SISTER NIVEDITA GOVERNMENT NURSING COLLEGE

IGMC, SHIMLA

SUBJECT : OBSTETRICS AND GYNECOLOGICAL NURSING

ASSIGNMENT ON : AMNIOCENTESIS

SUBMITTED TO: SUBMITTED BY:

Mrs. Prema Negi Archita Sharma

Lecturer MSc. (N) 1st Year

Obstetrics and Gynaecological Nursing SNGNC, IGMC

SNGNC, IGMC Shimla

Shimla

SUBMITTED ON:
INTRODUCTION:

As the pregnancy related diseases are influencing the health of newborn, new methodologies
are being developed to detect the underlying causes. One such technique is the amniocentesis,
which is a predominant technique under prenatal diagnostic measures. It is a medical
procedure carried out to detect the fetal infections, chromosomal and genetic defects as well
as to find out the gender of the baby. However, unless it is strongly indicated for a medical
reason, sex determination is prohibited in India. During amniocentesis, a small amount of
amniotic fluid is being extracted by making a tiny puncture into the amniotic sac. This is
because, the amniotic fluid lie close to the fetus contain fetal cells which can give a clue
about any defect in their chromosomes and DNA.

Amniocentesis is a prenatal test that can diagnose genetic disorders (such as Down syndrome
and spina bifida) and other health issues in a fetus. A provider uses a needle to remove a
small amount of amniotic fluid from inside your uterus, and then a lab tests the sample for
specific conditions.

During pregnancy, the fetus grows inside the amniotic sac. Amniotic fluid surrounds and
protects the fetus inside the amniotic sac. It also contains some of the fetus's cells. These cells
contain genetic information that helps diagnose genetic conditions

Amniocentesis is a prenatal testing procedure usually performed during the second or third
trimester of pregnancy. It can diagnose certain chromosomal conditions or genetic conditions
(such as cystic fibrosis).
DEFINITION:

 Amniocentesis is a procedure in which amniotic fluid is removed from the uterus for
testing or treatment.
OR

 A medical test in which some liquid is taken from a pregnant woman’s womb to find out if
the baby has particular illnesses or health problems is defined as Amniocentesis.
OR

 Amniocentesis is a procedure used to take out a small sample of the amniotic fluid for
testing. This is the fluid that surrounds the fetus in a pregnant woman. Amniotic fluid
is a clear, pale yellow fluid that: Protects the fetus from injury.
OR

 Amniocentesis is an invasive prenatal test that has the potential to cause maternal and
fetal blood cell mixing, which can worsen Rh isoimmunization.

INDICATIONS:

1. The procedure is usually performed between 14-20 weeks nevertheless, it may be

necessary to perform the procedure on emergency basis as indicated by the physician.
2. It is used for both diagnostic and treatment purposes.
3. During the third trimester, it is used to determine labour - related issues.
4. At the time of premature rupture of membranes, the sample can help to detect the
evidence of uterine infections.
5. It is also helpful to find out the severity of fetal anemia in babies with Rh disease so
that prior preparation can be done to arrange for life saving blood transfusions.
6. Another reason for amniocentesis is to assess the lung maturity which can be done
shortly before delivery.
7. It is a frontline tool to detect diseases such as Down syndrome (Trisomy 21), trisomy
13 , trisomy 18, sex chromosome anomalies, Fragile X syndrome, inherited metabolic
disorders, neural tube defects such as anencephaly and spina bifida ( with the help of
alpha- fetoprotein levels).
 8. Amniocentesis can collect DNA from the fetus that can then be compared to DNA
from the potential father.
9. As a therapeutic measure it is used to decompress the polyhydramnios to drain out the
excess of fluid that hinders the delivery which eventually help to prevent aspiration of
fluid by the baby.
10. Women with family history of a specific genetic condition may need to recheck her
status by amniocentesis.

CONTRA -INDICATIONS:

1. Acute skin infections near the site of needle placement.

2. Maternal fever.
3. Allergies to material used like skin preparation materials, local anesthesia
4. May be difficulty in-patient with multiple pregnancies.
5. Low risk pregnancy with risk of spontaneous abortion far outweighing the risk of a
chromosomal abnormality.

6. Patients on heparin need to have this stopped before the test is performed.
PREPARATION FOR AMNIOCENTESIS:

 Mother must be advised to drink plenty of fluids before the procedure but the bladder
should be empty during amniocentesis to minimize the chance of puncture.
 The procedure must be explained to the mother to reassure and gain support.
 A legal consent form should be filled before the procedure begins.
 Trace out the history of uterine and urinary tract infections to be on safer side. It is not
advisable to undergo amniocentesis if the mother is suffering from a known infection.

PROCEDURE:

 The patient is asked to empty her bladder and then lie in dorsal position.
 The abdominal wall is prepared aseptically with betadine lotion and spirit and then
draped.
 The proposed site of puncture is infiltrated with a few ml. of 1% of inj. Lignocaine.
 A 20 - 22 gauze spinal needle about 4 inch in length is pierced into the amniotic
cavity with the help of ultrasound into the wall of the uterus through mother's
abdominal wall.
 Puncturing must be done slowly because improper insertion can cause rupture of the
sac.
 The stilette is then withdrawn and few drops of the liquor is discarded.
 Then about 10 ml of fluid is collected in a test tube for diagnostic purposes.
 The preferred sites of puncture are: a) in early months - 1/3rd of the way up the uterus
from symphysis pubis.
 In later months - trans- isthmic suprapubic approach is used after lifting the presenting
part or through the flanks in between the foetal limbs or below the umbilicus behind
the neck of the foetus.
 If the amniocentesis is used for prenatal genetic diagnosis, fetal cells must be
separated first the whole amniotic fluid and these must be preserved in a laboratory
setting and then stained to observe under a microscope.
 After the procedure, the mother must be instructed to take rest for at least 24 hours
post-procedure.
 Any untoward reaction such as bleeding, abdominal pain, fever and fluctuation of
blood
pressure must be reported immediately.
COMPLICATIONS:
A. Maternal Complications:

1.Infection,
2.Haemorrhage (placental or uterine injury),
3.Premature rupture of membranes and premature labour,
4.Maternal iso-immunisation in Rh - negative mother.

B. Foetal complications:

1.Trauma
2.Foeto-maternal haemorrhage.

C. Others

1. Improper procedure can leak the amniotic fluid which can lead to a state of complete
collapse which is dangerous.
2. In some cases, repeated amniocentesis can lead to miscarriage.
3. If a mother is already suffered from infectious diseases such as hepatitis C,
toxoplasmosis or HIV/AIDS - the infection might be transferred to the baby through
this procedure.
NURSING RESPONSIBILITIES IN AMNIOCENTESIS:

 Assist the physician during amniocentesis.

 Support the woman undergoing the procedure.
 Obtain informed consent.
 Clarify the physician’s instructions or explanations.
 Obtain baseline vital signs.
 Obtain baseline fetal heart rate.
 After procedure, review reportable side effects.
 Assess vital signs and fetal heart rate.

 To insure client understanding of the purpose and procedure of amniocentesis.

 To provide the necessary equipment for the procedure.
 To assist the physician with the procedure.
 To monitor the client carefully after the procedure.
 To insure obtaining an uncontaminated specimen of amniotic fluid.
SUMMARY:
Amniocentesis is a test you may be offered during pregnancy to check if your baby has a
genetic or chromosomal condition, such as Down's syndrome, Edwards' syndrome or Patau's
syndrome. It involves removing and testing a small sample of cells from amniotic fluid, the
fluid that surrounds the baby in the womb (uterus).

The goal of amniocentesis is to examine a small amount of this fluid to obtain information
about the baby, including its sex, and to detect physical abnormalities such as Down
syndrome or spina bifida. Amniocentesis is only performed on women thought to be at higher
risk of delivering a child with a birth defect. Amniocentesis is a test on the fetus carried out
during pregnancy to check for and to detect chromosomal abnormalities and other defects or
disorders in the fetus. It can also be used for sex determination. It is carried out by testing a
sample of the amniotic fluid from the uterus of pregnant women.
CONCLUSION:
Amniocentesis is the procedure which is performed for the diagnostic and therapeutic
purposes of patient and the fetus. The fetus grows inside the amniotic sac. Amniotic fluid
surrounds and protects the fetus inside the amniotic sac. It also contains some of the fetus's
cells. These cells contain genetic information that helps diagnose genetic conditions,
abnormalities and disease conditions. It is also helpful to find out the severity of fetal anemia
in babies with Rh disease so that prior preparation can be done to arrange for life saving
blood transfusions.

As a therapeutic measure it is used to decompress the polyhydramnios to drain out the excess
of fluid that hinders the delivery which eventually help to prevent aspiration of fluid by the
baby.
BIBLIOGRAPHY:
BOOK REFERENCES

 Dutta DC, Textbook of Obstetrics including Perinatology and Contraception, 8 th

Edition. New Delhi; Jaypee Brother’s Medical Publishers (P) Ltd. 2015. 106-116.

NET REFERENCES

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