Chorionic Villi Sampling

INTRODUCTION:
Chorionic villi are villi that sprout from the chorion in order to give a
maximum area of contact with the maternal blood. Embryonic blood is carried to
the villi by the branches of the umbilical arteries, and after circulating through the
capillaries of the villi, is returned to the embryo by the umbilical veins. Thus, the
villi are part of the border between maternal and fetal blood during pregnancy. Villi
cells have the same genetic makeup as the growing fetus so it is easy to analyze and identify
genetic & chromosomal abnormalities.

Chorionic Villus Sampling (CVS)

• Chorionic villus sampling (CVS) is the removal of a small piece of chorionic villi
(placenta) from the uterus during early pregnancy to screen the baby for genetic defects. itis an
invasive prenatal diagnostic procedure that is usually performed between 11 and 13+6 weeks of
gestation. it involves the biopsy of the placental villi (chorionic villi), with the aim of
diagnosing chromosomal abnormalities and autosomal dominant and recessive conditions.
INDICATIONS
 Chorionic villus sampling is offered to pregnant women who have an increased risk of
fetal chromosomal/genetic abnormalities. These include:
 Increased risk of abnormality identified through antenatal screening (risk >1:150)
 A previous child with chromosomal or genetic abnormality
 Known carrier status for a genetic condition
 A family history of a genetic condition Ultrasound scan evidence of fetal abnormalities
that are associated with a chromosomal or genetic condition.
 Abnormal first trimester screen results.
 Increased nuchal translucency or other abnormal ultrasound findings.
 Family history of a chromosomal abnormality or other genetic disorder.
 Parents are known carriers for a genetic disorder.

PROCEDURE

 Two ways

1. Transcervical

2. Transabdominal.

Preparation of the patient:

 An abdominal ultrasound is performed to determine the position of the uterus, the size of
the gestational sac, and the position of the placenta within the uterus. vulva, vagina,
cervix, and abdomen are cleaned with an antiseptic.
Trans Abdominal

 It is performed by inserting a thin plastic tube through vagina & cervix to reach placenta
with the help of ultrasound guided images.
 Maternal Abdomen is painted and draped Gauge 18-20 disposable spinal needle of
adequate length (7.5-15mm)used
 The needle passed through anterior abdominal wall into the substance of the chorion
frondosum under continuous ultrasound guidance by freehand / needle guide technique.
 The stylet is withdrawn and 20ml syringe attached.Gentle up & down movements with
continuous negative pressure are made taking care to avoid puncturing fetal aspect of
amniotic membrane by U/S control with continuous needle tip visualization.

 The tissue is then transferred to the culture medium containing tubes or petri dish and
examined for adequacy of CV before the needle is withdrawn.
 The chorionic villi appear as free-floating, white structures with fluffy, filiforme
branches.
 Contaminating decidua tissue has a more amorphous appearance and lacks distinct
branches.
Transcervical CVS Technique

 1.5mm cannula made of plastic with metal obturator Distal 3-5 cm obturator slightly
curved.
 Under aseptic conditions, cannula passed through Cx till internal.
 OS reached (cervix usually held with tenaculum) Cannuala tip visualized under U/S
guidance .
 In advanced & guided into the substance of chorion frondosum Cannula placed parallel to
axis of developing placenta & advanced almost to distal end.

 It is performed by inserting a needle through the abdomen utreus to reach placenta

with the help of ultrasound guided images.

 It will be done in 10 weeks to term.

Post Procedure Care

 Antibiotics

 To expect mild spotting for 3-5 days.

 To expect slight pain for 1-2 days.

 Restricted activity 1-2 days.

 Abstinence - 2 weeks.

 Follow up ultrasound after 2 weeks.

Complications

 Bleeding

 Rupture of membranes Elevated MSAFP

 Chorio- amnionitis Rh Isoimmunisation

 Pregnancy Loss

 Fetal Malformations -oro mandibular limb hypogenesis syndrome,terminal transverse

limb reduction defect