Cordocentesis: Diagnosing Fetal Concerns

Cordocentesis

• Performed to diagnose fetal malformations, infection (e.g. toxoplasmosis, rubella), fetal platelet count, fetal anemia, and isoimmunization
• Potential side effects include blood loss, infection, drop in fetal heart rate, premature rupture of membranes, fever, chills, and leaking of amniotic fluid

Malposition

• A term used to describe a fetus that is rotated so that it is in the occiput posterior or occiput transverse positions
• Types: occipitoposterior positions, occipitotransverse positions
• Factors: multipara, lax abdominal wall

Occipitoposterior Positions

• The most common malposition
• The head initially engages normally but then the occiput rotates posteriorly rather than anteriorly
• Related factors: flat sacrum, android, anthropoid or contracted pelvis, poorly flexed head, weak uterine contractions, epidural analgesia

Nursing Management

• Close maternal and fetal monitoring
• Counterpressure on the sacrum
• Applying hot or cold
• Lying on side opposite the fetal back to help fetus rotate
• Woman should void every 2 hours and receive adequate fluid and IV glucose solution
• May need to instruct not to push before full dilatation

Occipitotransverse Position

• It is the incomplete rotation of OP to OA results in the fetal head being in a horizontal or transverse position
• Management: manual rotation with Keillands forcep or delivery using vacuum extraction, immediate CS if failure to deliver through forceps
• Abdominal examination: the lower part of the abdomen is flattened, fetal limbs are palpable anteriorly, and the fetal flank
• Vaginal examination: the posterior fontanelle is toward the sacrum and the anterior fontanelle may be easily felt if the head is deflexed
• Maternal risks: prolonged labor, potential for operative delivery, extension of episiotomy, 3rd or 4th degree laceration of the perineum
• Maternal symptoms: intense back pain in labor, dysfunctional labor pattern, prolonged active phase, secondary arrest of dilatation, arrest of descent

Nursing Management

• Encourage the mother to lie on her side from the fetal back, which may help with rotation
• Pelvic-rocking knee-chest position may help and facilitate rotation
• Apply sacral counter-pressure with heel of hand to relieve back pain
• Continue support and encouragement: Keep client and family informed of progress
• Praise client's efforts to maintain control
• Monitor FHT appropriately
• Be prepared for childbirth emergencies such as C-section, forceps-assisted delivery, and neonatal-resuscitation

Management

• If there are signs of obstruction or the fetal heart rate is abnormal at any stage, deliver by caesarean section
• If the cervix is not fully dilated and there are no signs of obstruction, augment labor with oxytocin
• If the cervix is fully dilated but there is no descent in the expulsive phase, assess for signs of obstruction
• If the cervix is fully dilated and if the leading bony edge of the head is above -2 station, perform caesarean section
• If the leading bony edge of the head is between 0 station and -2 station, deliver by vacuum extraction and symphysiotomy
• If the operator is not proficient in symphysiotomy, perform caesarean section
• If the bony edge of the fetal head is at 0 station, deliver by vacuum extraction or forceps

Vertex Presentation

• The vertex presentation describes the orientation a fetus should be in for a safe vaginal delivery
• Types: breech presentation
• Breech presentation: it means that either the buttocks or the feet are the first body parts that will contact the cervix
• Most common malpresentation, occurs in approximately 3% of the births
• More common in premature labor
• Breech presentations can be difficult births, with the presenting point influencing the degree of difficulty
• Approx 1/3 are diagnosed during labor

Types of Breech Presentation

• Complete (Flexed) Breech Presentation: the baby's hips and knees are flexed so that the baby is sitting crosslegged, with feet beside the bottom
• Footling Breech Presentation: one or both feet come first, with the bottom at a higher position, rare at term but relatively common with premature fetuses

Cordocentesis is a diagnostic test used to identify fetal malformations, infections, and other concerns. This test may be performed to diagnose issues such as toxoplasmosis, rubella, fetal anemia, and isoimmunisation. However, it carries potential side effects like blood loss, infection, and premature rupture of membranes.