ABSTRACT. Utilizing an easy and safe ~rocedure for fetal
MATERIALS AND METHODSblood sampling in utero we have studied 409 fetuses for prenatal diagnosis of rubella, toxoplasmosis, hemophilia, and hemoglobinopathies. Retrospectively we selected 163 fetuses confirmed as normal at birth and tested between 18 and 30 wk of gestation to establish normal hematological parameters and to follow the evolution of erythropoiesis, differential counts, hemoglobin synthesis, and hemostasis. Total white blood cell and platelet counts did not change during this period. Our knowledge of fetal hematology is limited due to the fact that most earlier studies were performed on aborted fetuses or under sampling conditions which may have altered hematological values. Moreover, only a few hematological values during gestation have been published (1). Having developed an easy and safe technique for fetal blood sampling, we selected retrospectively for this study 163 fetuses born healthy at full term delivery to establish reference fetal hematological values using standardized methods. To date no fetal loss or premature labor has been attributed to these fetal samplings.Sampling procedure. The fetal sampling method has been described in detail previously (2, 3). A real time ultrasound scanner (ATL MARK 111) was used to locate the umbilical cord insertion on the placenta and to determine the best route of access to it without fetal interposition. The transducer was then maintained immobile while, under aseptic conditions, local anesthesia was performed with 1 % xylocaine into the anterior abdominal wall at the chosen puncture site. No /3-mimetic drugs or other medication were used prior to the procedure. A 20-gauge spinal needle (10 or 13 cm long), filled with 0.129 M sodium citrate solution and fixed to a 2 ml disposable syringe containing 0.1 ml of this solution, was introduced into the plane of the ultrasound sector near the transducer. The needle tip emitted a clearly visible echo and its progress toward the insertion of the cord was followed on the scope. The vein of the cord was punctured about 1 cm from its insertion.Immediately after the first d r o~ of blood was obtained, the syringe was replaced by a new one containing no additive. The blood sample was immediately transferred into special tubes containing adequate anticoagulant for biological studies. The duration of the entire procedure was less than 10 min in 90% of the cases, and the automated evaluations of hematological parameters were completed within 30 min.Patients. We studied 409 pregnancies and 435 fetal blood samplings were camed out (26 repetitive samplings) with the approval of the ethics committee of the hospital, the medical expert panel, and the informed consent of the patients. The fetal samplings were conducted for the prenatal diagnosis of toxoplasmosis (285 cases), rubella (37 cases), or hemophilia (30 cases), for rapid fetal karyotyping (32 cases), or for diagnosis of other miscellaneous conditions (25 cases). Medical abortions of affected fetuses were perfor...