Chorionic Villus Sampling
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What is the test?
Chorionic villi are
small structures in the placenta that act like blood vessels.
These structures contain cells from the developing fetus. A test
that removes a sample of these cells through a needle is called
chorionic villus sampling (CVS).
CVS answers many of
the same questions as amniocentesis about diseases that the baby
might have. Diseases that can be diagnosed with CVS include Tay-Sachs,
sickle cell anemia, cystic fibrosis, thalassemia, and Down syndrome.
(Rh incompatibility and neural tube defects, however, can be
diagnosed only through amniocentesis.) CVS can be done earlier
in pregnancy than amniocentesis and can be done when there is
not enough amniotic fluid to allow amniocentesis. However, it
has some extra risks when compared with amniocentesis.
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How do I prepare
for the test?
CVS can be done between
the 10th and 13th weeks of pregnancy. Tell your doctor ahead
of time if you have ever had an allergic reaction to lidocaine
or the numbing medicine used at the dentist's office.
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What happens
when the test is performed?
There are two ways that
your doctor can perform CVS. Some patients have the sampling
done through the vagina and cervix. Most patients have the sampling
done through the abdominal wall. For both types of sampling,
you lie on your back on an examination table and the doctor uses
ultrasound to locate the fetus and the placenta.
If the sampling is to
be done through the vagina and cervix, you place your feet in
footrests and bend your knees up, as you would for a pelvic examination.
A speculum (a device that looks like a duck-bill that can be
opened and closed) is used to open the vagina so that your doctor
can see inside. A long tube, much narrower than a straw, is inserted
through the cervix and moved forward while your doctor watches
on the ultrasound until it is next to the fetal side of the placenta.
A small sample of the lining around the fetus is then pulled
into the tube for testing.
If the sampling is to
be done through the abdominal wall, your lower abdomen is cleaned
with an antibacterial soap. In some cases, the doctor uses a
small needle to inject a numbing medicine just under the skin,
so that you do not feel the sampling needle. (Because the sampling
needle does not cause much more stinging than the numbing medicine
itself, not every doctor includes this step.) A hollow needle
several inches long is inserted through the skin and muscle of
the abdomen and through the wall of the uterus, to the edge of
the placenta. This needle is held in place as a guide needle.
A narrower needle is then inserted through the first needle and
is rotated and moved inward and outward a number of times while
a sample is collected into an attached syringe.
The fetal heart tones
and the mother's blood pressure and heart rate are checked at
the beginning and end of the procedure. The whole procedure takes
close to 30 minutes.
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What risks are
there from the test?
The risk of miscarriage
and other complications from CVS is slightly higher than the
risk from amniocentesis, although some parents feel that it is
worth the extra risk to be able to makedecisions earlier in the
pregnancy if the results show the baby has a health problem.
There have also been some reports that suggest there is a very
small risk of birth defects (abnormal limbs) in the fetus.
One particular difficulty
with this test is that due to variability in the cells of the
placenta (called mosaicism), occasionally you can have an abnormal
test result even if the baby is normal and healthy. This might
lead you to make decisions about pregnancy termination that you
would not have made if you had better information.
Some women have vaginal
bleeding after the procedure. Infection is uncommon.
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Must
I do anything special after the test is over?
You should notify your
doctor if you are having vaginal bleeding, especially if it is
heavy or lasts longer than three days. You should also tell your
doctor about strong abdominal pain or fever.
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How
long is it before the result of the test is known?
Chromosome analysis
of the sample takes two weeks or more. The results of some tests
may be available sooner.
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