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Question 22
Feto-maternal medicine → Perinatology
Classification
Question
SSBAQuestion Header
Abnormal amniotic fluid appearance
Question Stem
During amniocentesis the aspirated fluid appears cloudy and purulent. What is the most appropriate immediate management?
Options
A
Discard the sample and provide routine reassurance
B
Continue the procedure and take no additional action
C
Consider microbiological investigation and antibiotic treatment
D
Arrange maternal serum screening only
E
Repeat amniocentesis immediately through the same needle track
Explanation
Severe infection following invasive prenatal diagnosis is very rare, but cloudy or purulent amniotic fluid should raise concern for infection. RCOG advises considering microbiological investigation and antibiotic treatment in this situation. Appropriate aseptic precautions include sterile skin preparation, sterile ultrasound gel and a sterile probe cover or bag, with continuous ultrasound guidance during the procedure.
Option Validity
A) Purulent or cloudy fluid may indicate infection and should not simply be disregarded.
B) The abnormal appearance requires clinical consideration rather than routine completion without further action.
D) Maternal serum screening does not address suspected intra-amniotic infection.
E) Immediate repeat sampling through the same track does not address the potential infectious problem.
Further Reading
Navaratnam K, Alfirevic Z; Royal College of Obstetricians and Gynaecologists. Amniocentesis and chorionic villus sampling: Green-top Guideline No. 8. BJOG. 2022;129:e1-e15.