Midpregnancy cordocentesis training of maternal-fetal medicine fellows

Objective: To describe systematic cordocentesis training among maternal-fetal medicine (MFM) fellows.

Methods: During their 2-year training period, five MFM fellows, who had completed systematic model training, performed 1116 midpregnancy diagnostic cordocentesis procedures (mean, 223 (range, 185-259) procedures each) under expert supervision. The details of the procedures were recorded prospectively. Multiple pregnancies and those with fetal chromosomal or structural anomalies were excluded from analysis. The outcome measures included success rate, duration of the procedure, fetal loss and complications.

Results: Of the 1116 procedures performed, 184 were excluded because of fetal abnormalities; the remaining 932 were available for analysis. Cordocentesis was performed on free-floating umbilical cord (79.3%) and at the placental insertion site (20.7%). There was an immediate complication of transient fetal bradycardia in 10% of cases. Individual success rates ranged from 98.1 to 100% and the mean cumulative success rate had plateaued by approximately 60 procedures. The overall fetal loss rate was 1.3%. The overall mean +/- SD duration of successful procedures was 4.4 +/- 4.7 min, individual mean durations ranging from 3.7 to 5.9 min.

Conclusions: MFM fellows with systematic training are able to perform cordocentesis with very high success rates, and with an acceptable procedure-related fetal loss rate. An intensive course of preclinical training with the model, and more than 60 procedures on patients under supervision is recommended.