Chp. 6 Antepartal

Biochemical tests

> Chorionic villus sampling > Amniocentesis > Percutaneous umbilical cord blood sampling(PUBS) tests

Antenatal Fetal Surveillance tests

> Fetal movement counting > Nonstress test (NST) > Contraction stress test (CST) > Amniotic fluid index (AFI) > Biophysical profile (BPP)/modified BPP > Vibroacoustic stimulation (VAS)

MRI risks

none

reasons for ultrasound in each trimester

table 6-2

doppler flow nsg actions

• Explain the procedure to the woman and her family. The Doppler test evaluates the blood flow through the placenta and umbilical cord vessels using ultrasound. • Address questions and concerns. • Provide comfort measures. • Provide emotional support. • Schedule appropriate follow-up.

ultrasound risks

• None, but controversy exists on the use of routine ultrasound for low-risk pregnant women, as there is no evidence it improves outcomes. • Ultrasonography is safe for the fetus when used appropriately and should be used when medical information about a pregnancy is needed.

cell-free DNA screening

• Screens for common fetal aneuploidies • Analysis of cell-free DNA fragments in the maternal circulation starts around 9 to 10 weeks of pregnancy • Identify fetal sex

what is a key component of perinatal care?

assessment of fetal status

Common maternal conditions indicating a need for antenatal tests

Antiphospholipid syndrome Hemoglobinopathies Hypertensive disorder Renal disease Cardiac disease Systemic lupus erythematosus Insulin-treated diabetes mellitus Hyperthyroidism

doppler flow risks

none

AFI nsg actions

• Explain the procedure to the woman and her family. This test uses ultrasound to measure the amount of amniotic fluid to assess fetal well-being and how well the placenta is working. • Provide comfort measures. • Provide emotional support. • Schedule appropriate follow-up. • Special training in obstetric ultrasound is required for evaluation of amniotic fluid volume

modified BPP

> combines an NST as an indicator of short-term fetal well-being and AFI as an indicator of long-term placental function to evaluate fetal well-being. > It is indicated in high-risk pregnancy related to maternal conditions or pregnancy-related conditions

Fetal movement counting

> FMC, the pregnant woman counts fetal movements in a specified time period to identify potentially hypoxic fetuses. > FMC is based on physiological principles that compromised fetuses reduce activity in response to decreased oxygenation, conserving energy > Maternal perception of fetal movement was one of the earliest and easiest tests of fetal well-being and remains an essential assessment of fetal health > Fetal activity is diminished in the compromised fetus, and cessation of fetal movement has been documented preceding fetal demise > Maternal perception of fetal activity is highly correlated with fetal activity

CST interpretation

• The CST is considered negative or normal when there are no significant variable decelerations or no late decelerations in a 10-minute strip with three UCs in more than 40 seconds, assessed with moderate variability. • The CST is positive when there are late decelerations of FHR with 50% of UCs. • A positive result has been associated with an increased rate of fetal death, fetal growth restriction, lower 5-minute Apgar scores, cesarean section, and the need for neonatal resuscitation due to neonatal depression. This requires further testing such as BPP. • The CST is equivocal or suspicious when there are intermittent late or significant variable decelerations; further testing may be done, or the test may be repeated in 24 hours.

most common abnormality of chromosome number

aneuploidy - which there is an extra or missing chromosome or chromosomes

tests performed for a biophysical assessment

• Ultrasound • MRI • Doppler flow

Percutaneous umbilical cord blood sampling(PUBS) tests

> Fetal blood sampling and percutaneous umbilical blood sampling (FBS/PUBS), or cordocentesis, is the removal of fetal blood from the umbilical cord. > The blood is used to test for metabolic and hematological disorders, fetal infection, and fetal karyotyping. > It can also be used for fetal therapies such as red blood cell and platelet transfusions > Usually used after ultrasound has detected an anomaly in the fetus. > Usually performed after 18 weeks' gestation to evaluate results of potential diagnoses and make further recommendations for medical management if necessary

issues in antepartal tests

> Responsible translation of reproductive and genetic technologies into prenatal care requires that all health-care professionals ensure women's informed decision-making in clinical practice > Nurses have a professional and ethical responsibility to facilitate women's informed decision-making regarding antenatal testing so they can make meaningful decisions about their health.

MRI & purpose

> a diagnostic radiological evaluation of tissue and organs from multiple planes > During pregnancy, it is used to visualize maternal or fetal structures for detailed imaging when screening tests indicate possible abnormalities. > It is most commonly performed for complex fetal anomalies such as suspected brain abnormality or to further evaluate abnormal placentation > Tissue, organs, and vascular structures can be evaluated without the need to inject iodinated contrast

Alpha-fetoprotein (AFP)

> a glycoprotein produced in the fetal liver, gastrointestinal tract, and yolk sac in early gestation > Assessing for the levels of AFP in the maternal blood is a screening tool for certain developmental defects in the fetus, such as fetal NTDs and ventral abdominal wall defects. > Because 95% of NTDs occur in the absence of risk factors, routine screening is recommended • High and low levels • Abnormal findings, false positives, falsenegatives

multiple marker screening

> a maternal serum test performed in the second trimester that gives information regarding the risk of open fetal defects in addition to risk assessment for trisomy 21 and 18. > The quad screen involves the measurement of four maternal serum analytes—human chorionic gonadotropin (hCG), AFP, dimeric inhibin A (DIA), and unconjugated estriol (uE3)—in combination with maternal factors such as age, weight, race, and the presence of pregestational diabetes to calculate a risk estimate. > The triple marker screen measures serum hCG, AFP, and uE3, and provides a lower sensitivity for the detection of trisomy 21 (sensitivity of 69% at a 5% positive screening test result rate) than quad screen and first-trimester screening

doppler flow

> a noninvasive screening technique that uses advanced ultrasound technology to assess resistance to blood flow in the placenta. > It evaluates the rate and volume of blood flow through the placenta and umbilical cord vessels using ultrasound. > Increased resistance in the placenta, suggestive of poor function, results in reduced diastolic blood flow > Evaluating fetal circulation and uteroplacental blood flow with Doppler flow provides critical information regarding fetal reserves and adaptation > Doppler assessment may provide insight into the etiology of fetal growth restriction. Increased impedance in the umbilical artery suggests that the pregnancy is complicated by underlying placental insufficiency

Amniotic Fluid Index (AFI)

> a screening tool that measures the volume of amniotic fluid with ultrasound to assess fetal well-being and placental function. > The amniotic fluid level is based on fetal urine production, which is the predominant source of amniotic fluid and is directly dependent on renal perfusion > In prolonged fetal hypoxemia, blood is shunted away from the fetal kidneys to other vital organs > Persistent decreased blood flow to the fetal kidneys results in reduction of amniotic fluid production and oligohydramnios. > Used with NST, AFI is a strong indicator of fetal status, as it is accurate in detecting fetal hypoxia.

NST

> a screening tool that uses FHR patterns and accelerations as an indicator of fetal well-being. > The heart rate of a physiologically normal fetus with adequate oxygenation and an intact autonomic nervous system accelerates in response to movement. > Acceleration in the FHR is a sign of fetal well-being. > The NST records accelerations in the FHR in relation to fetal activity. > It is the most widely accepted method of evaluating fetal status, particularly for high-risk pregnant women with complications such as hypertension, diabetes, multiple gestation, trauma, or bleeding; woman's report of lack of fetal movement; and placental abnormalities. > NST is the most common method of antepartum fetal surveillance.

Contraction Stress Test (CST)

> a screening tool to assess the ability of the fetus to maintain a normal FHR in response to UCs in women with a nonreactive NST at term gestation. > The purpose of the CST is to identify a fetus that is at risk for compromise through observation of the fetal response to intermittent reduction of in utero placental blood flow associated with stimulated UCs

Biophysical Profile (BPP)

> an ultrasound assessment of fetal status along with an NST > It uses real-time ultrasound with EFM to assess five fetal variables: NST reactive, fetal movement, tone, breathing, and amniotic fluid volume > The combination accounts for acute changes in fetal reserve (NST, breathing, flexion, and extensions) as well as changes influenced over a more chronic time (amniotic fluid volume and fetal tone) > If fetal oxygen consumption is reduced, the immediate fetal response is reduction of activity regulated by the CNS > The BPP provides improved prognostic information because physiological parameters associated with chronic and acute hypoxia are evaluated > It is indicated in pregnancies involving increased risk of fetal hypoxia and placental insufficiency, such as maternal diabetes and hypertension > Some controversy exists related to this test, as a Cochrane Review concluded that available evidence from randomized clinical trials provides no support for the use of BPP as a test of fetal well-being in high-risk pregnancies

chorionic villus sampling

> aspiration of a small amount of placental tissue (chorionic villi) for chromosomal, metabolic, or DNA testing > This test is used for chromosomal analysis between 10 and 13 weeks' gestation to detect fetal abnormalities caused by genetic disorders. > There appears to be no significant difference between transcervical and transabdominal CVS. > The primary advantage of CVS over amniocentesis is that the procedure can be performed earlier in pregnancy and the viable cells obtained by CVS for analysis allow for shorter specimen processing time (5 to 7 days versus 7 to 14 days), so the results are available earlier in pregnancy. > After an abnormal first-trimester ultrasound examination or screening test, the earlier CVS results allow for more management options.

screening tests for pregnant women

> designed to identify those who are not affected by a disease or abnormality > Certain screening tests assess the risk that the fetus has specific common birth defects, but screening tests cannot tell whether the baby actually has a birth defect > These tests carry no risk to the fetus.

diagnostic tests for pregnant women

> provide a yes or no answer to whether a fetus is normal or abnormal and can detect many, but not all, birth abnormalities caused by defects in a gene or chromosomes > Diagnostic testing may be done instead of screening if a couple has a family history of a birth defect, belongs to a certain ethnic group, or already has a child with a birth defect > Diagnostic tests also are available as a first choice for all pregnant women, including those who do not have risk factors. > Some diagnostic tests carry risks, including a small risk of pregnancy loss.

goal of fetal testing

> reduce the number of preventable stillbirths and to avoid unnecessary interventions. > The purpose of antenatal testing is to validate fetal well-being or identify fetal hypoxemia and intervene before permanent injury or death occurs

genetic tests for pregnant women

> testing is most commonly done with cells obtained by amniocentesis or CVS using traditional karyotype analysis, with results available in 7 to 14 days. > Analysis of cell-free DNA from maternal plasma has been used for prenatal testing for several DNA abnormalities or traits, such as Rh type, but cell-free DNA testing still is considered to be a screening method and is not sufficiently accurate to be considered diagnostic for any indication

amniocentesis

> the most common technique used for obtaining fetal cells for genetic testing. > It is a diagnostic procedure in which a needle is inserted through the maternal abdominal wall into the uterine cavity to obtain amniotic fluid. > Although commonly performed for genetic testing, it can also be done for assessment of fetal lung maturity, assessment of hemolytic disease, or intrauterine infection and therapy for polyhydramnios > Usually offered between 15 and 20 weeks for genetic testing.

ultrasonography

> the use of high-frequency sound waves to produce an image of an organ or tissue > Ultrasonography is not associated with risk and is the imaging technique of choice for the pregnant patient but should be used prudently to answer a relevant clinical question or otherwise provide medical benefit to the patient > The principle of ALARA (as low as reasonably achievable) should be considered in the use of fetal ultrasound, meaning sonography should only be performed for a valid indication using the lowest possible exposure

genetic tests for pregnant women purpose

> to detect health problems that could affect the woman, fetus, or newborn and provide the woman and her providers with information to allow a fully informed decision about pregnancy management.

nurse's role for antepartal tests

> varies based on the specific test > In general, it includes assessing for risk factors and providing information, emotional support, and comfort to women undergoing antenatal tests. > Sometimes, the nurse assists or performs the antenatal test, which may require advanced competencies > Monitor maternal and fetal response

The multiple marker screenings identify: A. Neural tube defects B. Cerebral palsy C. Hemolytic diseases D. Cleft palate

A. Neural tube defects Multiple marker screenings can identify most open neural tube defects. They also identify Down syndrome.

Which test best provides an answer to the question of whether or not the infant has a congenital defect? A. Screening B. Diagnostic test C. Biophysical profile D. Multiple marker screening

B. Diagnostic test - Diagnostic tests, which are often invasive and can pose risks to the fetus, can obtain a definitive answer on suspected congenital defects.

common pregnancy related conditions indicating a need for antenatal tests

Gestational hypertension Preeclampsia Gestational diabetes Decreased fetal movement Hydramnios, oligohydramnios, and polyhydramnios Fetal growth restriction Multiple gestation with growth discrepancy or monochorionic diamniotic multiples Post-term pregnancy Previous unexplained fetal demise Isoimmunization Fetal anomalies

Maternal Assays

an increasingly common way to screen pregnant women for fetal birth defects or genetic anomalies

Modified BPP interpretation

• A modified BPP is considered normal when the NST is reactive and the amniotic fluid volume is greater than 2 cm in the deepest vertical pocket or if the AFI is normal. • A modified BPP is considered abnormal if either the NST is nonreactive or the amniotic fluid volume is less than 2 cm in the deepest vertical pocket or if the AFI is less than 5.0. • An AFI less than or equal to 5 is indicative of oligohydramnios. Oligohydramnios is associated with increased perinatal mortality, and decreased amniotic fluid may reflect acute or chronic fetal asphyxia. Amniotic fluid volume changes more slowly over time as the fetus preferentially shunts cardiac output to the heart and brain while decreasing renal perfusion and thus fetal urine output, thereby decreasing the volume of amniotic fluid.

BPP interpretation

• A score of 2 (present) or 0 (absent) is assigned to each of the five components. • A total score of 8/10 is reassuring. • A score of 6/10 is equivocal and may indicate possible fetal asphyxia; may repeat testing in 12 to 24 hours of delivery, depending on gestational age. • A score of 4/10 is nonreassuring, as it indicates probable fetal asphyxia and warrants further evaluation and consideration of delivery • A score of 2/10 or lower indicates almost certain fetal asphyxia, which prompts immediate delivery. • Fetal activity decreases or stops to reduce energy and oxygen consumption as fetal hypoxemia worsens. Decreased activity occurs in reverse order of normal development. • Fetal activities that appear earliest in pregnancy (tone and movement) are usually the last to cease, and activities that are the last to develop are usually the first to be diminished (FHR variability) (Table 6-3).

Examples of diagnostic tests

• Amniocentesis • Chorionic villi sampling • Magnetic resonance imaging (MRI) • Percutaneous umbilical blood sampling • Ultrasonography

examples of screening tests

• Amniotic fluid index (AFI) • Biophysical profile • Contraction stress test • Daily fetal movement count • Multiple marker screening: alpha-fetoprotein screening, triple marker, and quad marker • Nonstress test (NST) • Ultrasonography • Nuchal translucency • Umbilical artery Doppler flow • Vibroacoustic stimulation

AFI interpretation

• Average measurement in pregnancy is 8 cm to 24 cm (Cunningham et al., 2018). • Abnormal AFI is below 5 cm. An AFI less than 5 cm is indicative of oligohydramnios, which is associated with increased prenatal mortality and a need for close maternal and fetal monitoring. • Represented graphically: decreased uteroplacental perfusion → decreased fetal renal blood flow → decreased urine production → oligohydramnios • An AFI above 24 cm is polyhydramnios, which may indicate fetal malformation such as NTDs, obstruction of the fetal gastrointestinal tract, or fetal hydrops.

Factors to assess for a high risk pregnancy

• Biophysical - originate from the mother or fetus and impact the development or function of the mother or fetus. They include genetic, nutritional, medical, and obstetric issues • Psychosocial - include maternal behaviors or lifestyles that have a negative effect on the mother or fetus. Examples include smoking, alcohol or drug use, and psychological status. • Socioeconomic - variables pertaining to the woman and her family that place the mother and the fetus at increased risk. Examples include access to prenatal care, age, parity, marital status, income, and ethnicity. • Environmental - hazards in the workplace or the general environment that impact pregnancy outcomes. Various environmental substances can affect fetal development. Examples include exposure to chemicals, radiation, and pollutants.

PUBS risks

• Complications are similar to those for amniocentesis and include cord vessel bleeding or hematomas, maternal-fetal hemorrhage, fetal bradycardia, and risk for infection. • PUBS is typically not indicated when less invasive measures such as evaluation of amniocytes or chorionic villi will provide adequate diagnostic information • The overall procedure-related fetal death rate is 1.4% but varies depending on indication

multiple marker screening nsg actions

• Educate the woman about the test. This is a maternal blood test that assesses for the levels of chemicals in the maternal blood to screen for certain developmental abnormalities. • Provide emotional support for the woman and her family. • Assist in scheduling additional testing if needed. • Provide information on support groups if an NTD occurs.

modified BPP nsg actions

• Explain the procedure to the woman and her family. A modified BPP is an NST and measurement of the amount of amniotic fluid. • Provide comfort measures. • Provide emotional support. • Special training in ultrasound is required for interpretation of amniotic fluid volume (see Box 6-2). • Schedule appropriate follow-up; the typical interval for testing is 1 week, but for specific pregnancy complications it may be biweekly.

BPP nsg actions

• Explain the procedure to the woman and her family. The BPP is an ultrasound evaluation of fetal status and involves observation of various fetal reflex activities. • Provide comfort measures. • Provide emotional support. • Special training in obstetric ultrasound is required for interpretation of ultrasound components of the test (see Box 6-2). • Schedule appropriate follow-up; the typical interval for testing is 1 week but for specific pregnancy complications, it may be biweekly.

CST nsg actions

• Explain the procedure to the woman and her family. The CST stimulates contractions to evaluate fetal reaction to the stress of contractions. • Have patient void before testing. • Position patient in a semi-Fowler's position. • Monitor vitals before and every 15 minutes during the test. • Provide comfort measures. • Provide emotional support. • Correctly interpret FHR and contractions. • Safely administer oxytocin (i.e., avoid uterine tachysystole). Uterine tachysystole is defined as more than five UCs in 10 minutes, fewer than 60 seconds between contractions, or a contraction greater than 90 seconds. • Recognize adverse effects of oxytocin. • Schedule appropriate follow-up.

NST nsg actions

• Explain the procedure to the woman and her family. The NST uses EFM to assess fetal well-being. • Have the patient void before the procedure and lie in a semi-Fowler's or lateral position to avoid aortocaval compression. • Provide comfort measures. • Provide emotional support. • Interpret FHR and accelerations; report results to the care provider. • Document the date and time the test was started, the patient's name, the reason for the test, and the maternal vital signs. • Schedule appropriate follow-up; the typical interval for testing is biweekly or weekly, depending on indication.

nsg actions for ultrasound

• Explain to the woman and her family that ultrasound uses sound waves to produce an image of the baby. • Assess for latex allergies with transvaginal ultrasound. • For transvaginal ultrasound, have the patient put on a gown and undress from the waist down. For abdominal ultrasound, only the lower abdomen needs to be exposed. • For transvaginal ultrasound, inform the woman that a sterile sheathed probe is inserted into the vagina. Inform her that she may feel pressure, but pain is not usually felt. • Position the patient in a lithotomy position for transvaginal ultrasound and supine for abdominal ultrasound. • Provide comfort measures to the woman during the procedure, such as a pillow under her head and a warm blanket above and below her abdomen. • Be sensitive to cultural and social as well as modesty issues. • Provide emotional support. • Schedule appropriate follow-up. • Document the ultrasound examination according to the institutional policy.

FMC interpretation

• In the 2-hour approach, maternal perception of 10 distinct fetal movements within 2 hours is considered normal and reassuring; once movement is achieved, counts can be discontinued for the day. • In the 1-hour approach, the count is considered reassuring if it equals or exceeds the established baseline; in general, four movements in 1 hour is reassuring. • Decreased fetal movement should be reported to the provider and is an indication for further fetal assessment, such as an NST or biophysical profile (AAP & ACOG, 2017). • Fewer than four fetal movements in 2 hours should be reported to the provider

MRI nsg actions

• Nurses are involved in the pre- and post-procedure. • Explain the procedure to the woman and her family. The MRI is used to see maternal or fetal structures for detailed pictures. • Address questions and concerns and provide information and support; some women may experience claustrophobia or fear of equipment.

PUBS nsg actions

• Nurses may be involved in the pre- and post-procedure. • Explain the procedure to the woman and her family. During PUBS, fetal blood is removed from the umbilical cord. • Address questions and concerns. • Position the client in a lateral or wedged position to avoid supine hypotension during fetal monitoring tests. • Have terbutaline ready as ordered in case uterine contractions (UCs) occur during the procedure. • Assess fetal well-being post-procedure for 1 to 2 hours via external fetal monitoring. • Educate the patient on how to count fetal movements for when she goes home.

Patients with increased risk of a fetal genetic disorder include those in these categories:

• Older maternal age above 35: risk of aneuploidy increases with increasing maternal age. • Older paternal age, with 40 to 50 years as a definition of advanced paternal age: risk of having a child with a single-gene disorder. • Parental carrier of chromosome rearrangement—In general, this refers to carriers of chromosome rearrangements that are identified after the birth of a child with an abnormality. • Parental aneuploidy or aneuploidy mosaicism are concerns. • Prior child with a structural birth defect—This refers to most birth defects, because these conditions tend to recur in families. • Parental carrier of a genetic disorder—Parents who are affected by or are carriers of genetic disorders are at increased risk of having an affected child. • Previous fetus or child with autosomal trisomy or sex chromosome aneuploidy is a concern. • Structural anomalies identified by ultrasonography—The presence of a fetal structural abnormality increases the likelihood of aneuploidy, copy number variants such as microdeletions, and other genetic syndromes.

amniocentesis nsg actions

• Review the procedure with the woman and assure her that precautions are followed during the procedure with ultrasound visualization of the fetus to avoid fetal or placental injury. • Explain that in the amniocentesis procedure a needle is inserted through the abdomen into the womb to obtain amniotic fluid for testing. • Explain that discomfort will be minimized during needle aspiration with a local anesthetic. • Explain that a full bladder may be required for ultrasound visualization if the woman is less than 20 weeks' gestation. • Instruct the woman in breathing and relaxation techniques she can use during the procedure. • Provide comfort measures. • Provide emotional support. • Recognize anxiety related to test results. • Prep the abdomen with an antiseptic such as betadine if indicated. • Label specimens. • Assess fetal and maternal well-being post-procedure, monitoring and evaluating the FHR. • Instruct the woman to report abdominal pain or cramping, leaking of fluid, bleeding, decreased fetal movement, fever, or chills to the care provider. • Instruct the woman not to lift anything heavy for 2 days. • Administer Rho(D) immune globulin (RhoGAM) to Rh-negative women post-procedure as per order to prevent antibody formation in the Rh-negative woman.

CVS nsg actions

• Review the procedure with the woman and her family. This test obtains amniotic fluid to test for fetal abnormalities caused by genetic problems. • Instruct the woman in breathing and relaxation techniques she can use during the procedure. • Assist the woman into the proper position. - Lithotomy for transvaginal aspiration - Supine for transabdominal aspiration • Provide comfort measures. • Provide emotional support. • Recognize anxiety related to test results. • Label specimens. • Assess fetal and maternal well-being post-procedure. Auscultate FHR twice in 30 minutes. • Instruct the woman to report abdominal pain or cramping, leaking of fluid, bleeding, fever, or chills to the care provider. • Administer RhoGAM to Rh-negative women post-procedure as per order to prevent antibody formation in Rh-negative women.

amniocentesis risks

• Studies suggest a loss rate as low as 0.1% to 0.3% • Trauma to the fetus or placenta • Bleeding or leaking of amniotic fluid in 1% to 2% of cases • Preterm labor • Maternal infection • Rh sensitization from fetal blood into maternal circulation • Pregnant women who have hepatitis B virus, hepatitis C virus, or HIV should be counseled about the possibility of an increased risk of transmission to the newborn that may come with CVS or amniocentesis.

FMC nsg actions/pt teaching

• Teach the woman how to do kick counts and provide a means to record them. Instruct the woman to lie on her side while counting movements. Explain that maternal assessment of counting fetal movements is an important evaluation of fetal well-being. • If fetal movement is decreased, the woman should be instructed to eat something, rest, and focus on fetal movement for 1 hour. Four movements in 1 hour are considered reassuring, whereas fewer than four movements in 2 hours should be reported. • Instruct the woman to report decreased fetal movement below normal, as this is an indication for further assessment by care providers.

NST interpretation

• The NST is considered reactive when the FHR increases 15 beats above baseline for 15 seconds twice or more in 20 minutes (Fig. 6-9). • In fetuses less than 32 weeks' gestation, two accelerations peaking at least 10 bpm above baseline and lasting 10 seconds in a 20-minute period is reactive • Nonreactive NST is one without sufficient FHR accelerations in 40 minutes and should be followed up with further testing such as an ultrasound or biophysical profile • Presence of repetitive variable decelerations that are longer than 30 seconds requires further assessment of amniotic fluid or prolonged monitoring

CVS risks

• There is a 0.22% (1 in 455) fetal loss rate due to bleeding, infection, and rupture of membranes • Ten percent of women experience some bleeding after the procedure • Pregnant women who have hepatitis B virus, hepatitis C virus, or HIV should be counseled about the possibility of an increased risk of transmission to the newborn that may come with CVS or amniocentesis.