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Cerebrospinal Fluid Leakage, an Uncommon Complication of Fetal Blood Sampling: A Case Report and Review of the Literature

Schaap, Timme P. MD*; Moormann, Karlijn A. MD; Becker, Jeroen H. MD; Westerhuis, Michelle E. M. H. MD, PhD*; Evers, Annemieke MD; Brouwers, Hens A. A. MD, PhD#; Schuitemaker, Nico W. E. MD, PhD; Visser, Gerard H. A. MD, PhD§; Kwee, Anneke MD, PhD

Obstetrical & Gynecological Survey: January 2011 - Volume 66 - Issue 1 - p 42-46
doi: 10.1097/OGX.0b013e318213e644

In a recently published randomized clinical trial on intrapartum fetal monitoring, fetal blood samples were obtained in 879 women. One serious complication of fetal blood sampling (FBS) was reported, a case in which physical examination of the neonate after delivery revealed clear fluid loss from the incision site. Four layers of the scalp appeared to be incised. The subarachnoid space was closed with 2 sutures, and antibiotics were started due to the risk of meningitis. The patient was discharged in good clinical condition. In this article, the case is presented and the literature reviewed. We found 12 articles reporting 37 cases of a complication due to FBS, none concerning leakage of cerebrospinal fluid. In conclusion, complications of FBS are rare but can be serious. Excessive fetal bleeding is most frequently reported and often associated with an underlying coagulopathy in the neonate.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this educational activity, the obstetrician/gynecologist should be better able to assess the chance of possible complications due to fetal blood sampling; select fetuses at risk for complications due to fetal blood sampling; and evaluate certain technical precautions when performing this procedure.

*Physician, †Obstetrician, Department of Obstetrics and Gynecology, Diakonessenhuis Utrecht, Utrecht, the Netherlands; ‡Physician, §Professor in Obstetrics, ¶Obstetrician, Department of Perinatology and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands; and #Neonatologist, Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credits™ can be earned in 2011. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors, faculty and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

Timme P. Schaap and Karlijn A. Moorman contributed equally in the preparation of this manuscript.

Correspondence requests to: Anneke Kwee, MD, PhD, University Medical Center Utrecht, Location WKZ, Department of Obstetrics and Gynecology, KE. 04.156.1, PO Box 85090, 3508 AB Utrecht, the Netherlands. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.