Amniocentesis to remove amniotic fluid

“We have to remove amniotic fluid from you” It is undoubtedly a phrase that no mother wants to hear, the fear of harming the baby is completely natural, but there are very specific cases in which the benefits of analyzing the baby’s genes are considerable… In addition An amniocentesis in the hands of experts in Maternal Fetal Care like Dr. Carlos Monsalve is very safe.

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Today I want to talk to you about a very important topic in obstetrics which is amniocentesis, look, a few days ago we were doing an amniocentesis, at that time we did not show it live due to patient issues but well, we are going to teach you and I will Let’s talk about amniocentesis. What is it? What is it for? Its benefits, its risks, so that you are more informed about, perhaps, about a procedure that is often stigmatized, you are more afraid of it than we really have to be, so I do want you to learn and know a little about it. amniocentesis.

Before showing you the video, showing you how an amniocentesis is technically done, I want to talk to you a little about it. Amniocentesis is indeed an invasive procedure that is very useful, it basically serves to diagnose chromosomal problems, genetic problems that may exist in a baby, it also helps us to identify certain infections when a mother had an infection and we want to know if it is being transmitted to the baby. baby can also be detected by amniocentesis. There are other cases to help a baby when a baby has excessively fluid or the opposite when he no longer has enough fluid through amniocentesis we can extract fluid or administer fluid to improve the baby’s conditions or just like that, with amniocentesis we can then know genetic infections, not only chromosomal ones such as Down syndrome, but also genetic diseases that could be contained in the family and we want to know if a baby suffers from it or not. Okay? So, there are many cases in which amniocentesis can be used that we are currently not using as much due to the issue of fear. Why the fear? Because if it is true that amniocentesis can cause pregnancy loss, but at the same time I want you to know that the risk is very, very low, the risk is 0.5%. What does this mean? That of every 200 amniocenteses that we perform, a baby can be lost due to the amniocentesis and nothing would happen to the other 199, however, the statistic of 0.5% loss is worldwide. We here at Creafam are specialized in Maternal-Fetal Medicine and we have already exceeded 200 amniocenteses by far and thank God nothing has ever happened to a baby. It has to be done with a fully prepared team, we have an assistant, we are 2 gynecologists who are in charge of performing the amniocentesis, I am dedicated to doing the puncture and the doctor is going to do the extraction, which you will see in the video how we do an amniocentesis.

Removal of amniotic fluid: Amniocentesis

Here we are already preparing all the instruments and what is necessary to be able to perform the amniocentesis, as you will see, before taking the test you will see that in the abdomen we have already put isodine, which is an antiseptic, a bactericide. . This is to avoid any risk of infection to the baby, as we are doing the introduction of a foreign body in a completely sterile environment, so we have to manage those conditions. The completely sterile needle, in fact they are disposable needles, they are only used once for a single puncture and we clean the entire abdominal region, although we only do the puncture in a single place, we have to do all the cleaning of the abdominal region and there they will see how we are doing with the ultrasound, checking where the baby is, how the baby is arranged, where we have the best space or window to be able to take the baby, which is where I always tell them that it takes us a while a little more because once we introduce the needle, we take the liquid, well all that is very fast. You may be wondering: “Hey, have you ever stung a baby? No, never, that’s what we use ultrasound for.

Many years ago they performed a blind amniocentesis, they just palpated, palpated and took the puncture. Currently, amniocentesis necessarily has to be done under ultrasound, with ultrasound guidance, and what we do is: I measure exactly where the fluid is, so that the baby is completely far from that lagoon of amniotic fluid where I am going to take it, and we always try to do the aspiration of the fluid without crossing the placenta to avoid any contamination, then we look for a space free of placenta, we look for a space where we have a good gap of amniotic fluid and where the baby is far from that amniotic gap, we see it in different shots of the ultrasound and we make a very safe puncture for the baby. As I said, the risk is 0.5% and here at Creafam we have never had a loss due to an amniocentesis. Although when you read the literature you will notice that there may be risks of infection, that there may be risks of rupture of membranes and loss of pregnancy, 0.5%, but with the care and with the staff and with the trained team, those risks are still present. We decreased a lot.

Here you are going to see how we are doing the puncture through the abdominal wall to enter the uterus, I explain to you, when we do the first puncture, which is to go through the skin, you will feel a little prick that is less painful than an injection in the butt, it is a sensation It’s strange about a puncture because the needles are even thinner than the needles with which we inject into the buttocks, so it will be a very light puncture. Once we pass the uterus it gives a strange sensation, it feels like a colic sensation but it is a colic that is very mild and very temporary. Once we extract the fluid, it will take a minute at most, you will see it in the video, it is seconds and if you see the amount of fluid it is because we take out 2 syringes, we try to get 10 to 15 milliliters of amniotic fluid .

Because? Because in this case with that amniotic fluid, with one we are going to do the amniotic fluid culture from the amniocentesis of the chromosomes, which will take us 2 to 3 weeks but in the same study we can have a quick study that we call with FISH. Through this study, in a matter of 5 days we already have the study of the mainly affected chromosomes, such as 21, 18, 13 and the sexual ones baby if they have any affectation due to chromosome 21 such as Down syndrome or any affectation at the level of the sex chromosomes or any affectation at the level of chromosome 18 or 13 which are commonly the most affected and then nothing more than waiting for the 2, 3 weeks to be able to have a complete karyotype, this is talking about chromosomal problems, chromosomal diseases. When we talk about a genetic disease or a paternity test or an infection, everyone takes their time, which is not given by the geneticist and the laboratory where all our samples are sent.

Other facts about amniocentesis

Well, it is also important that you know, amniocentesis cannot be done at any time during pregnancy, the ideal is always to wait until at least week 15 because early amniocentesis can cause shortening of limbs or there may simply be not enough fetal cells and then there is not an adequate culture of these cells to be able to have the chromosomal diagnosis. So, an amniocentesis is important to be done from week 15 of pregnancy. She is a patient who was also sent to us at week 13 because she had cystic hygroma, so we decided to wait until week 15 to be able to do the amniocentesis, which fortunately was normal, a completely normal karyotype. What do I tell you with this? Not all cystic hygromas are related to a chromosomal problem, but it is important that any cystic hygroma requires an amniocentesis to rule out a chromosomal problem.

In what other cases is amniocentesis recommended? Well, whenever at any time a fetal malformation is detected, be it facial clefts such as cleft lip or heart disease or shortening or lack of limbs, but in any fetal anatomical defect it will always be recommended to do an amniocentesis to give you the greatest peace of mind. that the baby is well chromosomally. Remember we do not inject, we do not prick the baby, we simply place a needle inside her space and extract 15 milliliters of amniotic fluid. In a matter of 24 hours to 36 hours, that liquid was recovered again, so do not worry about that liquid that is extracted.

I also have to tell you that amniocentesis is not only for detecting chromosomal or genetic diseases or paternity tests, we don’t have much that a couple asked me if I could know if their baby’s lungs were ready to be born, we are talking about This test can be done with an amniocentesis: Remove amniotic fluid, send it to the laboratory to study and they will tell me if the baby has sufficient lung maturity to be born. When are these studies done? When a baby is compromised inside the mother’s womb. When it is inside the mother and it is compromised, it is not growing, the fluid is decreasing and the gynecologist already wants to know if it is ready for the baby to be born properly or if it is better to wait a moment longer. Many times we do not do these tests because we give priority to how the baby is feeling… If the baby is feeling well then we give it more time, if the baby has to be born then even if the lungs are not yet 100% then it will have They have to be born because it is no longer a comfortable environment at the moment they are in, but they should know that the amniocentesis test can also be used to determine lung maturity.

To say goodbye, this video of this amniocentesis that we performed came out in a very satisfactory way in every way. Why? Because chromosomally the baby was healthy and the baby was already born and everything was born very well… Yes with the problem of hygroma but the hygroma can be resolved externally, and knowing that there is no chromosomal compromise towards the baby, since the Dads go calmer. It is a study that is currently very safe in the hands of specialists.

“The risk of 0.5% is a worldwide statistic, at Creafam we are specialists and we have already far exceeded 200 amniocenteses without anything happening to a baby”

Dr. Carlos Monsalve
Dr. Carlos Monsalve
Specialist in gynecology and obstetrics

Perinatology, invasive techniques and obstetric ultrasound.
Hospital Universitario La Fe, Valencia, España.

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