Duchatel F, Oury J F, Mennesson B, Muray J M
Service de Gynécologie-Obstétrique, C.H. René Dubos, Pontoise, France.
Eur J Obstet Gynecol Reprod Biol. 1993 Dec 15;52(2):95-104. doi: 10.1016/0028-2243(93)90234-4.
To study the complications of percutaneous umbilical blood sampling (PUBS) conducted for purely diagnostic purposes, in a retrospective study of 341 personal cases and an analysis of 4922 cases from literature.
Analysis of the sampling procedure and complications seen in 341 punctures, including 12 failures.
Freehand echo-guided percutaneous umbilical blood sampling. PARAMETERS STUDIED: Conditions in which the blood samples were taken (gestational age, indications, placental location, technique--including number of punctures, duration); total number of fetal deaths and number of fetal deaths related to the procedure; other complications (bradycardia, hematoma of the umbilical cord, hemorrhage, premature births).
20 fetal deaths (FDs) were recorded in 341 cases (5.87%) (figures for the literature: 189/4922 = 3.84%); 3 FDs appeared to be directly related to the procedure (0.88) (figures for the literature: 48/4922 = 0.98%). There were 32 cases of bradycardia (9.38%); this complication was seen more frequently after repeated and prolonged punctures. Hematomas of the cord (1.47%) were seen when punctures were attempted in a free loop of the cord. There was a marked increase in the number of complications (8.96% FDs and 20.73% of bradycardias) when the procedure lasted more than 10 min and/or when more than 3 punctures were attempted (33.33% FDs). These two occurrences are closely related to the gestational age at which the PUBS was conducted, the placental location, the experience of the operators and the condition for which the sample was being taken. Pathological pregnancies (fetal malformation, disease or hypotrophy of the fetus, diseases of the amniotic fluid) had a mortality rate of 11.24% (19/169), whereas fetuses that were presumed to be healthy had a lower risk of 0.58% (1/172).
The overall mortality (including all fetal and neonatal deaths) appears to be around 5.0% (between 3.84 and 5.87%), but the mortality rate directly related to the procedure seems to be around 1% (between 0.88 and 0.98%). It seems that the fetal mortality rate is closely related to: (a) The state of the fetus and thus to the indication of the procedure. The higher overall mortality rate observed is related to the natural history of the conditions for which the procedure was conducted and the time taken to conduct the procedure and the number of punctures. This depends on the experience of the teams, on the observation of the rule that the attempt should not be prolonged beyond 10 min and no more than 2 punctures should be attempted in any one session.
