amniocentesis (redirected from Amniocentesis-indications for)

Amniocentesis 

Definition

Amniocentesis is a procedure used to diagnose fetal defects in the early second trimester of pregnancy. A sample of the amniotic fluid, which surrounds a fetus in the womb, is collected through a pregnant woman's abdomen using a needle and syringe. Tests performed on fetal cells found in the sample can reveal the presence of many types of genetic disorders, thus allowing doctors and prospective parents to make important decisions about early treatment and intervention.

Purpose

Since the mid-1970s, amniocentesis has been used routinely to test for Down syndrome, by far the most common, nonhereditary, genetic birth defect, afflicting about one in every 1,000 babies. By 1997, approximately 800 different diagnostic tests were available, most of them for hereditary genetic disorders such as Tay-Sachs disease, sickle cell anemia, hemophilia, muscular dystrophy and cystic fibrosis.

Amniocentesis, often called amnio, is recommended for women who will be older than 35 on their due-date. It is also recommended for women who have already borne children with birth defects, or when either of the parents has a family history of a birth defect for which a diagnostic test is available. Another reason for the procedure is to confirm indications of Down syndrome and certain other defects which may have shown up previously during routine maternal blood screening.

The risk of bearing a child with a nonhereditary genetic defect such as Down syndrome is directly related to a woman's age—the older the woman, the greater the risk. Thirty-five is the recommended age to begin amnio testing because that is the age at which the risk of carrying a fetus with such a defect roughly equals the risk of miscarriage caused by the procedure-about one in 200. At age 25, the risk of giving birth to a child with this type of defect is about one in 1,400; by age 45 it increases to about one in 20. Nearly half of all pregnant women over 35 in the United States undergo amniocentesis and many younger women also decide to have the procedure. Notably, some 75% of all Down syndrome infants born in the United States each year are to women younger than 35.

One of the most common reasons for performing amniocentesis is an abnormal alpha-fetoprotein (AFP) test. Alpha-fetoprotein is a protein produced by the fetus and present in the mother's blood. A simple blood screening, usually conducted around the 15th week of pregnancy, can determine the AFP levels in the mother's blood. Levels that are too high or too low may signal possible fetal defects. Because this test has a high false-positive rate, another test such as amnio is recommended whenever the AFP levels fall outside the normal range.

Amniocentesis is generally performed during the 16th week of pregnancy, with results usually available within three weeks. It is possible to perform an amnio as early as the 11th week but this is not usually recommended because there appears to be an increased risk of miscarriage when done at this time. The advantage of early amnio and speedy results lies in the extra time for decision making if a problem is detected. Potential treatment of the fetus can begin earlier. Important, also, is the fact that elective abortions are safer and less controversial the earlier they are performed.

Precautions

As an invasive surgical procedure, amnio poses a real, although small, risk to the health of a fetus. Parents must weigh the potential value of the knowledge gained, or indeed the reassurance that all is well, against the small risk of damaging what is in all probability a normal fetus. The serious emotional and ethical dilemmas that adverse test results can bring must also be considered. The decision to undergo amnio is always a matter of personal choice.

Key terms

Alpha-fetoprotein (AFP) — A protein normally produced by the liver of a fetus and detectable in maternal blood samples. AFP screening measures the amount of alpha-fetoprotein in the blood. Levels outside the norm may indicate fetal defects.

Anencephaly — A hereditary defect resulting in the partial to complete absence of a brain and spinal cord. It is fatal.

Chorionic villus sampling (CVS) — A procedure similar to amniocentesis, except that cells are taken from the chorionic membrane for testing. These cells, called chorionic villus cells, eventually become the placenta. The samples are collected either through the abdomen, as in amnio, or through the vagina. CVS can be done earlier in the pregnancy than amnio, but carries a somewhat higher risk.

Chromosome — Chromosomes are the strands of genetic material in a cell that occur in nearly identical pairs. Normal human cells contain 23 chromosome pairs-one in each pair inherited from the mother, and one from the father. Every human cell contains the exact same set of chromosomes.

Down syndrome — The most prevalent of a class of genetic defects known as trisomies, in which cells contain three copies of certain chromosomes rather than the usual two. Down syndrome, or trisomy 21, usually results from three copies of chromosome 21.

Genetic — The term refers to genes, the basic units of biological heredity, which are contained on the chromosomes, and contain chemical instructions which direct the development and functioning of an individual.

Hereditary — Something which is inherited-passed down from parents to offspring. In biology and medicine, the word pertains to inherited genetic characteristics.

Maternal blood screening — Maternal blood screening is normally done early in pregnancy to test for a variety of conditions. Abnormal amounts of certain proteins in a pregnant woman's blood raise the probability of fetal defects. Amniocentesis is recommended if such a probability occurs.

Tay-Sachs disease — An inherited disease prevalent among the Ashkenazi Jewish population of the United States. Infants with the disease are unable to process a certain type of fat which accumulates in nerve and brain cells, causing mental and physical retardation, and death by age four.

Ultrasound — A technique which uses high-frequency sound waves to create a visual image (a sonogram) of soft tissues. The technique is routinely used in prenatal care and diagnosis.

Description

The word amniocentesis literally means "puncture of the amnion," the thin-walled sac of fluid in which a developing fetus is suspended during pregnancy. During the sampling procedure, the obstetrician inserts a very fine needle through the woman's abdomen into the uterus and amniotic sac and withdraws approximately one ounce of amniotic fluid for testing. The relatively painless procedure is performed on an outpatient basis, sometimes using local anesthesia.

The physician uses ultrasound images to guide needle placement and collect the sample, thereby minimizing the risk of fetal injury and the need for repeated needle insertions. Once the sample is collected, the woman can return home after a brief observation period. She may be instructed to rest for the first 24 hours and to avoid heavy lifting for two days.

The sample of amniotic fluid is sent to a laboratory where fetal cells contained in the fluid are isolated and grown in order to provide enough genetic material for testing. This takes about seven to 14 days. The material is then extracted and treated so that visual examination for defects can be made. For some disorders, like Tay-Sachs, the simple presence of a telltale chemical compound in the amniotic fluid is enough to confirm a diagnosis. Depending on the specific tests ordered, and the skill of the lab conducting them, all the results are available between one and four weeks after the sample is taken.

Cost of the procedure depends on the doctor, the lab, and the tests ordered. Most insurers provide coverage for women over 35, as a follow-up to positive maternal blood screening results, and when genetic disorders run in the family.

An alternative to amnio, now in general use, is chorionic villus sampling, or CVS, which can be performed as early as the eighth week of pregnancy. While this allows for the possibility of a first trimester abortion, if warranted, CVS is apparently also riskier and is more expensive. The most promising area of new research in prenatal testing involves expanding the scope and accuracy of maternal blood screening as this poses no risk to the fetus.

Preparation

It is important for a woman to fully understand the procedure and to feel confident in the obstetrician performing it. Evidence suggests that a physician's experience with the procedure reduces the chance of mishap. Almost all obstetricians are experienced in performing amniocentesis. The patient should feel free to ask questions and seek emotional support before, during and after the amnio is performed.

Aftercare

Necessary aftercare falls into two categories, physical and emotional.

Physical aftercare

During and immediately following the sampling procedure, a woman may experience dizziness, nausea, a rapid heartbeat, and cramping. Once past these immediate hurdles, the physician will send the woman home with instructions to rest and to report any complications requiring immediate treatment, including:

• vaginal bleeding. The appearance of blood could signal a problem.
• premature labor. Unusual abdominal pain and/or cramping may indicate the onset of premature labor. Mild cramping for the first day or two following the procedure is normal.
• signs of infection. Leaking of amniotic fluid or unusual vaginal discharge, and fever could signal the onset of infection.

Emotional aftercare

Once the procedure has been safely completed, the anxiety of waiting for the test results can prove to be the worst part of the process. A woman should seek and receive emotional support from family and friends, as well as from her obstetrician and family doctor. Professional counseling may also prove necessary, particularly if a fetal defect is discovered.

Risks

Most of the risks and short-term side effects associated with amniocentesis relate to the sampling procedure and have been discussed above. A successful amnio sampling results in no long-term side effects. Risks include:

• maternal/fetal hemorrhaging. While spotting in pregnancy is fairly common, bleeding following amnio should always be investigated.
• infection. Infection, although rare, can occur after amniocentesis. An unchecked infection can lead to severe complications.
• fetal injury. A very slight risk of injury to the fetus resulting from contact with the amnio needle does exist.
• miscarriage. The rate of miscarriage occurring during standard, second trimester amnio appears to be approximately 0.5%. This compares to a miscarriage rate of 1% for CVS. Many fetuses with severe genetic defects miscarry naturally during the first trimester.
• the trauma of difficult family-planning decisions. The threat posed to parental and family mental health from the trauma accompanying an abnormal test result can not be underestimated.

Normal results

Negative results from an amnio analysis indicate that everything about the fetus appears normal and the pregnancy can continue without undue concern. A negative result for Down syndrome means that it is 99% certain that the disease does not exist.

An overall "normal" result does not, however, guarantee that the pregnancy will come to term, or that the fetus does not suffer from some other defect. Laboratory tests are not 100% accurate at detecting targeted conditions, nor can every possible fetal condition be tested for.

Abnormal results

Positive results on an amnio analysis indicate the presence of the fetal defect being tested for, with an accuracy approaching 100%. Prospective parents are then faced with emotionally and ethically difficult choices regarding treatment options, the prospect of dealing with a severely affected newborn, and the option of elective abortion. At this point, the parents need expert medical advice and counseling.

Resources

Periodicals

Dreisbach, Shaun. "Amnio Alternative." Working Mother (March 1997): 11.

Organizations

American College of Obstetricians and Gynecologists. 409 12th St., S.W., P.O. Box 96920, Washington, DC 20090-6920. http://www.acog.org.

Other

Holbrook Jr., Harold R. Stanford University School of MedicineWeb Home Page. February 2001. 〈http://www.stanford.edu/∼holbrook〉.

---

amniocentesis /am·nio·cen·te·sis/ (am″ne-o-sen-te´sis) surgical transabdominal or transcervical penetration of the uterus for aspiration of amniotic fluid.

Amniocentesis.

---

am·ni·o·cen·te·sis (mn--sn-tss)

n. pl. am·ni·o·cen·te·ses (-sz)

A procedure in which a small sample of amniotic fluid is drawn out of the uterus through a needle inserted in the abdomen and is then analyzed to detect genetic abnormalities in the fetus or to determine the sex of the fetus.

---

amniocentesis

[am′nē·ōsentē′sis]

Etymology: Gk, amnos, lamb's caul, kentesis, pricking

an obstetric procedure in which a small amount of amniotic fluid is removed for laboratory analysis. It is usually performed between the sixteenth and twentieth weeks of gestation to aid in the diagnosis of fetal abnormalities, especially genetic disorders.

method With the use of ultrasound imaging techniques the position of the fetus and the location of the placenta are determined. The skin on the mother's abdomen is aseptically prepared, and a local anesthetic is usually injected. A needle attached to a syringe is introduced into a part of the uterus where there is the least chance of perforating the placenta or scratching the fetus. Between 20 and 25 mL of amniotic fluid is aspirated. Amniocentesis is performed to diagnose various inherited disorders, including chromosomal aberrratiions, neural tube defects, and Tay-Sachs disease. It is also performed to discover the sex of the fetus if certain sex-linked disorders are suspected. Later in pregnancy, amniocentesis may be performed to assess fetal lung maturity by testing the lecithin/sphingomyelin ratio and the presence of phosphatidyl-glycerol in the laboratory before elective delivery. The fluid may be tested for the concentration of creatinine, another indicator of fetal maturity. When postmaturity is suspected, amniocentesis is performed to examine the amniotic fluid for meconium.

nursing considerations A woman must sign an informed consent form before amniocentesis. Specifically stated in the consent form are the reasons for performing the procedure and the facts that fluid is to be removed after needle puncture of the uterus, that ultrasound imaging techniques are usual adjuncts, that the procedure may fail to give the results intended, and that spontaneous abortion, nausea, abdominal pain, or fetal injury may occur. The woman is reassured that complications and failure are rare; she is given emotional support before, during, and after the procedure. In testing for inherited disorders, 10 days to 2 weeks is usually necessary for tissue culture before a diagnosis may be made; this waiting period may be extremely stressful for the mother. The woman is warned to report any signs of infection or of the onset of labor. Rh_o(D) immunoglobulin should be given to pregnant women who are Rh negative.

outcome criteria Spontaneous abortion occurs in approximately 1% of women undergoing amniocentesis. Perforation of the placenta or a blood vessel in the umbilical cord or placenta may cause hemorrhage or isoimmunization and hemolytic disease of the fetus, possibly leading to fetal death. Maternal and fetal infection with attendant morbidity or mortality may occur but it is rare. Premature rupture of membranes, preterm labor, or trauma to the fetus or umbilical cord may occur. Compare chorionic villus sampling.

---

amniocentesis (amˈ·nē·ō·sen·tēˑ·sis),

n procedure in obstetrics in which a needle is inserted into a pregnant woman's uterus in order to draw out a sample of amniotic fluid for laboratory analysis. Often used in older mothers to detect possible birth defects before birth.

---

amniocentesis

transabdominal perforation of the amniotic sac for the purpose of obtaining a sample of amniotic fluid, which contains cells shed from the skin of the fetus as well as biochemical substances.

---

amniocentesis

Obstetrics A procedure in which fluid is obtained by an ultrasonographically-guided needle from the amniotic cavity–usually between wks 15-17 of pregnancy to detect fetal abnormalities by karyotyping or chemical analysis; accuracy is reported to be 99.4%; complication rate < 0.5% above the background pregnancy loss of 2-3%; fetal loss minimal  Defects identified by amniocentesis Cultured amniotic cells can be used for cytogenetic studies, DNA analysis–karyotyping, and enzyme assays. Cf Chorionic villus biopsy

Amniocentesis—indications for

Maternal age > 35 3+ spontaneous abortions Previous child with chromosome defect, metabolic disease, neural tube defect Parent, or family Hx of chromosome defect(s) Possible carrier of X-linked disease.

---

Patient discussion about Amniocentesis-indications for.

Q. what does enlarged heart mean? is it linked to down syndrome? My wife is 16 weeks pregnant. we did a prenatal US and we were told that the baby hes an enlarged heart and that we are advised to do amniocentesis. A friend of mine had a baby with down syndrome, and he was toled that if they have done this procedure, the doctors could have find it on time and abort the pregnancy. Is there a clear connection between the enlarged hart and the fact that the doctor advised us to do this procedure to down syndrome?

A. Enlarged heart means that the heart is bigger than normal. It might be connected to down syndrome but it is not very likely. Usually in down syndrome the US will reveal impaired Nuchal translucency (which mean "thick neck" in normal English).
On the other hand you can never be sure and as our physician told us when my wife was pregnant: "In medicine it always better safe than sorry"

Q. Can I get a little more information on amniocentesis…. hi all…..I am 38 years pregnant. I am expecting my 3rd child and I will have my amniocentesis test next week ………can I get a little more information on amniocentesis…. what else I can find and why do they take this and can it harm….. Please.

A. Hi………. Amniocentesis is done in 15 – 18 weeks for genetic screening. It’s mainly done for the pregnant women of more than 35 years of age. This is mainly carried out, if the prenatal test had shown any likelihood of problem with the baby or If found with any genetic problem with previous child and any previous miscarriages also. It’s used to check the baby`s heart rate and lung maturity. They check for any chromosomal abnormalities. Generally risk is very less such as high loss of blood, infection, premature labor.