Yeah. Mm. Mhm. Oh, Mhm. Mhm. Since ancient times, childbirth has been covered with a veil of uncertainty. The ever present dangers to both mother and child were taken for granted. As the knowledge concerning childbirth increased new techniques and methods attempted to improve the rate of both infant and maternal survival. Slowly, with more scientific resources, the emphasis was expanded to include the detection and prevention of neonatal complications. Amniocentesis, begun in the 1930s, is one technique increasingly used for the diagnosis and management of obstetrical problems. By the introduction of a needle into the amniotic cavity and the aspiration or injection of fluid, prenatal analysis and treatment can minimize the risks of previously dreaded complications. Yeah, all right. Mary Lawrence is 32 years old and the mother of four. Yet this is the first time she has been advised to have an amniocentesis performed. Hello, Mary. How are you? Dr. Baidu is waiting for you. Why don't you go on in? An essential part of Mary's amniocentesis will take place long before the actual procedure. Hello, Mary. How are you? Fine. How's the baby? Is it moving? All right? Yes. And how is everything with you? in a comfortable setting and with a minimum of distraction, she will be interviewed and counseled. Through honest and accurate information and explanation. Mary will be thoroughly informed of her doctors plans for both her and the baby. She will be given the opportunity to express her concerns and uncertainties and to ask questions all to reduce her tension and lead to her informed cooperation. And, of course, her most natural first question is why the indications for amniocentesis are varied. However, they fall into three general categories early and late. Diagnosis of abnormalities, therapy and research. Let us first consider diagnostic indications. Our patient here is discussing an amniocentesis late in the gestation period to determine fetal maturity. Fetal maturity studies are a preliminary to pregnancy intervention, such as in Mary's elective Repeat Cesarean section. With the ability to determine parameters such as fetal lung maturity and fetal kidney maturity, the number of premature deliveries has decreased. Another late gestation indication for amniocentesis is the diagnosis of a re throw blastocysts fit talus, a hemolytic disease of the newborn. Here, a study of the amniotic fluid allows for the management of the pregnancy and the timing of the delivery in Rh sensitized patients. Am Neon graffiti is a radiographic procedure which necessitates the injection of a radio opaque dye into the amniotic fluid conditions such as high drops. Fetal is fetal death and congenital defects of the esophagus and trachea may thus be diagnosed. This amnesia graph, however, displays a normally developed fetus. In cases of suspected fetal distress, amniocentesis is again used. The extracted fluid is studied for its color and for other information about the intra uterine environment, this fluid is from a normal pregnancy. The whitish color, which becomes milky a term indicates no present fetal distress. This fluid has a greenish tinge, indicating the presence of meconium and possibly ongoing fetal distress. The reddish color of this fluid may be indicative of fetal death, fiber optic visualization of the placenta and fetus, or to Tosca. P identifies gross abnormalities with photography through amniocentesis. The hand of this fetus is seen and identified. Also, the Penis, the buttocks and one of the lower limbs. Fetal and placental biopsy is another more developed means of determining abnormalities. Hereditary blood diseases or pathology of the placenta are examples of conditions that may be diagnosed through amniocentesis, biopsies or fetal blood samples. All varieties of diagnostic amniocentesis are not performed late in the pregnancy As early as the 14th through 18th week of gestation. The amniotic fluid may be studied for purposes of genetic counseling. Chromosomal analysis is employed to detect abnormalities as seen in this Down's syndrome specimen. It is also used for fetal sex determination, where there is the possibility of sex linked diseases like hemophilia. Biochemical studies are also possible through early gestation fluid analysis, for example, enzymatic deficiencies may be detected. The detection of intra uterine infection is the last common diagnostic indication for amniocentesis, leading to effective therapy and treatment. Therapy is another important and essential indication for amniocentesis. Therapeutic abortion is often employed after an initial diagnostic. Amniocentesis, a substance such as hyper tonic, saline or Yuria, is used in the second trimester of pregnancy to terminate the gestation. Management of poly hydra MEOWS and excess in the amount of amniotic fluid may be achieved by the aspiration and removal of unnecessary fluid. Intra uterine transfusion may be indicated for the management of severe hemolytic disease of a sensitized fetus. Intra amniotic injection of drugs is a form of prenatal therapy that may be of future benefit. The direct injection of drugs such as digitalis or injections of substances such as amino acids, have been experimentally used to increase fetal survival. Over the years, research in the field of amniocentesis has expanded knowledge of both the fetal and intra uterine environments, leading to expanded indications and uses for amniocentesis. Our patient is now ready for the next step prior to the amniocentesis, a sonogram of the uterus. Once again, careful explanation and good communication is necessary to establish rapport and cooperation grand before we do the annual. And the reason is first, to organize the placenta and to know from which point of the abdomen we take the fluid and you know what the sonogram is? It takes a picture of the baby also gives us an idea about the the maturity and the size of the baby's head. Previously, methods such as soft tissue, X ray angiography or thermography were used for evaluation and planning prior to amniocentesis. Now ultra sonography using a B scan is the primary method employed in sonography. A probe is passed over the abdomen, causing ultrasound waves to longitudinal e and trans verse. Lee scanned the entire structure. A video image displayed on a monitor shows sections of the uterus, which are only a centimeter thick. These sections are then photographically recorded and used to determine the number of fetuses, the position of the fetus, the gestation age and, most important for amniocentesis, the localization of the placenta. To aid in the identification of structures, the patient is asked to arrive with a full bladder, providing an interface between the bladder and the uterus. The photographic results of the sonogram are an invaluable aid in determining site selection for amniocentesis and thus minimizing the danger of placental puncture. There are three major puncture sites, which are most commonly used for amniocentesis. If, upon examination of the sonogram, it is determined that the placenta is in a posterior position, the most common puncture site is between the upper and lower extremities of the fetus. This uses an anterior approach to the fluid space. In cases where the placenta is anterior, the possibility of injury to the umbilical cord is increased. Therefore, the preferred site is just posterior to the neck. In most situations, the head must be moved slightly to one side to provide a rich fluid space in babies who present abnormally an alternative site might be a super pubic approach, placing the needle just below the head of the fetus. Here, an assistant is required to raise the head. There may be some difficulty if the fetus is firmly engaged in the pelvis, and also there is the slightly increased possibility of membrane rupture. However, all possible alternatives must be discussed after review of the sonogram before a particular puncture site is selected in the sonogram of our patients. The structures are well defined. The anterior abdominal wall of the mother, the fetal body and head, which is in the Vertex presentation. The mother's full bladder posterior lee. We see the maternal spine and directly in front of it the placenta, which is posterior to the fetus. This allows for a safe anterior approach to the amniotic fluid. The patient interviewing and evaluation phase is now complete, and she is scheduled for the amniocentesis. A sterile tray will be used for the procedure. It consists of four towels to drape the patient. A five CC syringe for aspiration of the anesthetic agent 3 10 cc syringes for the aspiration of the amniotic fluid specimen four x 4 Gauze, 2 20 gauge 3.5 inch spinal needles with style It's the style it's are to prevent plugging of the loom in when the needle is being advanced and especially in genetic studies, to avoid contamination of the Lumen with maternal tissue. A bowl for application of the anesthetic agent. A 25 gauge half inch needle for the local anesthesia if used. A 20 gauge, 1.5 inch needle to aspirate the anesthetic agent and three bottles or tubes with their covers to store and transport the specimens. The dark brown color is used since Billy Rubin pigments are photosensitive. Dr. Samir Beydoun and Dr Teresa Campbell um, are now ready to begin just Lawrence. I'm going to get your blood pressure and listen to your baby's heartbeat before we do the procedure.