Ulm J E, Shah D M, Dev V G, Phillips J A
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232.
Am J Med Genet. 1990 Jan;35(1):75-8. doi: 10.1002/ajmg.1320350114.
Counseling before fetal blood sampling via cordocentesis is more difficult than that done before amniocentesis because 1) a fetal anomaly has been detected or is very likely, 2) the cordocentesis procedure may have a higher risk than does amniocentesis, and 3) the gestational age is frequently advanced before referral. These factors result in counseling and decision dilemmas that include that 1) the advanced gestational age may preclude the option of termination, 2) fetal prognosis may be poor despite normal cytogenetic results, and 3) the benefit of a diagnosis to provide indications for various delivery options must be weighed against the psychological burden of documenting a chromosome abnormality far in advance of delivery. Thus, counseling before cordocentesis requires engaging the couple in decision making regarding potential management of the pregnancy as a prerequisite to choosing or declining the procedure.
通过脐带穿刺进行胎儿血液采样前的咨询比羊膜穿刺术前的咨询更困难，原因如下：1）已检测到或极有可能存在胎儿异常；2）脐带穿刺术的风险可能高于羊膜穿刺术；3）转诊前孕周常常已较大。这些因素导致咨询和决策困境，包括：1）孕周较大可能排除了终止妊娠的选择；2）尽管细胞遗传学结果正常，但胎儿预后可能很差；3）做出诊断以为各种分娩选择提供依据的益处，必须与在分娩前很久就记录染色体异常所带来的心理负担相权衡。因此，脐带穿刺术前的咨询需要让夫妇参与到关于妊娠潜在处理方式的决策中，这是选择或拒绝该操作的前提条件。
