Government College of Nursing Jodhpur (Raj.) : Procedure On-Amniocentesis Subject-Obstetrics & Gynaecology Specialty-I

GOVERNMENT COLLEGE OF
NURSING
JODHPUR(RAJ.)
Procedure
On-
AMNIOCENTESIS
Subject-Obstetrics & Gynaecology Specialty-I
SUBMITTED TO - SUBMITTED BY-

Mrs. ANAMMA SUMON PRIYANKA GEHLOT
NURSING LECTURER M.sc (N) Pre. Year
GCON, Jodhpur GCON, Jodhpur
AMNEOCENTESIS
Introduction:
Amniocentesis is a procedure whereby a sample of fluid is removed from the amniotic sac for analysis. The
amniotic sac is in the uterine cavity. The amniotic sac is the fluid-filled structure inside a pregnant woman's
uterus within which the baby lives. Fetal cells, proteins, and fetal urine freely move within this sac.
Amniocentesis (amniotic fluid test or AFT)

It is a medical procedure used in prenatal diagnosis of abnormalities and fetal infections, and also used for
sex determination in which a small amount of amniotic fluid, which contains fetal tissues, is sampled from
the amnion or amniotic sac surrounding a developing fetus, and the fetal DNA is examined for genetic
abnormalities. The most common reason to have an "amino" is to determine whether a baby has certain
genetic disorders or a chromosomal abnormality, such as Down syndrome.
Amniocentesis (or another procedure, called chorionic villus sampling (CVS)) can diagnose these problems
in the womb. Amniocentesis is usually done when a woman is between 16 and 22 weeks pregnant. Women
who choose to have this test are primarily those at increased risk for genetic and chromosomal problems, in
part because the test is invasive and carries a small risk of miscarriage.
There are a few tests that can be performed on amniotic fluid to detect infections that are passed from
mother to baby during pregnancy (congenital infections). Some of these infections may have serious
consequences for the developing fetus. A few examples include tests for cytomegalovirus (CMV),
toxoplasmosis, and bacterial infections.
Definition:
Amniocentesis is a prenatal test in which a small amount of amniotic fluid is removed from the sac
surrounding the fetus for testing. The sample of amniotic fluid (less than one ounce) is removed through a
fine needle inserted into the uterus through the abdomen, under ultrasound guidance. The fluid is then sent
to a laboratory for analysis. Different tests can be performed on a sample of amniotic fluid, depending on the
genetic risk and indication for the test.
Volume:
• The amount of amniotic fluid increases throughout pregnancy, reaching a peak of approximately 1 L
during the third trimester, and then gradually decreases prior to delivery.
• The volume of amniotic fluid is positively correlated with the growth of fetus. From the 10th to the
20th week it increases from 25ml to 400ml approximately. From the 8th week, when the fetal
kidneys begin to function, fetal urine is also present in the AF.
• Then the relationship between AF and fetal growth stops. It reaches the high peak of 800ml at the 28
weeks.
• The amount of fluid declines to roughly 400 ml at 42 weeks age.
• An excessive amount of amniotic fluid is called polyhydramnios. This condition can occur with
multiple pregnancy (twins or triplets), congenital anomalies, or gestational diabetes.
• An abnormally small amount of amniotic fluid is known as oligohydramnios. This condition may
occur with late pregnancies, ruptured membranes, placental dysfunction, or fetal abnormalities.
• Abnormal amounts of amniotic fluid may cause the health care provider to watch the pregnancy
more carefully. Removal of a sample of the fluid, through amniocentesis, can provide information
about the sex, health, and development of the fetus
Color and appearance:
• Normal amniotic fluid is colorless and may exhibit slight to moderate turbidity from cellular debris,
particularly in later stages of fetal development.
• Blood-streaked fluid may be present as the result of a traumatic tap, abdominal trauma, or intra-
amniotic hemorrhage.
• The presence of bilirubin gives the fluid a yellow color and is indicative of red blood cell destruction
resulting from HDN.
Indication:
Amniocentesis has two main indications:
 Diagnostic
 Therapeutic
Diagnostic:
Early month (14-16 weeks): this procedure is used in antenatal diagnosis of chromosomal genetic
disorders like:
Sex link disorders
Karyotyping
Inborn error of metabolism
Neural tube defects
Testing for infections
Later month:
 For assessing fetal maturity
 Degree of fetalhemolysis in Rh sensitized mother
 Meconium staining of liquor-an evidence of fetaldistress
 Amniography or foetography following instillation of radio opaque dyein the amniotic fluid
cavity.
Therapeutic:
First half:
o Induction of labour by instillation of chemical such as hypertonic saline, urea or prostaglandins.
o Repeated decompression of uterus in acute hydraminos
Second half:
o To give intrauterine fetaltransfusion in severe hemolysis following Rh –iso- immunization.
Genetic diagnosis
Early in pregnancy, amniocentesis used for diagnosis of chromosomal and other fetal problems such as:
 Down syndrome (trisomy 21)
 Trisomy 13
 Trisomy 18
 Rare, inherited metabolic disorders
 Neural tube defects (anencephaly and spina bifida) by alpha-fetoprotein levels.
Lung maturity
Amniocentesis can predict fetal lung maturity, which is inversely correlated to the risk of infant respiratory
distress syndrome. In pregnancies of greater than 30 weeks, the fetal lung maturity may be tested by
sampling the amount of surfactant in the amniotic fluid.
Other
Amniocentesis can also be used to detect problems such as:
 Infection
 Rh incompatibility
 Decompression of polyhydramnios
An emerging indication for amniocentesis is in the management of preterm rupture of membranes where
measurement of certain amniotic fluid inflammatory markers may be helpful. If amniotic fluid IL-6, a
marker of inflammation, is elevated, the fetus is at high risk and delivery should be considered.
Risks and drawbacks:
Amniocentesis carries various risks, including:

 Miscarriage. Second-trimester amniocentesis carries a slight risk of miscarriage — between 1 in 300
and 1 in 500. Research suggests that the risk of miscarriage is higher for amniocentesis done before 15
weeks of pregnancy.
 Needle injury. During amniocentesis the baby might move an arm or leg into the path of the needle.
Serious needle injuries are rare.
 Leaking amniotic fluid. Rarely, amniotic fluid leaks through the vagina after amniocentesis. If the
leak seals, the pregnancy is likely to proceed normally. It's possible, however, for chronic leakage to lead
to orthopedic problems for the baby.
 Rh sensitization. Rarely, amniocentesis might cause the baby's blood cells to enter the mother's
bloodstream. If you have Rh negative blood, you'll be given a drug called Rh immunoglobulin after
amniocentesis to prevent you from producing antibodies against your baby's blood cells.
 Infection. Rarely, amniocentesis might trigger a uterine infection.
 Infection transmission. If you have an infection — such as hepatitis C, toxoplasmosis or human

immunodeficiency virus — the infection might be transferred to your baby during amniocentesis.
Amniocentesis is performed between the 15th and 20th week of pregnancy; performing this test earlier may
result in fetal injury. Complications of amniocentesis include preterm labor and delivery, respiratory
distress, postural deformities, chorioamnionitis, fetal trauma .Studies from the 1970s originally estimated the
risk of amniocentesis-related miscarriage at around 1 in 200 (0.5%).Three more recent studies from 2000-
2006 estimated the procedure-related pregnancy loss at 0.6-0.86%.
Amniotic fluid embolism has been described as a possible risk.
Amniocentesis facts
 Amniocentesis may be performed for chromosome analysis or the detection of genetic defects and
conditions in the fetus.
 Pregnant women over the age of 35 years are candidates for amniocentesis to detect chromosomal
abnormalities in the fetus.
 Amniocentesis can also be used to determine the maturity of the lungs of the fetus or the cause of
unknown fever in the mother.
 For genetic testing, chromosome analysis, and the evaluation of an abnormal alpha feto protein test,
amniocentesis is usually performed between the 15th and 20th weeks of pregnancy.
 The risk of fetal loss from the amniocentesis procedure is less than 1%.
Precaution:
I. Prior sonographic localization of placenta is must to prevent blood tap and foeto- maternal bleeding.
II. Prophylactic administration of 100 micro gm. Of anti-D immunoglobulin in Rh- negative non-
immunized mother.
Complication:
Maternal complication:
o Infection
o Hemorrhage (placenta or uterine injury)
o Premature rupture of membranes and premature labour.
Fetal complication:
 Trauma
 Fetal-maternal hemorrhage
Procedure:
 The patient is asked to empty her bladder and then lie in dorsal position.
 The abdominal wall is prepared aseptically with betadine lotion and spirit and then draped.
 Before the start of the procedure, a local anesthetic can be given to the mother in order to relieve the
pain felt during the insertion of the needle used to withdraw the fluid.
 After the local anesthetic is in effect, a needle is usually inserted through the mother's abdominal
wall, then through the wall of the uterus, and finally into the amniotic sac. With the aid of
ultrasound-guidance, a physician punctures the sac in an area away from the fetus and extracts
approximately 20ml of amniotic fluid.
 The most common abnormalities detected are Down syndrome (trisomy 21), Edwards
syndrome (trisomy 18), and Turner syndrome (monosomy X).
Nurse’s role in amniocentesis:

Pre- procedure:
 Ask the women to drink 2-3 glasses of water one hour prior to appointment as a full bladder enables
a clear examination of uterine content and pelvic structures.
 Amniocentesis should always be preceded by explanation, education and counseling of the parents.
 Information on the procedure, potential adverse effects including the risk of pregnancy loss, potential
benefit and implications of test should be explained.
 The explanation will decrease anxiety and allow an informed consent to be made.
 Ensure the woman understand the procedure and has signed a consent form. A signed consent to be
made.
 Ensure the woman understand the procedure and has signed a consent form. A signed consent form
indicates the women’s agreement to undergo the procedure and acknowledges her awareness of the
risks involved.
 Check women’s allergy status.
 Check women’s blood group. Amniocentesis carries the risk of transplacental hemorrhage to prevent
Rh immunization, Rh negative women require blood sampling for Keilhauer and administration of
Rh immunoglobulin post procedure.
Procedure
 Assist women to change into a hospital gown.
 Set up sterile amniocentesis trolley as required by operator
 Assist operator with the procedure.
Post procedure
 Check the insertion site on completion of the procedure
 Label specimen and send to the lab with appropriate forms.
 Ensure correct labeling of specimen tubes
 Administer appropriate dose of anti-D immunoglobulin to unsensitized Rh negative women and
document.
Advise the women regarding:

 That menstrual cramps for 1-2 hours, lower abdominal discomfort for up to 48 hours, or tenderness
at insertion site may be experienced
 That vaginal fluid loss bleeding, uterine contractions or abdominal pain, fever or chills need to be
reported to her doctor. Post procedure instructions enable the women to recognize normal and
abnormal side effects and when to seek further advice and treatment
 To engage in light activity for 24 hours. Light activity will decrease uterine irritability and increase
placental blood flow.

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GOVERNMENT COLLEGE OF

SUBMITTED TO - SUBMITTED BY-

Amniocentesis (amniotic fluid test or AFT)

Risks and drawbacks:

Amniocentesis carries various risks, including:

 Infection. Rarely, amniocentesis might trigger a uterine infection.

 Infection transmission. If you have an infection — such as hepatitis C, toxoplasmosis or human

Nurse’s role in amniocentesis:

Advise the women regarding:

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