Background Information:

What are the other Names for the Procedure?

• AFT
• Centesis
• Prenatal Diagnosis

What is the Amniocentesis surgical procedure?

• Amniocentesis is a medical procedure that involves removal of a small amount of amniotic fluid from the amnion for prenatal diagnosis
• However, the procedure is limiting in its scope, as it does not help diagnose all chromosomal abnormalities of the fetus

What part of the Body does the Procedure involve?

Amniocentesis involves the uterus and the amniotic sac of a pregnant woman.

Why is the Amniocentesis surgical procedure Performed?

Amniocentesis is performed for various reasons as mentioned below:

• As a prenatal diagnosis
• To detect spina bifida
• To determine Rh factor compatibility
• To check for any chromosomal abnormality in the fetus
• To investigate the fetal lung maturity
• To examine for any neural tube defects or disorders
• As a routine test, if the mother is over 35 years of age
• To examine for any infection

What are some Alternative Choices for the Procedure?

There are various alternatives to Amniocentesis, which are broadly classified as non-invasive and invasive:

• The non-invasive alternatives include Fetal Cells in Maternal Blood (FCMB), Cell-Free Fetal DNA in Maternal Blood, Ultrasound Detection, etc.
• The invasive alternatives are Chorionic Villus Sampling, Fetoscopy, Percutaneous Umbilical Cord Blood Sampling, etc.

What are the Recent Advances in the Procedure? 

Amniocentesis is an advancement in itself with regards to prenatal diagnosis.

What is the Cost of performing the Amniocentesis surgical procedure?

The cost of Amniocentesis procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities. 

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Amniocentesis and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.mayoclinic.com/health/amniocentesis/MY00155/DSECTION=risks

http://www.nlm.nih.gov/medlineplus/ency/article/003921.htm

Prior to Amniocentesis surgical procedure:

How is the  Amniocentesis surgical procedure Performed?

• Amniocentesis is performed under local anesthesia and with the help of ultrasound for visual monitoring
• A hollow needle is injected through the abdomen, uterus and into the amniotic sac and a small amount of the amniotic fluid is suctioned and the needle is withdrawn
• The needle is guided into the amniotic sac with the help of continuous imaging from an ultrasound scanner
• After withdrawal of the needle, the point of insertion is bandaged

Where is the Procedure Performed?

An Amniocentesis is usually performed in an out-patient surgery center facility or a hospital. Normally, the person can go home once the procedure is completed.

Who Performs the Procedure?

The procedure is performed by an obstetrician and/or a gynecologist, with assistance from a radiologist.

How long will the Procedure take?

The procedure normally does not take more than 45 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• if you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• Immediately before the procedure, the person is advised to drink plenty of water and fill-up their bladder, in order to facilitate a good ultrasound scan and monitor
• Apart from this no particular preparations are required

A physician will request your consent for the Amniocentesis procedure using an informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Amniocentesis procedure using an informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Amniocentesis surgical procedure?

Urine analysis and blood tests may be necessary prior to the procedure. The physician determines the extent of tests that are needed.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is Amniocentesis?
• Why is this procedure necessary? How will this procedure help?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• How will an Amniocentesis benefit me?
• Will this procedure in anyway affect the fetus growth?
• Are there any chances of miscarriage due to this procedure?
• How much amniotic fluid is withdrawn? Will this fluid replace itself in the body?
• What are the alternatives to this procedure?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• When can I resume normal work?
• How many such procedures have you (the physician) performed?
• What are the costs involved?

During the Amniocentesis surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia is administered during the procedure. Maximum care is taken to ensure the safety of the fetus; hence the healthcare provider usually avoids administering any sedative.

How much Blood will you lose, during the Procedure?

Since the procedure is minimally invasive, there is little or no blood loss involved.

What are the possible Risks and Complications during  Amniocentesis surgical procedure?

The possible risks and complications that may arise during an Amniocentesis are:

• Accidental injury to the fetus
• Bleeding
• Surgical wound infection
• Rh sensitization

What Post-Operative Care is needed at the Healthcare Facility after Amniocentesis surgical procedure?

Generally, there is no requirement for any post-procedure care at the healthcare facility, unless any complications arise.

After the Amniocentesis surgical procedure:

What are the possible Risks and Complications after Amniocentesis surgical procedure?

The possible risks and complications that may arise after Amniocentesis are:

• Miscarriage
• Infection
• Difficulty in breathing
• Pre-term labor

What is the Prognosis after the Surgery?

The prognosis is excellent and usually no injury to the fetus occurs. Women are able to resume their day-to-day activities almost immediately after the procedure.

When do you need to call your Physician?

Do inform your physician, if any of the following symptoms are observed:

• Pain or cramping in the abdomen
• Vaginal bleeding
• Dizziness
• Signs of possible infection like fever, muscle ache, or even a headache
• Any discomfort or uneasiness

What Post-Operative Care is needed at Home after Amniocentesis surgical procedure?

No particular post-operative care is required at home, apart from what is generally taken during a pregnancy.

How long does it normally take to fully recover, from the Procedure?

It takes only about 2-3 hours to recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The amniotic fluid is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The amniotic fluid is processed in the laboratory under a qualified pathologist’s supervision
• The required tests and investigations are performed and the fluid is processed, and this is examined by a pathologist and a report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Amniocentesis surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility, or the hospital
• An obstetrician and gynecologist
• A pathologist (if the amniotic fluid was sent for analysis)
• A radiologist (if radiological tests were performed during the procedure)

The patient is advised to inquire and confirm the type of billing, before Amniocentesis is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA