WOMENS-HEALTH Messages for April, 1998: Re: Amniocenesis

Re: Amniocenesis

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Wed, 8 Apr 1998 22:09:57 -0500 (CDT)

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At Wed, 8 Apr 1998, Hil wrote: >
>Since I am 37, my doctor strongly advises me to take the amnio test. I
>am prepared to have this baby in whatever condition he/she may come. So
>I am struggling with whether I should take the test. What are the
>benefits beside knowing in advance he health of the baby?

This is an excellent question. First, an amniocentesis consists of placing a long, but very thin, needle through the skin of the abdomen directly into the uterus, to collect amniotic fluid. Despite the obvious connotation of being "punctured" through the abdomen, about 95% of my patients say "that was it?" when it's over. In fact, most find that an IV hurst more.

An amniocentesis is used for a number of diagnoses or treatments during pregnancy. Amniotic fluid mostly consists of cells from the baby's lungs and skin, and fetal urine. Early in pregnacy we can determine the karyotype (genetic makeup) of the baby by examining these cells. This can determine the presence of such things as Down syndrome, trisomy 18, and trisomy 13. It can also determine whether other genetic disorders are present, such as Kleinfelter's syndrome, and Turner's syndrome. In addition, it helps rule out spina bifida. Later in pregnancy we can remove excess amniotic fluid (polyhydramnios), check for infection around the baby, perform intrauterine blood transfusions, place medications directly into the baby, and check whether the baby's lungs are "mature" or not. As you can see, it's a pretty helpful test. It has a risk of ruptured membranes, infection, or stillbirth of about 1 in 200 to 1 in 400 (roughly).

If one would terminate a pregnancy due to an abnormality there is an obvious reason to check an amniocentesis. However, why would one have this procedure if she would not terminate the pregnancy under any circumstances? From a medical standpoint, the family may need preparation from an emotional and financial perspective to receive a baby with special needs. Furthermore, doctors may need to perform additional tests, or have specialists available at birth or shortly thereafter if, for example, a baby with Down syndrome has a cardiac defect. Babies with spina bifida should probably be born by c/section to prevent worsening paralysis. Special monitoring may be necessary for some conditions. Finally, in the case of a fetal abnormality that is always lethal, it would be unfortunate to perform a c/section, which can be dangerous to the mother, if, for example, the fetal heart rate decreased dramatically during labor.

As with almost all medical procedures, this is a personal choice. I appreciate the opportunity to answer your question, and thanks for visiting obgyn.net.

-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://www.gate.net/~dahmd

I apologize, but I am unable to answer personal e-mail due to time constraints.

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