OB/GYN ultraosund guided procedures Flashcards
What is percutaneous umbilical blood sampling (PUBS?
- aka cordocentesis
- smapling of blood via the vein in the umbilical cord
- a diagnostic test that examines blood from the fetus to detect fetal abnormalities
PUBS procedure?
- advanced imaging U/S determines location of umbilical cord insertion into the placenta
- ultrasound guides a thin needle through the abdomen and uterine walls to the umbilical cord
- needle is inserted into umbilical cord to retreieve a small sample of fetal blood
- sample sent to lab for analysis and results are usually available within 72 hrs
- simular to amniocentesis except the objectibe is to receive blood from fetus versus amniotic fluid
when is a PUBS test performed?
when diagnostic information can not be obtained through amniocentesis, CVS, ultrasound or the results of these tests were inconclusive
when is cordocentesis performed?
after 17 weeks into pregnancy
PUBS risk? (6)
- miscarriage is the primary risk (occurs 1-2 times out of every 100 procedures)
- Blood loss from the puncture site
- Cord hematoma
- Infection
- Drop in fetal heart rate
- Premature rupture of membranes
what does PUBS detect?
- chromosome abnormalities and blood disorders
PUBS may be performed to help diagnose what? (5)
Malformations of the fetus Fetal infection (i.e. toxoplasmosis or rubella) Fetal platelet count in the mother Fetal anemia Isoimmunisation – Rh compatibility
how is PUBS different from amniocentesis?
it does not allow testing for neural tube defects
renatal testing- reasons to test?
- pursue potential medical interventions that may exist
- begin planning for a child with special needs
- start addressing anticipated lifestyle changes
- identify support groups and resources
- make a decision about carrying the child to term
why might parents decline prenatal testing?
- personal or religious reasons where terminating the pregnancy is not an option
- outcome has no impact on their comfort level
- avoid risk of miscarriage or injury to fetus
what is coelocentesis?
- sampling of fluid from the exocoelomic cavity
- endovagninal approach
- prenatal diagnosis at 7 weeks
disadvantages of coelocentesis?
- coelomic calls difficult to culture
- nuchal lucency + lab as accurate
- procedure safety
what is culdocentesis?
- fluid is aspirated from the posterior cul-de-sac
culdocentesis findings? (3)
blood: intraperitoneal bleeding
pus: infectious process
serous: ascitic fluid
culdocentesis indications?
- large collection of fluid in the posterior col-de-sac
culdocentesis contraindications? (4)
- masses
- cysts
- fixed retroverted uterus
- bleeding diathesis
culdocentesis procedure?
- sterile procedure
- informed consent obtained
- patients must sit or stand for 10-15 mins prior to procedure
- topical anethetic applied to posterior vagina and cervix
- lithotomy position, head elevated 60 degrees
- speculum inserted
- vagina and cervix cleansed with iodine
- tenaculum used to grasp cervix
- 18G needle attached to 20mL syringe instered through the posterior vaginal wall into posterior cul-de-sac
- peritoneal fluid aspirtated
culdocentesis complications?
- puncture pelvic nerves
- puncture vessels
what is Hysterosonography &Hysterosonosalpingography?
- procedure used to improve or further evaluate the visualization of the uterus, endometrial canal, and tubal patency
- typically performed 4-10 days into patients menstrual cycle
Hysterosonography &Hysterosonosalpingography indications? (6)
- infertility
- recurrent miscarriage
- endometrial polyps, hyperplasia, carcinoma
- AUB/ pre and postmenopausal
- submucosal fibroids
- uterine anomalies
Hysterosonography &Hysterosonosalpingography contraindications?
- pregnancy
- pelvic infections
- excessive vaginal bleeding
Hysterosonography &Hysterosonosalpingography prior to procedure?
- NSAID 1 hr prior
- patient consent obtained
- empty bladder
- per procedural engovaginal images taken
what pre procedural endovaginal images are taken prior to Hysterosonography &Hysterosonosalpingography?
- uterus and cervical position
- size of uterus
- endometrial thickness
- rt and lt adnexa
- r/o hydrosalpinx/ PID
Hysterosonography &Hysterosonosalpingography during procedure?
- speculum is placed into vagina
- swab with iodine is used to clean cervix
- catheter is placed into the cervical os to access uterine cavity
- speculum is removed
- saline is injected slowly into uterus
- sag and trv images and cine clips are taken during procedure
Hysterosonography &Hysterosonosalpingography diagnosis (4)?
- endometrial polyps
- submucosal fibroids
- asherman syndrome (uterine synechiae)
- tubal patency
Hysterosonography &Hysterosonosalpingography complications? (7)
Pain Cramping Spotting / light bleeding Watery discharge Nausea Vasovagal Infection
Hysterosonography &Hysterosonosalpingography failed attempts (4)?
- severe cervical stenosis
- pelvic pain
- vagal symptoms
- fear of procedure
what is amniocentesis?
- prenatal test where amniotic fluid is removed from amniotic cas by FNA
how much fluid is drawn in amniosentesis?
- less than 1 ounce of amniotic fluid
- body make more fluid therefore no harm done
what is amniocentesis used for?
- the infusion of dye (indigo carmine) to evaluate for rupture of membranes
- Amniocentesis with the infusion of fluids (amnioinfusion) has been used in cases of oligohydramnios for therapeutic reasons or to improve visualization
Amniotic fluid can help determine what? (7)
- Used to obtain amniocytes for fetal karyotype
- Prenatal genetic diagnosis of specific disorder
- Evaluation for neural tube defects
- Evaluation for infection
- Determination of fetal lung indices
- Determination of degree of fetal anemia
- Therapeutic amniocentesis for polyhydramnios
optimal time during pregnancy for amniocentesis?
- 15-20w GA
genetic testing should be done when? (4)
- positive result from prenatal scanning
- chromosomal or neural tube defect in previous pregnancy
- > 35 years old
- family hystory of specific genetic condition
why should maturity testing be done? and when?
- to determine if the lungs have matured enough for birth
- only done is early delivary or c-section is taking place
- between 32-39 weeks
resons for amniocentesis? (5)
- genetic testing
- maturity testing
- infection or illness
- decrease amnitotic fluid amount
- evalutate serverity of anemia in babies with Rh sensitization
your doctor may advise against amniocentesis is? (3)
- placenta problems
- history of preterm labour
- incompetent cervix
risk/complications of amniocentesis?
- miscarriage
- leaking amniotic fluid
- bleeding
- membrane rupture
- preterm labour
- Rh sensitization
- needle injury
- infection and infection transmission
amniocentesis pre-procedure?
- informed consent
- done in an out-patient facility or healthcare provider’s clinic
- bring along someone for moral support and to drive you home
- <20 w GA- full bladder
- > 20w GA- empty blasser
- lay on back with abdo exposed, u/s done to demonstrate position of fetus
- takes approximately 20-30 mins
amniocentesis pre-procedure?
- informed consent
- done in an out-patient facility or healthcare provider’s clinic
- bring along someone for moral support and to drive you home
- <20 w GA- full bladder
- > 20w GA- empty blasser
- lay on back with abdo exposed, u/s done to demonstrate position of fetus
- takes approximately 20-30 mins
anesthetic used in amniocentesis?
- povidone-iodine (betadine) or chlorhexidine
- topical anestheic where needle is inserted
needle for amniocentesis?
- 22G
- 3.5 inch spinal needle
20G used sometimes for therapeutic reasons later in GA
5-7 inch needles may be required in obese people
how is amniocentesis preformed?
- needle inderted
- once in amniotic cavity, the stylet is removed and a syringe is attached to the needle
- amniotic fluid if extracted into syringe
- needle slowly removed
- fetal cardiac activity is documented before the patient leaves the room
- Rh0(D) immune globulin (RhoGAM) should be given for Rh-negative mothers after amniocentesis is complete
- Appropriate cleaning and sterilization techniques used to clean the room and the equipment
what should be given for Rh- negative mothers after amniocentesis is complete?
Rh0(D) immune globulin (RhoGAM)
amniocentesis post-procedure?
- A stinging sensation may be felt where the needle was inserted and withdrawn from
- A cramping feeling may be felt from the needle puncturing the uterus
- A post-procedure ultrasound will be done to monitor the fetal heart rate
- Vaginal bleeding may follow the completion of the procedure
- No strenuous physical activity is to be done 2-3 days afterward
If any of these symptoms persist after an amniocentesis, contact your doctor (6)?
- Persistent fluid leaking from vagina
- Heavy vaginal bleeding
- Abdominal pain uterine cramping that lasts more than a few hours
- Fever
- Redness and inflammation where the needle was inserted
- Unusual fetal activity or a lack of fetal movement
results of amniocentesis?
- The cells extracted from the amniotic fluid can be tested directly or grown in cultures
- Generally, the results will be available within 10-14 days following the procedure
- For specific analysis – such as Trisomy 21, 18, or 13 – information can be gathered sooner using fluorescence in situ hybridization (FISH)
what is chorionic villus sample (CVS)?
a prenatal test that involves taking a sample of fetal cellsfrom the tissue of the placenta under the guidance of an ultrasound scan.
- These cells are taken from tiny finger-like projections on the placenta called the chorionic villi
- The amniotic sac where your baby is growing will not be disturbed
- Samples are then sent to a lab for genetic analysis
purpose of CVS? (3)
- Assess the fetal karyotype
- Biochemical test of fetal cells for evaluation of disease status
- Detectsmore than 200 genetic disorders including
CVS detects more than 200 genetic disorders including? (2)
- Trisomy 13, 18, 21
- tay-sachs disease
what is CVS persormed?
between 10-13 weeks of pregnancy
in CVS successful genetic diagnosis is obtained in what % of cases?
99.7%
indications for CVS?
- early u/s showed fetus has structural defects associated with chromosomal abnormality
- mom or dad are both carriers of a recessive genetic disorder (cystic fibrosis/sickle cell disease)
- previous pregnancy with genetic abnormality
- family history
- increased maternal age >35
what are the 2 tequniques used to acquire CVS?
- transcervical CVS
- transabdominal CVS
- placental location dictates approach
when is transcervical approach used?
posterior and low placentas
when is transabdominal approach used?
fundal and anterior placentas
For either technique, an ultrasound is performed prior to the procedure to? (3)
- measure size of baby
- document location of placenta
- obtain HR
transcervical CVS procedural steps?
- speculum inserted into vagina
- cervix cleansed with antiseptic (betadine or chlorhexidine)
- 5.7 Fr flexible CVS cannula with a rigid metal introducer is guide into placenta under u/s guidance
- introducer withdrawn and a 20-cc syringe with 2mL of cell-transport is connected to cannula
- suction applied to cannula as it is slowly withdrawn from placenta
- once withdrawn suction is applied as the cannula is withdrawn from uterus and cervix
- remainder of cell-transport medium is drawn through cannula to clear any residual villi
- specimen is examined under a dissecting microscope for adequacy (at least 15 mg sample)
- repeat pass with new needle may be performed if specimen is inadequate
- fetal cardiac activity is documented
transabdominal procedural steps CVS?
- abdo prepared with antiseptic solution
- shot of local anestheic (1% lidocaine)
- u/s transducer sterilely draped
- 18-20G needle inserted into placenta and stylet removed
- 20 cc syringe with 2mL cell-transport medium is connected to needle
- needle is guided back and forth through placenta while suction is intermittently applied to syringe
- needle withdraw and remainder of cell-transport medium is drawn through medium to clear any villi lodged in needle
- specimen is examines for adequacy
- repeat pass with new needle may be needed in specimen is inadequate
- fetal cardiac activity documented
If your blood is Rh-Negative what will be administed after CVS?
RhoGam shot
- because your babys blood may have mixed with yours during procedure and may not be compatible
recovery from CVS?
- about 24hr recovery
- some may experience light bleeding or cramps
when to contact your doctor after CVS?
- high temp (100.4F) or over
- excess bleeding
- excess vaginal discharge
sonographers role during CSV?
- perform prescan and confirm placental location
- prepare trays and equipment
- ensure and maintain sterile field
- directly visualize needle of the catheter for precise diagnosis
- watch patient for signs of discomfort or vasovagal reaction
complications of CVS?
- miscarriage (1%)- slighly higher % when done through cervix
- bleeding
- infection
- Rh incompatibility in mother
- rupture of membranes
what has a high risk of miscarrige between amniocentesis and CVS?
CVS
Results of CVS?
- 2 weeks
- the technicians at the laboratory isolate the fetal tissue cells and allow them to reproduce
- analyze the cells for chromosomal abnormalities.
- testing can tell baby’s gender
what is a negative CVS?
- negative for signs of any genetic defects
- possibility of the test missing some genetic defects
postitive CVS?
- baby has disorder being tested for
Talk to doctor about:
- How the condition or defect may be treated either during or after the pregnancy
- Special needs your child may have after birth
- What other options you have regarding maintaining your pregnancy
