COMPLICATIONS OF DIAGNOSTIC ULTRASOUND-GUIDED PERCUTANEOUS UMBILICAL BLOOD-SAMPLING - ANALYSIS OF A SERIES OF 341 CASES AND REVIEW OF THE LITERATURE

Objective: To study the complications of percutaneous umbilical blood sampling (PUBS) conducted for purely diagnostic purposes, in a retrosp ective study of 341 personal cases and an analysis of 4922 cases from literature. Subject: Analysis of the sampling procedure and complicati ons seen in 341 punctures, including 12 failures. Interventions: Freeh and echo-guided percutaneous umbilical blood sampling. Parameters stud ied: Conditions in which the blood samples were taken (gestational age , indications, placental location, technique - including number of pun ctures, duration); total number of fetal deaths and number of fetal de aths related to the procedure; other complications (bradycardia, hemat oma of the umbilical cord, hemorrhage, premature births). Results: 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 see n more frequently after repeated and prolonged punctures. Hematomas of the cord (1.47%) were seen when punctures were attempted in a free lo op of the cord. There was a marked increase in the number of complicat ions (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 expe rience of the operators and the condition for which the sample was bei ng taken. Pathological pregnancies (fetal malformation, disease or hyp otrophy of the fetus, diseases of the amniotic fluid) had a mortality rate of 11.24% (19/169), whereas fetuses that were presumed to be heal thy had a lower risk of 0.58% (1/172). Conclusions: The overall mortal ity (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 seem s that the fetal mortality rate is closely related to: (a) The state o f the fetus and thus to the indication of the procedure. The higher ov erall mortality rate observed is related to the natural history of the conditions for which the procedure was conducted and the time taken t o conduct the procedure and the number of punctures. This depends on t he experience of the teams, on the observation of the rule that the at tempt should not be prolonged beyond 10 min and no more than 2 punctur es should be attempted in any one session.