Summary
Fetal blood samples can be obtained in utero by direct sampling of the umbilical cord vessels, using an ultrasound guided technique termed percutaneous umbilical sampling (PUBS). This procedure is being used more frequently in high risk pregnancies to obtain direct fetal laboratory data. In specialized centers, with trained personnel, the technique can be used with a high degree of safety and efficiency. Direct access to the fetal circulation can also allow an accurate determination of the fetal platelet count in cases of suspected fetal thrombocytopenia. The technique may be used to plan appropriate clinical management of maternal ITP as well as to diagnose the presence of fetal alloimmune thrombocytopenia. A logical strategy for obstetric management and evaluation of fetal risk can be planned. The procedure also has the potential to allow direct fetal treatment as has been the case in the management of severe fetal anemia.
Similar content being viewed by others
References
Ayromlooi J (1978) A new approach to the management of immunologic thrombocytopenic purpura in pregnancy. Am J Obstet Gynecol 130: 235–236
Benacerraf BR, Barss VA, Saltzman DH, Greene MF, Penso CA, Frigoletto FD (1988) Fetal abnormalities: Diagnosis or treatment with percutaneous umbilical blood sampling under continuous US guidance. Radiology 166: 105–107
Berkowitz RL, Chitkara U, Wilkins I, Lynch L, Mehalek KE (1987) Technical aspects of intravascular intrauterine transfusions: Lessons learned from 33 procedures. Am J Obstet Gynecol 157: 4–9
Buchanan GR (1987) Hemorrhagic diseases. In: Nathan DG, Oski FA (eds) Hematology of infancy and childhood, 3rd Ed. Saunders, Philadelphia
Burrows RF, Kelton JG (1988) Incidentally detected thrombocytopenia in healthy mothers and their infants. N Eng J Med 219: 142–145
Carloss HW, McMillan R, Crosby WH (1980) Management of pregnancy in women with immune thrombocytopenic purpura. JAMA 244: 2756–2758
Cines DB, Dusak B, Tomaski A, Mennuti M, Schreiber AD (1982) Immune thrombocytopenic purpura and pregnancy. N Eng J Med 306: 826–831
Christiens GCML, Helmerhorst FM (1987) Validity of intrapartum diagnosis of fetal thrombocytopenia. Am J Obstet Gynecol 157: 864–865
Daffos F, Capella-Pavlovsky M, Forestier F (1983) Fetal blood sampling via the umbilical cord using a needle guided by ultrasound. Report of 66 cases. Prenat Diagn 3: 271–277
Daffos F, Forestier F, Muller JY (1984) Prenatal treatment of alloimmune thrombocytopenia. Lancet 2: 623 (letter)
Daffos F, Capella-Pavlovsky M, Forestier F (1985) Fetal blood sampling during pregnancy with use of a needle guided by ultrasound: A study of 606 consecutive cases. Am J Obstet Gynecol 153: 655–660
Forestier F, Daffos F, Galacteros F, Bardakjian J, Rainaut M, Beuzard Y (1986) Hematologic values of 163 normal fetuses between 18 and 32 weeks of gestation. Pediatr Res 20: 342–346
Hobbins JC, Grannum PA, Romero R, Reece EA, Mahoney MJ (1985) Percutaneous umbilical blood sampling. Am J Obstet Gynecol 152: 1–6
Hoffman PC (1985) Idiopathic thrombocytopenic purpura in pregnancy. Clin Perinatol 12: 599–607
Kelton JG (1983) Management of the pregnant patient with idiopathic thrombocytopenic purpura. Ann Intern Med 99: 796–800
Kelton JG, Blanchette VS, Wilson WE, Powers P, Pai KRM, Effer SB, Barr RD (1980) Neonatal thrombocytopenia due to passive immunization. N Eng J Med 301: 1401–1403
Ludomirski A, Weiner S (1988) Percutaneous fetal umbilical blood sampling. Clin Obstet Gynecol 31: 19–26
Ludomirski A, Nemiroff R, Johnson A, Ashmead GG, Weiner S, Bolognese RJ (1987) Percutaneous umbilical blood sampling: A new technique for prenatal diagnosis. J Reprod Med 32: 276–279
Ludomirski A, Weiner S, Ashmead GG, Liebrizzi RJ, Bolognese RJ (1988) Percutaneous fetal umbilical blood sampling: Procedure safety and normal fetal hematologic indices. Am J Perinat 5: 264–266
Moise KJ, Carpenter RJ, Cotton DB, Wasserstrum N (1987) Fetal platelet counts by cordocentesis prior to delivery in patients with idiopathic thrombocytopenic purpura. Society of perinatal Obstetricians, Orlando, Florida (abstr 131)
Moise KJ, Carpenter RJ, Deter RL, Kirshon B, Diaz SF (1987) The use of fetal neuromuscular blockade during intrauterine procedures. Am J Obstet Gynecol 157: 874–879
Nicolaides KH (1988) Cordocentesis. Clin Obstet Gynecol 31: 123–135
Nicolaides KH, Rodeck CH, Soothill PW, Campbell S (1986) Ultrasound guided sampling of umbilical cord and placental blood to assess fetal wellbeing. Lancet I: 1065–1067
Patriarcho M, Yeh S-Y (1986) Immunological thrombocytopenia in pregnancy. Obstet Gynecol Surv 41: 661–671
Scott JR, Rote NS, Cuikshank DP (1983) Antiplatelet antibodies and platelet counts in pregnancies complicated by autoimmune thrombocytopenic purpura. Am J Obstet Gynecol 145: 932–936
Sideropoulos D, Herrmann U, Morell A, Von Muralt G, Barundun S (1986) Transplacental passage of intravenous immunoglobulins in the last trimester of pregnancy. J Pediatr 109: 505–508
Stuart MJ, Kelton JG (1987) The platelet: Quantitative and qualitative abnormalities. In: Nathan D, Oski F (eds) Hematology of infancy and childhood, 3rd Ed. Saunders, Philadelphia
Territo M, Finkelstein J, Oh W, Hobel C, Cattlove H (1973) Management of autoimmune thrombocytopenia in pregnancy and in the neonate. Obstet Gynecol 41: 579–584
Wenske C, Gaedicke G, Kuenzlen E, Heyes H, Mueller-Eckhardt C, Kleihauer E, Lauritzen C (1983) Treatment of idiopathic thrombocytopenic purpura in pregnancy by highdose intravenous immunoglobulin. Blut 46: 347–353
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sacher, R.A., King, J.C. Perinatal diagnosis of passive ITP: Use of percutaneous umbilical blood sampling (PUBS). Blut 59, 128–131 (1989). https://doi.org/10.1007/BF00320264
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00320264