Amniocentesis Health Article

Preparation

The usual precautions concerning sterility of the injection site and sterility of equipment and the hands of those who will come into contact with a woman must be taken during amniocentesis.

Counseling must be offered to a woman or couple to ensure that they fully understand the results of an amniocentesis test. Counseling should be offered prior to the procedure so that a woman or couple can understand the procedure and slight risk of miscarriage that is associated with amniocentesis.

Aftercare

Physical care after an amniocentesis procedure involves the site of needle insertion. It should be kept clean and dry. Covering the puncture site with a sterile bandage is usually sufficient.

Mental care after an amniocentesis may be more important than physical care. Many women or couples require emotional support and reassurance while they are waiting for test results. Those receiving abnormal results often require ongoing support while they weigh options and make decisions that are appropriate for them. Some may require long-term support as they adjust to the outcomes of their decisions.

Complications

Women who have had an amniocentesis often describe it as uncomfortable, involving some mild pressure or pain as the needle is inserted. Fewer women

describe it as extremely painful. A local anesthetic may be used to numb the upper layer of the mother's skin prior to testing. This medicine has no effect on the fetus, but may help the mother feel more comfortable during the procedure. An experienced physician can, on average, perform amniocentesis in approximately one to two minutes.

Common complaints after amniocentesis include mild abdominal tenderness at the site of needle insertion or mild cramping. These usually go away within one to two days. More serious complications are significantly less common but include leakage of amniotic fluid, vaginal bleeding, or uterine infection. These complications are estimated to occur in less than 1% of pregnancies. In some women, complications after amniocentesis may lead to a miscarriage, or loss of the pregnancy. A woman's background risk of having a miscarriage, without amniocentesis, is approximately 2-3% in her second trimester. In experienced hands, the risk for an amniocentesis-related pregnancy loss is estimated to be an additional 0.25-0.50%, or roughly one in every 200-400 pregnancies.

Much attention is often paid to the physical side effects of amniocentesis. However, it is important to also emphasize some of the emotional side effects of amniocentesis. Many of these are also applicable to other forms of prenatal diagnosis.

The offer of prenatal testing is associated with increased anxiety. This appears to be true whether a woman knew prenatal testing would be offered to her during the pregnancy or if it comes about unexpectedly, as is usually the case following abnormal screening results. Women to whom genetic amniocentesis is presented must consider the perceived benefits of testing, such as the reassurance that comes when results are normal, and compare them to the possible risks. Examples of potential risks include not only the risk of a complication after testing but also the potential burden of knowing that she will have a child with a serious disability or chronic medical condition. The nature of the child's possible diagnosis is also important. For example, could it lead to an early death, be more subtle and cause few outward signs of a problem, or be somewhere in between? There are few treatments available to correct the hundreds of known genetic disorders. Couples may wish to consider whether or not they would consider a termination of the pregnancy if a serious abnormality were detected. The definition of serious is often a matter of personal opinion. A couple's value system and family history, including that of other pregnancies and their outcomes, all influence their decision regarding amniocentesis. Ideally, a woman and her partner will have discussed at least some of these issues with each other and with either the woman's doctor or a genetic counselor prior to testing. The choice to have amniocentesis depends on many factors and should remain a personal decision.