به نام خدا به نام خدا

CVS CVS Dr. Minoo MovahediDr. Minoo Movahedi

CVSCVS

Prenatal diagnosis Prenatal diagnosis

Chromosome & DNA Chromosome & DNA

Ten weeks Ten weeks

TC & TA TC & TA

TC – CVSTC – CVS Culture Culture Needle Needle Sterile Speculum Sterile Speculum Metal sond Metal sond Syring 20 cc Syring 20 cc Media Media Tenaculom Tenaculom

TA - CVSTA - CVS Sterile Gel Sterile Gel Sterile Probe Sterile Probe Needle Needle Syringe Syringe Media Media Holder Holder P&D P&D Long axis placenta Long axis placenta

Multiple GestationsMultiple Gestations

Monochromic Twins : single sample Monochromic Twins : single sample Dechorionic Twins : Dechorionic Twins : Separate placentas Separate placentas Ant : TA – CVS Ant : TA – CVS Post : TC – CVS Post : TC – CVS Fused Placenta : Placental Margin Fused Placenta : Placental Margin

insertion of Cord insertion of Cord Follow up Amniocenteses : 6 % Follow up Amniocenteses : 6 %

CVS IndicationsCVS IndicationsDNA DNA Karyotyping Karyotyping Mendelian disorder Mendelian disorder Increased maternal Age Increased maternal Age Screen down syndrome Screen down syndrome Family history Family history Paternity Paternity Infections Infections

Contraindications TC – CVSContraindications TC – CVS

Vaginismus Vaginismus

Cervical stenosis Cervical stenosis

Cervical Myomas Cervical Myomas

Cervical infection Cervical infection

Lower segment myoma Lower segment myoma

Sever antiflextion Sever antiflextion

Retrofelxtion of Uterus Retrofelxtion of Uterus

Contraindication of TA – CVSContraindication of TA – CVS

Sever uterine retroflextion Sever uterine retroflextion

With intestinal Loop With intestinal Loop

Fetal position Fetal position

posterior Placentaposterior Placenta

All type of CVSAll type of CVS

Maternal isoimmunization Maternal isoimmunization

Fetomaternal Hemorrhage Fetomaternal Hemorrhage

Erythroblustosis fetalis Erythroblustosis fetalis

CVS complicationsCVS complications Damage or fetal lossDamage or fetal loss

< 28 w : 2.8 – 3.9 % < 28 w : 2.8 – 3.9 %

>28 w : 3.9 – 4.2 % >28 w : 3.9 – 4.2 %

TC – CVS increased TC – CVS increased

TA – CVS = Amniocentesis TA – CVS = Amniocentesis

Prenatal mortality rate = 6-7% Prenatal mortality rate = 6-7%

Rupture of membering 0.5 % Rupture of membering 0.5 %

Bleeding = Bleeding =

1/3 cases - 6% increased VB – 4% Hematoma 1/3 cases - 6% increased VB – 4% Hematoma

Infection = 0.5 % chorioamnionitis , Infection = 0.5 % chorioamnionitis ,

septic shock peritonitis septic shock peritonitis

Placental MosaicismPlacental Mosaicism

Direct method (Trophoblasts ) Direct method (Trophoblasts )

Long term cultures (Mesechymal Long term cultures (Mesechymal cells ) cells )

Specificity 99.9 % Specificity 99.9 %

Sensitivity 99.6 % Sensitivity 99.6 %

Increased IUGR Increased IUGR

Limb reduction Limb reduction Defects and Defects and Oromandibular Oromandibular hypogenesishypogenesis

GA < 9 weeks GA < 9 weeks

Needle Needle

Experience Experience

CVS failure obtainedCVS failure obtained

TC – CVS > TA – CVS TC – CVS > TA – CVS

Multiple insertion Multiple insertion TC – CVS > TA – CVTC – CVS > TA – CV

Ob complicationsOb complications

Controversy Controversy

PIHPIH

Long term Out come Long term Out come

No differences No differences

TA & TC CVSTA & TC CVS

TA CVS is preferable:TA CVS is preferable:Fetal loss decreased Fetal loss decreased Bleeding decreased Bleeding decreased Infections decreased Infections decreased Multiple insertions decreased Multiple insertions decreased Success rate increased Success rate increased

CVS is safer than CVS is safer than

early Amniocentesisearly Amniocentesis

< 15 weeks< 15 weeks

خسته خسته نباشيدنباشيد