registry of invasive obstetric procedures performed at its 13 member institutions. Each institution performed percutaneous umbilical blood sampling by its own method, and a protocol for the procedure was neither developed nor suggested. During the time period of 1986 through 1990, a total of 302 procedures were attempted for diagnostic purposes at six of the 13 institutions. Data were collected on standardized forms and included information regarding indications for the procedure, technical details, ultrasonographic findings, tests performed, procedure-related complications, and perinatal outcome. For the purpose of common reporting, we used 3 days after the procedure as the definition of an intrauterine death. Statistical analysis was performed with the Statistical Program for the Social Sciences.
From the Center for Perinatal Studies, Swedish Hospital Medical Center and Departments of Epidemiology and Obstetrics and Gynecology, University of Washington,' and the Good Samaritan Medical Center.' Pnsented at the Fifty-eighth Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, Ashland, 01-egon, September 9-12,1991. Reprint requests: Durlin E. Hickok, MD, MPH, Center for Perinatal Studies, Swedish Hospital Medical Center, 747 Summit Ave., Seattle, WA 98104. 6/6/37492
During the study period, 302 percutaneous umbilical blood sampling procedures were attempted between 16 and 39 gestational weeks for a variety of indications (Table I). The most frequent reasons included Rh isoimmunization, idiopathic thrombocytopenia, nonimmune hydrops, fetal anomalies, and idiopathic thrombocytopenia purpura. Of the 302 procedures, 283 were accomplished, for a success rate of 93.7%.
1614
Results
Percutaneous umbilical blood sampling
Volume 166 Number 6. Part I
The procedure was performed most frequently with a 22-gauge needle (81.6% of cases) and next most commonly with a 20-gauge needle (15.6% of cases). A 25gauge needle was used in
Key words: Percutaneous umbilical blood sampling, fetal anomalies, Rh isoimmunization
Material and methods
Percutaneous umbilical blood sampling has become an increasingly more important and frequently performed diagnostic procedure in evaluating fetal health. I -' This relatively new technology has also allowed more direct access to the fetus for treatment in conditions such as Rh isoimmunization" Although fetal bradycardia and uterine irritability are recognized transient side effects of percutaneous umbilical blood sampling; serious complications such as fetal death appear to be quite uncommon. The safety of the procedure, however, has largely been established from studies originating from single centers with extensive experience of only a few operators. As tertiary level perinatal centers in the United States have greatly increased over the last decade, invasive obstetric procedures are now performed at a large number of locations, quite in contrast to the more centralized experience reported in other countries. 6 -s We conducted a multicenter investigation to assess the safety of the procedure.
The Western Perinatal Collaborative Group is a nonprofit research organization that maintains a registry of invasive obstetric procedures performed at its 13 member institutions. Each institution performed percutaneous umbilical blood sampling by its own method, and a protocol for the procedure was neither developed nor suggested. During the time period of 1986 through 1990, a total of 302 procedures were attempted for diagnostic purposes at six of the 13 institutions. Data were collected on standardized forms and included information regarding indications for the procedure, technical details, ultrasonographic findings, tests performed, procedure-related complications, and perinatal outcome. For the purpose of common reporting, we used 3 days after the procedure as the definition of an intrauterine death. Statistical analysis was performed with the Statistical Program for the Social Sciences.
From the Center for Perinatal Studies, Swedish Hospital Medical Center and Departments of Epidemiology and Obstetrics and Gynecology, University of Washington,' and the Good Samaritan Medical Center.' Pnsented at the Fifty-eighth Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, Ashland, 01-egon, September 9-12,1991. Reprint requests: Durlin E. Hickok, MD, MPH, Center for Perinatal Studies, Swedish Hospital Medical Center, 747 Summit Ave., Seattle, WA 98104. 6/6/37492
During the study period, 302 percutaneous umbilical blood sampling procedures were attempted between 16 and 39 gestational weeks for a variety of indications (Table I). The most frequent reasons included Rh isoimmunization, idiopathic thrombocytopenia, nonimmune hydrops, fetal anomalies, and idiopathic thrombocytopenia purpura. Of the 302 procedures, 283 were accomplished, for a success rate of 93.7%.
1614
Results
Percutaneous umbilical blood sampling
Volume 166 Number 6. Part I
The procedure was performed most frequently with a 22-gauge needle (81.6% of cases) and next most commonly with a 20-gauge needle (15.6% of cases). A 25gauge needle was used in
