Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Royal Oak, MI, USA.
Am J Obstet Gynecol. 2013 Sep;209(3):170-80. doi: 10.1016/j.ajog.2013.07.014.
We sought to review indications, technical aspects, risks, and recommendations for fetal blood sampling (FBS).
A systematic review was performed using MEDLINE, PubMed, EMBASE, and Cochrane Library using the terms "fetal blood sampling," "percutaneous umbilical blood sampling," and "cordocentesis." The search was restricted to English-language articles published from 1966 through July 2012. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Evidence reports and guidelines published by organizations or institutions such as the National Institutes of Health, Agency for Health Research and Quality, American Congress of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. Grade (Grading of Recommendations Assessment, Development, and Evaluation) methodology was employed for defining strength of recommendations and rating quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence.
Ultrasound-guided FBS is the only procedure that provides direct access to the fetal circulation. When invasive testing is planned for suspected severe fetal anemia or thrombocytopenia, we recommend FBS as the procedure of choice, with availability of immediate transfusion if confirmed. We recommend against the use of FBS for indications in which other less invasive, and therefore lower risk, alternatives are available. The overall success rate of FBS is high, and blood samples can be obtained in >98% of patients. We suggest that counseling for FBS include discussion about the potential risk of FBS that may include, but may not be limited to: bleeding from puncture site (20-30%); fetal bradycardia (5-10%); pregnancy loss (≥1.3%, depending on indication, gestational age, and placental penetration); and vertical transmission of hepatitis or human immunodeficiency virus. We recommend that FBS be performed by experienced operators at centers with expertise in invasive fetal procedures when feasible.
我们旨在回顾胎儿血液取样（FBS）的适应证、技术方面、风险和建议。
使用 MEDLINE、PubMed、EMBASE 和 Cochrane Library 进行了系统评价，使用的术语有“胎儿血液取样”、“经皮脐静脉血取样”和“脐带穿刺术”。检索限定于 1966 年至 2012 年 7 月发表的英文文献。优先考虑报告原始研究的文章，特别是随机对照试验，尽管也查阅了综述文章和评论。会议报告的研究摘要不认为足以纳入本文件。还审查了美国国立卫生研究院、卫生保健研究与质量署、美国妇产科医师学会和母胎医学学会等组织或机构发布的证据报告和指南，并通过查阅已确定文章的参考文献找到了其他研究。采用（推荐评估、制定与评估分级）方法学来定义推荐建议的力度和评价证据质量的等级。与美国预防服务工作组指南一致，根据最高证据水平来评估参考文献的质量。
超声引导下的 FBS 是唯一能直接进入胎儿循环的方法。当计划对疑似严重胎儿贫血或血小板减少症进行有创性检查时，我们建议将 FBS 作为首选方法，如果确诊，可立即进行输血。我们不建议将 FBS 用于其他具有非侵入性、因此风险较低的替代方法的适应证。FBS 的总体成功率很高，超过 98%的患者可以获得血样。我们建议，对 FBS 的咨询应包括讨论 FBS 的潜在风险，这些风险可能包括但不限于：穿刺部位出血（20-30%）；胎儿心动过缓（5-10%）；妊娠丢失（≥1.3%，取决于适应证、胎龄和胎盘穿透）；以及乙型肝炎或人类免疫缺陷病毒的垂直传播。我们建议在可行的情况下，由有经验的操作人员在具有侵入性胎儿操作专业知识的中心进行 FBS。
