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    pink loader
    pregnancy

    Percutaneous Umbilical Blood Sampling (PUBS)

    • 10842 views
    • 4.5   (1 Votes)
    Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 15 Jun 2019 - Written by Dr. Madhu Goel - DNB, MBBS, MD - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

    Percutaneous umbilical blood sampling is a procedure used to detect any kind of defect, infection or chromosomal abnormalities in a fetus. This process is also known as cordocentesis and is processed later in the pregnancy period. PUBS process follows three steps i.e. imaging, blood sample retrieval, and sample analysis.

    Percutaneous umbilical blood sampling (PUBS) is also known as 'Cordocentesis'. It is a diagnostic procedure which is used to evaluate different kinds of fetal conditions. PUBS is generally conducted once the tenure of 18 to 19 weeks of pregnancy is going on. During the procedure of Percutaneous Umbilical Blood Sampling, a well-trained specialist uses ultrasound imaging. This helps in completing the procedure successfully by guiding a needle through the maternal abdomen and into the umbilical cord. This process helps the specialist to take a sample of fetal blood for inspection to find out the presence of any fetal conditions successfully. (1) After the procedure is completed, the blood sample can be used to diagnose a wide spectrum of any fetal conditions such as from infections to genetic disorders. (2) Confirming a suspected diagnosis before the birth of the child may offer the couple an opportunity to pursue medical interventions which is recommended for their case.

    PUBS is usually done by a specially trained primatologist, a doctor who specializes in the care of the fetus, especially in high-risk pregnancies. It is done as a part of diagnosing, treating, and monitoring fetal problems multiple times during pregnancy. PUBS may be taken for:

    • Diagnosing genetic or chromosome abnormalities
    • Checking for blood problems such as Rh disease and treating severe fetal anemia
    • Checking oxygen levels of the fetus
    • Checking for any infection in the fetus
    • Giving certain medications which are good for the health of the fetus

    Percutaneous Umbilical Blood Sampling
    This article will help you know about certain important details related to Percutaneous Umbilical Blood Sampling process such as its advantages, disadvantages, reasons for its uses, the procedure of the same, measures a woman needs to take during or after the process. It is necessary to discuss the risks and benefits of the medical test thoroughly with the healthcare provider of your choice. The healthcare provider will help you to evaluate whether the benefits from the results could outweigh any risks from the procedure or not. You will find the required and necessary details that could help a woman undergoing PUBS successfully.

    In this article you will get to know about:

    Why is Percutaneous Umbilical Blood Sampling (PUBS) performed?

    Percutaneous Umbilical Blood Sampling (PUBS) is usually done in addition to an ultrasound and amniocentesis. This process is required in multiple cases such as:

    • This process helps in quickly checking a baby's chromosomes for any defects or disorders
    • The main concern of this procedure is that the baby may have another problem as the pregnant woman may be diagnosed with low platelet count or a thyroid condition which can impact the overall health of the baby.

    Why is Percutaneous Umbilical Blood Sampling (PUBS) Performed
    The main advantage of PUBS is its ease of performing the medical test. This test is the only way to confirm if the fetus is anemic or have a platelet disorder. This procedure works efficiently because it uses a blood sample rather than an amniotic fluid sample. Percutaneous Umbilical Blood Sampling (PUBS) also allows transfusion of blood or needed fluids into the baby while the needle is in place. (3)After declaring the results of the medical test, the medical specialist will help the patient to understand the reports. If the reports are normal then he/she would discuss the need for any follow-up appointments or continue with general obstetric appointments. But if in case the baby has any kind of infection then the specialist would explain the treatment options related to it. If the baby has severe anemia then the specialist performs blood transfusion procedure through the umbilical cord in the pregnant woman. Lastly, if the medical test results indicate that the baby has a condition that can't be treated then a woman might be faced with wrenching decisions. The medical professional asks the patient to decide whether to continue with the pregnancy or not. A woman can seek support from her family members and the team at the hospital.

    Associated Risks and Complications:

    As mentioned earlier, PUBS is an invasive diagnostic procedure in the field of infertility medicine. This test carries a number of risks and complications which are related to a number of factors from the procedure, the experience of the staff performing the test to the gestational age. However, the risks involved in each case vary according to the indications of the procedure and the medical case of the patient. (4) For example, fetuses which are structurally abnormal or had any growth deficiencies were found to be more capable of the associated risks and complications of PUBS. Percutaneous Umbilical Blood Sampling is a very complex procedure that must be done by a specially trained doctor. It is used at that stage of pregnancy when other medical tests or procedures are not effective for the respective patient's case. It can be performed for pregnancies that are of 18 weeks or later. Some of the prominently found risks include:

    • Transient bleeding of the umbilical cord: The puncture site is most common and occurs in almost 20% of the pregnancy cases. Often the bleeding spontaneously stops within a short period of time i.e. within 1 minute in most of the patients if there are no already present complications in the patient. While in some cases, continued bleeding may prove that the fetus may have blood disorders i.e. alloimmune thrombocytopenia.
    • Transient fetal bradycardia: In this case, the heart rate of the fetus falls below 100bpm which is the most common complication after PUBS is performed. This complication has been found to occur during or immediately after PUBS was performed in approximately 8% of pregnancy cases. Transient fetal bradycardia occurs due to puncture issues. This causes changes in the circulation thus induces reflexes and releases the substances within the fetal circulation. In most of the cases, it brings short term changes in fetal heart rate during PUBS. Till now the test has not reported any long term fetal injury except for the presence of underlying fetal disorders. However, manual compression through the maternal abdomen is recently the most preferred method of fetus revival and it is conducted by a medical professional who has expertise in the same.
    • Failure to obtain a sample: It is also a complication occurring in few cases which may require further PUBS procedure. This could potentially increase the likelihood of fetal distress and preterm labor.
    • Preterm labor: It may impel upon the medical team, overseeing the procedure. They must be prepared to perform an immediate emergency cesarean delivery in these cases.
    • Fetal loss: Fetal death refers to the spontaneous intrauterine death of a baby at any time during pregnancy. (5) This is mostly found in less than 2% of cases which is attributed to a number of factors including procedural time, gestational age, underlying medical conditions, the expertise of the operator, pregnancy complications, and movement of the fetus. (6)
    • Slowing of the baby's heart rate: The baby's heart rate might slow temporarily after cordocentesis.
    • Passing maternal infection: If a pregnant woman has certain infections, such as hepatitis B, hepatitis C, or HIV, they might be passed to the baby. Such infections also pose to be one of the most common risks for the baby.

    Associated Risks and Complications
    The most common complication of PUBS procedure is a hemorrhage or bleeding, of the puncture site. It can be dangerous when the fetus is younger than 21 weeks in a pregnancy. The risk of hemorrhage is greater if the fetus has any defect that can affect its blood platelets as well. A transfusion of donor platelets is generally done in such cases to decrease the risk of bleeding. If in case, the bleeding is severe then the specialist may opt for immediate delivery as long as the fetus is old enough to survive. It may also be considered if the fetal blood volume can be restored with the help of certain medical measures.

    When is Percutaneous Umbilical Blood Sampling done?

    This procedure is generally performed when diagnostic information can't be accumulated via other tests such as amniocentesis, chorionic villus sampling (CVS), or ultrasound. However, the results of these tests were inconclusive. Percutaneous Umbilical Blood Sampling (PUBS) may also be used late in pregnancy. If in case, the woman has been exposed to a disease that could harm the fetus or when ultrasound has found the presence of a fetal abnormality, then the specialist can either suggest any treatment or else recommend to terminate the pregnancy. PUBS can be performed as early as the 18th week of the tenure of pregnancy in a woman. This is because performed before the 18th week of pregnancy the umbilical vein is too fragile for the procedure. But it's usually used later in pregnancy. The main advantage of this test is that it's less time-consuming which eases the experience with respect to the test. A doctor may recommend a woman for amniocentesis or CVS if the woman wants to check her baby whether it has a chromosomal defect or any blood disorder. It may take a few weeks to get the results of the amniocentesis test. However, compared to amniocentesis or CVS, PUBS can provide results quicker which can be advantageous for the health of the fetus. PUBS test may be worth it if a woman who is currently in her 20 weeks of pregnancy and is advised to end her pregnancy based on a finding of abnormalities or disorder in her fetus. (7)

    What can be diagnosed with PUBS?

    Percutaneous umbilical blood sampling can diagnose multiple abnormalities and disorders. Some cases that are successfully diagnosed by PUBS are:

    • Chromosomal abnormalities: A chromosomal abnormality occurs when a baby has either the incorrect number of chromosomes or else the chromosomes are structurally flawed. These abnormalities in a fetus may translate to the development of birth defects and disorders such as Down syndrome, or miscarriage. These defects or disorders may be diagnosed with PUBS efficiently.
    • Blood disorders: Bleeding disorders are also known as "coagulopathy" which are the conditions that can affect the body of a fetus as well as the mother. The ability to clot normally especially at the area of an injury can result in bleeding that can range from mild to severe. Bleeding disorders like anemia also affect the health of the fetus in the mother's womb.
    • Metabolic disorders: A metabolic disorder can only occur when abnormal chemical reactions alter the normal metabolic process in the body. (8)
    • PUBS can diagnose various infections such as toxoplasmosis and rubella which helps the pregnant woman take the required measures.
    • This test can also help in diagnosing some causes of structural problems or intrauterine growth restriction in the woman.

    This procedure is also utilized to perform blood transfusions to the fetus and to regulate medication directly into the fetal blood supply. (9)

    How is Percutaneous Umbilical Blood sampling is performed?

    This procedure is performed with the help of an advanced imaging ultrasound that determines the location where the umbilical cord inserts into the placenta. The ultrasound inserts and then guides a thin needle through the abdomen and uterine walls of a woman to the umbilical cord. In this process, the needle is inserted into the umbilical cord to retrieve a small sample of the fetal blood. The sample is then sent to a well equipped and advanced medical laboratory for analysis, and the results are normally available within 72 hours after the test is performed. This procedure is similar to amniocentesis, except their objective i.e. to retrieve blood from the fetus versus amniotic fluid. (10)

    How Is Percutaneous Umbilical Blood Sampling Is Performed

    Steps of Percutaneous Umbilical Cord Sampling (PUBS) Procedure:

    PUBS is performed by the advancement of a needle within an ultrasound visual field to a targeted puncture site in the maternal body. It consists of three fundamental steps which are mentioned below:

    Step 1– Imaging: Imaging means an advanced imaging ultrasound which is used to determine the location of where the umbilical cord inserts into the placenta. This ultrasound image is then used to guide in PUBS procedure in order to guide a thin needle through the abdomen and uterine wall of the pregnant woman and into the umbilical vein running through the cord. This guidance leads the needle to reach the placenta for the blood sample of the fetus.

    Step 2 - Retrieval of Fetal Blood Sample:The needle is then inserted into the cord to take a small blood sample of a fetus. There are two main routes for retrieving fetal blood. The method used to perform this procedure is determined by the position of the placenta in the uterus. This is the point of connection with the umbilical cord. However, the ideal sample site for PUBS is located at the root of the umbilical cord. It is due to its stable fixed position which is less susceptible to disturbances caused by fetal movement.

    There are two techniques that can be utilized when obtaining a blood sample of the fetus i.e. freehand and needle-guided. The choice of technique depends on a number of factors including the location of the cord root and the preferences of the physician who is performing the procedure.

    1. Freehand: This technique allows lateral readjustment of needle direction once within the uterus of the pregnant woman. A transducer is used to navigate the needle to the specific sample site. It is the more preferred technique due to the increased range of movement.
    2. Needle-guided: This technique involves the insertion of a separate needle straight into the targeted puncture site for diagnosing any kind of defect or infection present in the baby. This insertion is done with the support of the transducer, which builds a fixed passage through, with a second smaller needle that passes to retrieve the sample of fetal blood. Despite permitting precise alignment of the needle track with the vessel, the range of movement is limited to a single plane of travel.

    It is very important to note that when a specialist is performing PUBS, he/she should know whether the mother is Rh-negative, Rh Immune-Globulin (RhIG). If in case it is present in the mother than it is administered in the mother in order to prevent the development of Rh incompatibility and further sensitization.

    Step 3 - Sample Analysis:After taking the blood sample of the fetus, it is then sent to an advanced medical lab. Further, the sample is screened for genetic defects and other disorders in a laboratory full of advanced technology. Preliminary to this, Betke test is performed in order to confirm that the blood sample obtained is of a fetus. The result of the test is usually available within 72 hours. However, under some circumstances, it may take a few weeks to declare the result. In the event of diagnosis or any fetal abnormalities, the specialist has to perform the most suitable procedure.

    Advantages of PUBS:

    PUBS has multiple advantages but one of the most impressive advantages is that the result of this procedure is available at a quicker rate as compared to another test. After the reports are released and the abnormalities detected are at a normal stage then it is cured with the help of a specialist or expert. Or if in case any serious abnormality or infection or any defect is detected then the pregnancy of that woman is terminated after expert opinion. Some other advantages of this procedure are stated below:
    Advantages of PUBS

    • PUBS is absolutely successful in detecting the presence of any genetic or chromosomal abnormalities such as Down syndrome and Edwards Syndrome.
    • The blood sample taken via PUBS procedure is available for different types of analysis.
    • This procedure allows knowing about the specialized information related to the health of the fetus.
    • PUBS procedure checks and allows for treatment of serving fetal anemia or any other blood problem.
    • This process helps in checking whether any fetal infections are present.
    • This technique can also be used to administer certain medication directly to the baby.
    • The results of the PUBS are available relatively soon after the procedure has taken place.

    Disadvantages of PUBS:

    PUBS also has some of the common disadvantages, which are mentioned below:

    • It is one of the pre-natal diagnostic tests that is recognized as posing a slightly higher risk of having a miscarriage (1%-2%), infection, and temporary slowing the heartbeat of the fetus.
    • One of its disadvantages is that it is less commonly available than Amniocentesis and Chorionic Villus Sampling (CVS)
    • Only a few doctors have experience in performing this procedure.
    • PUBS procedure is performed later in the pregnancy in comparison to other pre-natal diagnostic techniques such as Amniocentesis and CVS.
    • It is unable to detect the severity of disorders detected by technique.
    • PUBS is a highly expensive procedure when compared to other tests which are recommended for checking genetic conditions in the baby.

    What are the important points to remember During or After PUBS procedure?

    A patient should know multiple things which she should remember during or after PUBS procedure.

    During the procedure: A patient should take antibiotics to reduce the risk of a uterine infection prior 30 to 60 minutes of the procedure. The antibiotics are usually injected through a tube into the targeted vein. The specialist performing the procedure will use ultrasound to determine the umbilical cord’s location in the uterus of the pregnant woman. The specialist will let the patient lie on her back on an examination table, and then apply a specific gel to her belly. The professional will then use a small device which is known as an 'ultrasound transducer' to show the baby's position on the monitor attached to it. After showing the movement the healthcare provider will clean the belly. Sometimes the medication is provided to the woman to prevent discomfort during the procedure. However, this medication is not often needed. Under the guidance of an ultrasound, the healthcare provider will insert a thin, hollow needle through the abdominal wall into the uterus. A small amount of blood from a vein in the umbilical cord is removed from the patient. It will be then withdrawn into a syringe and the needle will be removed. A woman might notice a stinging sensation when the needle enters her skin, and she also might feel cramping when the needle enters her uterus. Such sensation also occurs at the time of the removal of the needle from the patient.
    After PUBS procedure

    After the procedure:- After the blood sample is taken a patient might feel cramping or else have a small amount of discomfort. The healthcare provider will use an ultrasound or an external labor monitor to track the heartbeat of the baby during pregnancy. When a woman goes home after the procedure is successfully completed then the specialist might suggest resting for the rest of the day. A woman can likely be able to resume her normal activities, most probably from the next day. If in case a woman experiences vaginal bleeding or fluid leakage then she is recommended to call her healthcare advisor immediately. (11)

    Percutaneous Umbilical Blood Sampling (PUBS) is one of the most effective procedures to detect any chromosomal abnormalities or genetic problems in a fetus. A pregnant woman should take care of her baby and know whether her baby is safe from all kind of infections or not. This procedure helps a baby in starting a healthy life. Some couples may decide not to have this procedure for their personal reasons. Undergoing this procedure is the personal choice of the couples who are planning babies with infertility procedures. In case they need any kind of assistance then they can visit elawoman.com. They can go through some of our blogs related to pregnancy care or delivery. You can also contact our team at +918929020600for any expert focused medical assistance related to infertility diagnosis and treatments for the same.

    Dr. Madhu Goel

    Written by

    DNB, MBBS, MD
    Obstetrician, Laparoscopic Surgeon
    Delhi
    Dr. Madhu Goel is an infertility specialist and gynecologist who completed MBBS from University of Delhi in 1993. Then, she completed MD in Obstetrics and Gynecology and DNB in Obstetrics and Gynecology from Lady Hardinge Medical College, New Delhi. Her specializations include IVF, IUI, High-risk pregnancy care and Endoscopy procedures. Dr. Madhu has also received Dr. Pratibha Tiwari Memorial Award for the Best Post Graduate Student in 1994 along with other recognitions. Dr. Madhu is practicing at Goel Clinic and Fortis La Femme, Greater Kailash 2, Delhi. For more information, visit elawoman.com

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    Shrinivas Naimish

    June 15, 2019, 11:31 a.m. 4.5

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