CVS Dr Minoo Movahedi CVS Prenatal diagnosis Chromosome

CVS Dr. Minoo Movahedi

CVS Prenatal diagnosis Chromosome & DNA Ten weeks TC & TA

TC – CVS Culture Needle Sterile Speculum Metal sond Syring 20 cc Media Tenaculom

TA - CVS Sterile Gel Sterile Probe Needle Syringe Media Holder P&D Long axis placenta

Multiple Gestations Monochromic Twins : single sample Dechorionic Twins : Separate placentas Ant : TA – CVS Post : TC – CVS Fused Placenta : Placental Margin insertion of Cord Follow up Amniocenteses : 6 %

CVS Indications DNA Karyotyping Mendelian disorder Increased maternal Age Screen down syndrome Family history Paternity Infections

Contraindications TC – CVS Vaginismus Cervical stenosis Cervical Myomas Cervical infection Lower segment myoma Sever antiflextion Retrofelxtion of Uterus

Contraindication of TA – CVS Sever uterine retroflextion With intestinal Loop Fetal position posterior Placenta

All type of CVS Maternal isoimmunization Fetomaternal Hemorrhage Erythroblustosis fetalis

CVS complications Damage or fetal loss < 28 w : 2. 8 – 3. 9 % >28 w : 3. 9 – 4. 2 % TC – CVS increased TA – CVS = Amniocentesis Prenatal mortality rate = 6 -7% Rupture of membering 0. 5 % Bleeding = 1/3 cases - 6% increased VB – 4% Hematoma Infection = 0. 5 % chorioamnionitis , septic shock peritonitis

Placental Mosaicism Direct method (Trophoblasts ) Long term cultures (Mesechymal cells ) Specificity 99. 9 % Sensitivity 99. 6 % Increased IUGR

Limb reduction Defects and Oromandibular hypogenesis GA < 9 weeks Needle Experience

CVS failure obtained TC – CVS > TA – CVS Multiple insertion TC – CVS > TA – CV

Ob complications Controversy PIH Long term Out come No differences

TA & TC CVS TA CVS is preferable: Fetal loss decreased Bleeding decreased Infections decreased Multiple insertions decreased Success rate increased

CVS is safer than early Amniocentesis < 15 weeks