1
|
Giovannopoulou E, Tsakiridis I, Mamopoulos A, Kalogiannidis I, Papoulidis I, Athanasiadis A, Dagklis T. Invasive Prenatal Diagnostic Testing for Aneuploidies in Singleton Pregnancies: A Comparative Review of Major Guidelines. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1472. [PMID: 36295632 PMCID: PMC9609299 DOI: 10.3390/medicina58101472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/22/2022]
Abstract
Sophisticated screening protocols for genetic abnormalities constitute an important component of current prenatal care, aiming to identify high-risk pregnancies and offer appropriate counseling to parents regarding their options. Definite prenatal diagnosis is only possible by invasive prenatal diagnostic testing (IPDT), mainly including amniocentesis and chorionic villous sampling (CVS). The aim of this comparative review was to summarize and compare the existing recommendations on IPDT from the most influential guidelines. All the reviewed guidelines highlight that IPDT is indicated based on a positive screening test rather than maternal age alone. Other indications arise from medical history and sonography, with significant variations identified between the guidelines. The earlier time for amniocentesis is unequivocally set at ≥15 gestational weeks, whereas for CVS, the earlier limit varies from ≥10 to ≥11 weeks. Certain technical aspects and the overall approach demonstrate significant differences. Periprocedural management regarding Rhesus alloimmunization, virologic status and use of anesthesia or antibiotics are either inconsistent or insufficiently addressed. The synthesis of an evidence-based algorithm for IPDT is of crucial importance to healthcare professionals implicated in prenatal care to avoid unnecessary interventions without compromising optimal prenatal care.
Collapse
Affiliation(s)
- Eirini Giovannopoulou
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Papoulidis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
- Access to Genome—ATG, Clinical Laboratory Genetics, 551 34 Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| |
Collapse
|
2
|
Ghi T, Sotiriadis A, Calda P, Da Silva Costa F, Raine-Fenning N, Alfirevic Z, McGillivray G. ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:256-268. [PMID: 27485589 DOI: 10.1002/uog.15945] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/15/2016] [Indexed: 06/06/2023]
Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A Sotiriadis
- Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Calda
- Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic
| | - F Da Silva Costa
- Monash Ultrasound for Women and Perinatal Services, Monash Medical Centre, Melbourne, Victoria, Australia
| | - N Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK - Nurture Fertility, The Fertility Partnership
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - G McGillivray
- Victorian Clinical Genetics Services, Mercy Hospital for Women, Murdoch Children's Research Institute, Melbourne, Australia
| |
Collapse
|
3
|
Cheng WL, Hsiao CH, Tseng HW, Lee TP. Noninvasive prenatal diagnosis. Taiwan J Obstet Gynecol 2015; 54:343-9. [DOI: 10.1016/j.tjog.2015.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 01/14/2023] Open
|
4
|
Guía de práctica clínica: Diagnóstico prenatal de los defectos congénitos. Cribado de anomalías cromosómicas. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.diapre.2012.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
5
|
Kohatsu M, Carvalho MHBD, Vieira Francisco RP, Amorim Filho AGD, Zugaib M. Analysis of fetal and maternal results from fetal genetic invasive procedures: an exploratory study at a University Hospital. Rev Assoc Med Bras (1992) 2012; 58:703-8. [PMID: 23250100 DOI: 10.1590/s0104-42302012000600016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/30/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterize the indications of pregnant women who sought the Fetal Medicine Services of the Hospital das Clínicas, at the Medical School of the Universidade de São Paulo for performing invasive diagnostic procedures, and to evaluate the results of fetal karyotypes and their pregnancies. METHODS A retrospective and observational study on pregnant women who underwent chorionic villus sampling (CVS), amniocentesis, and cordocentesis in the period from February, 2005 to December, 2009. Other diagnostic or therapeutic procedures were not included. The result of pregnancy was obtained by consulting patient electronic records, medical records, and/or telephone call. RESULTS 713 procedures were performed (113 CVS, 340 amniocenteses, and 260 cordocenteses). The main indication for performing invasive procedures was the presence of structural changes in fetuses, followed by increased values of nuchal translucency, and advanced maternal age. Fetal karyotype was altered in 186 cases (26.1%). The 18 trisomy was the commonest aneuploidy followed by the 21 trisomy, X monosomy, and 13 trisomy. There were 4.9% cases of miscarriage, 25.7% cases of stillborn infants, and 13% cases of neonatal deaths. Eight pregnant women opted for legally induced abortion. 99% of pregnant women whose fetuses did not present abnormalities and presented normal fetal karyotype had infants who were born alive.
Collapse
Affiliation(s)
- Mario Kohatsu
- Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | |
Collapse
|
6
|
Kohatsu M, Burlacchini de Carvalho MH, Vieira Francisco RP, de Amorim Filho AG, Zugaib M. Análise dos resultados maternos e fetais dos procedimentos invasivos genéticos fetais: um estudo exploratório em Hospital Universitário. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70275-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
7
|
Boupaijit K, Wanapirak C, Piyamongkol W, Sirichotiyakul S, Tongsong T. Effect of placenta penetration during cordocentesis at mid-pregnancy on fetal outcomes. Prenat Diagn 2012; 32:83-7. [DOI: 10.1002/pd.2916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/03/2011] [Accepted: 10/03/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Kuanoon Boupaijit
- Department of Obstetrics and Gynecology; Faculty of Medicine Chiang Mai University; Chiang Mai; Thailand
| | - Chanane Wanapirak
- Department of Obstetrics and Gynecology; Faculty of Medicine Chiang Mai University; Chiang Mai; Thailand
| | - Wirawit Piyamongkol
- Department of Obstetrics and Gynecology; Faculty of Medicine Chiang Mai University; Chiang Mai; Thailand
| | - Supatra Sirichotiyakul
- Department of Obstetrics and Gynecology; Faculty of Medicine Chiang Mai University; Chiang Mai; Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology; Faculty of Medicine Chiang Mai University; Chiang Mai; Thailand
| |
Collapse
|
8
|
Tongsong T, Khumpho R, Wanapirak C, Piyamongkol W, Sirichotiyakul S. Effect of Umbilical Cord Bleeding following Mid-Pregnancy Cordocentesis on Pregnancy Outcomes. Gynecol Obstet Invest 2012; 74:298-303. [DOI: 10.1159/000339938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/03/2012] [Indexed: 11/19/2022]
|
9
|
Clinical applications of prenatal and postnatal therapy using stem cells retrieved from amniotic fluid. Curr Opin Obstet Gynecol 2011; 23:109-16. [PMID: 21386681 DOI: 10.1097/gco.0b013e32834457b1] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW To review the potential of stem cells derived from amniotic fluid and applications in prenatal and postnatal therapy. RECENT FINDINGS We have recently described that pluripotent stem cells can be isolated from amniotic fluid defined as amniotic fluid stem (AFS) cells by selection for expression of the membrane stem cell factor receptor c-Kit. AFS cells maintained for over 250 population doublings retained long telomeres and normal karyotype. Clonal human lines verified by retroviral marking were induced to differentiate into cell types representing each embryonic germ layer, including adipogenic, osteogenic, myogenic, endothelial, neuronal, and hepatic lineages. Rat AFS cells have been able to improve the repair of damaged smooth muscle in cryoinjury bladders. Furthermore, AFS cells could be differentiated toward cardiomyogenic lineages, when co-cultured with neonatal cardiomyocytes and have potential to generate hematopoietic lineages both in vitro and in vivo. These cells have been applied into fetal therapy, and widely used for tissue repair in animal models. Finally, we demonstrated a feasible way to do in-utero autologous AFS transplantation in sheep. SUMMARY Stem cells derived from amniotic fluid are a relatively new source of cells that could have a therapeutic value in various diseases prenatally and/or postnatally.
Collapse
|
10
|
Tangshewinsirikul C, Wanapirak C, Piyamongkol W, Sirichotiyakul S, Tongsong T. Effect of cord puncture site in cordocentesis at mid-pregnancy on pregnancy outcomes. Prenat Diagn 2011; 31:861-4. [PMID: 21706506 DOI: 10.1002/pd.2790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 04/24/2011] [Accepted: 04/29/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To compare the procedure and pregnancy outcomes of pregnancies undergoing cordocentesis between a group of cord insertion puncture and that of free loop puncture. MATERIALS AND METHODS Pregnancies undergoing cordocenteses meeting the following inclusion criteria were recruited: (1) singleton pregnancies at gestational ages of 18-22 weeks; (2) no fetal abnormalities; (3) the procedures performed by experienced operators; and (4) the procedures of no placenta penetration. The recruited cases were classified into two groups: a group of cordocenteses with puncture site at placental cord insertion (Group 1) and those with puncture site at cord free loop (Group 2). The primary outcomes to be compared were rates of fetal loss, newborns with low birth weight and preterm birth. The secondary outcomes included a rate of successful procedures, umbilical cord bleeding, fetal bradycardia, maternal blood contamination, and duration of the procedure time. RESULTS Of 6147 cordocenteses recruited, 2214 met inclusion criteria. The mean duration to complete the procedure in Group 1 was significantly shorter than that in Group 2 (4.5 ± 5.4 vs. 6.7 ± 8.5 min, Student's t-test; p = 0.001). The mean birth weight and gestational age at delivery were comparable between the two groups. No significant differences between the two groups were seen in rates of fetal loss, low birth weight, preterm birth, successful procedures, umbilical cord bleeding, or fetal bradycardia. However, the rate of maternal blood contamination was significantly higher in the group of puncture at the cord insertion site. CONCLUSION Of cordocenteses performed based on accessibility and quality of visualization, cord insertion puncture may cause more maternal blood contamination but free loop puncture may be associated with more difficult procedures, while the safety was comparable.
Collapse
|
11
|
Huang Z, Fong CY, Gauthaman K, Sukumar P, Choolani M, Bongso A. Novel approaches to manipulating foetal cells in the maternal circulation for non-invasive prenatal diagnosis of the unborn child. J Cell Biochem 2011; 112:1475-85. [DOI: 10.1002/jcb.23084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
12
|
Rapid Genome-wide Aneuploidy Diagnosis Using Uncultured Amniocytes and Array Comparative Genomic Hybridization in Pregnancy With Abnormal Ultrasound Findings Detected in Late Second and Third Trimesters. Taiwan J Obstet Gynecol 2010; 49:120-3. [DOI: 10.1016/s1028-4559(10)60026-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2009] [Indexed: 11/18/2022] Open
|
13
|
Bussel JB, Primiani A. Fetal and neonatal alloimmune thrombocytopenia: progress and ongoing debates. Blood Rev 2007; 22:33-52. [PMID: 17981381 DOI: 10.1016/j.blre.2007.09.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fetal and neonatal alloimmune thrombocytopenia (AIT) is a result of a parental incompatibility of platelet-specific antigens and the transplacental passage of maternal alloantibodies against the platelet antigen shared by the father and the fetus. It occurs in approximately 1 in 1000 live births and is the most common cause of severe thrombocytopenia in fetuses and term neonates. As screening programs are not routinely performed, most affected fetuses are identified after birth when neonatal thrombocytopenia is recognized. In severe cases, the affected fetus is identified as a result of suffering from an in utero intracranial hemorrhage. Once diagnosed, AIT must be treated antenatally as the disease can be more severe in subsequent pregnancies. While there have been many advances regarding the diagnosis and treatment of AIT, it is still difficult to predict the severity of disease and which therapy will be effective.
Collapse
Affiliation(s)
- James B Bussel
- Division of Hematology, Department of Pediatrics, Weill Medical College of Cornell University, New York, NY 10021-4853, United States.
| | | |
Collapse
|
14
|
Bon C, Raudrant D, Poloce F, Champion F, Golfier F, Pichot J, Revol A. [Biochemical profile of fetal blood sampled by cordocentesis in 35 pregnancies complicated by growth retardation]. ACTA ACUST UNITED AC 2006; 55:111-20. [PMID: 16815643 DOI: 10.1016/j.patbio.2006.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 04/21/2006] [Indexed: 01/24/2023]
Abstract
AIM OF THE STUDY Intra-uterine growth retardation (IUGR) is a frequent pathology in obstetrics characterized by high heterogeneity. Fetal smallness is sometimes constitutional, but can also be accompanied by fetal distress and vital risks for the infant. In 35 pregnancies complicated by IUGR of different etiologies, we measured on fetal blood obtained by cordocentesis, biochemical variables characteristic of the fetuses' respiratory and metabolic status. The aim of the study was to identify the discriminative biological alterations, related to growth retardation and fetal distress. PATIENTS AND METHODS The studied population includes 27 cases of severe IUGR, of gestational age 30,2+/-4,6 weeks of gestation (WG) (divided into 20 cases of isolated IUGR and 7 cases of IUGR associated with malformative syndrome), as well as 8 cases of moderate IUGR, of gestational age 26+/-4,5 WG; all fetuses had normal karyotypes. A group of 73 normal fetuses, of gestational age 26,3+/-5,7 WG, constituted a reference population. PH, pCO(2), bicarbonate concentration, pO(2) and SaO(2), as well as glucose, pyruvate, lactate, free fatty acids, aceto-acetate, beta-hydroxybutyrate and cholesterol concentrations were measured on umbilical venous blood (UVB). RESULTS In case of severe but isolated growth retardation, UVB analysis showed the frequency of acid-base and gasometric disturbances: acidemia and hypoxemia (65% of cases), hypercapnia (60% of cases). Metabolic abnormalities were shown: decrease in glycemia (35% of cases), increase in pyruvatemia and lactatemia (40% of cases), increased free fatty acids serum concentration; a diminution of umbilical venous cholesterol level, the most frequent abnormality, can be seen in 70% of fetuses. In case of severe IUGR associated with malformative syndrome, UVB acid-base and metabolic changes were rarely seen; however, UVB cholesterol level is low in some cases. In case of growth retardation classified as moderate, modifications are relatively not frequent and essentially gasometric. CONCLUSION In about 60% of cases of severe and isolated IUGR, there is a risk of fetal distress, related to an alteration of the transplacental transfer of respiratory gases and nutritional substrates; chronic fetal malnutrition can be involved, with an impact on the growth of the fetus. In case of IUGR associated with malformative syndrome, fetal smallness is probably a result of intrinsic fetal damage, without nutritional origin.
Collapse
Affiliation(s)
- C Bon
- Service de biochimie, Hôtel-Dieu, 1, place de l'Hôpital, 69288, Lyon cedex 02, France.
| | | | | | | | | | | | | |
Collapse
|
15
|
Cohen-Bendahan CCC, van de Beek C, Berenbaum SA. Prenatal sex hormone effects on child and adult sex-typed behavior: methods and findings. Neurosci Biobehav Rev 2005; 29:353-84. [PMID: 15811504 DOI: 10.1016/j.neubiorev.2004.11.004] [Citation(s) in RCA: 345] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Revised: 10/21/2004] [Accepted: 11/05/2004] [Indexed: 11/27/2022]
Abstract
There is now good evidence that human sex-typed behavior is influenced by sex hormones that are present during prenatal development, confirming studies in other mammalian species. Most of the evidence comes from clinical populations, in which prenatal hormone exposure is atypical for a person's sex, but there is increasing evidence from the normal population for the importance of prenatal hormones. In this paper, we briefly review the evidence, focusing attention on the methods used to study behavioral effects of prenatal hormones. We discuss the promises and pitfalls of various types of studies, including those using clinical populations (concentrating on those most commonly studied, congenital adrenal hyperplasia, androgen insensitivity syndrome, ablatio penis, and cloacal exstrophy), direct measures of hormones in the general population (assayed through umbilical cord blood, amniotic fluid, and maternal serum during pregnancy), and indirect measures of hormones in the general population (inferred from intrauterine position and biomarkers such as otoacoustic emissions, finger length ratios, and dermatoglyphic asymmetries). We conclude with suggestions for interpreting and conducting studies of the behavioral effects of prenatal hormones.
Collapse
Affiliation(s)
- Celina C C Cohen-Bendahan
- Department of Child and Adolescent Psychiatry, and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands
| | | | | |
Collapse
|
16
|
Antsaklis A, Daskalakis G, Souka AP, Kavalakis Y, Michalas S. Fetal blood sampling in twin pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:377-379. [PMID: 14528473 DOI: 10.1002/uog.211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the role of fetal blood sampling for prenatal diagnosis in twin pregnancies. METHODS This was a retrospective study of 84 twin pregnancies that had undergone fetal blood sampling between the years 1977 and 2000. These results were compared with those from a similar study on amniocentesis and chorionic villus sampling. RESULTS Miscarriage occurred in 3.6% of cases after fetal blood sampling. The total fetal loss rate was 13.6% and the fetal loss that could be attributed to the procedure was 8.2%. The procedure-related fetal loss rate was dependent on the indication for fetal blood sampling. The rates of preterm delivery at </= 32 weeks, preterm delivery at </= 35 weeks, perinatal mortality at </= 28 weeks, perinatal mortality at > 28 weeks and neonatal mortality were 16.9%, 28.3%, 10.9%, 3.1% and 7.7%, respectively. CONCLUSION Fetal blood sampling in twin pregnancies carries higher risks for the fetus than do amniocentesis and chorionic villus sampling. However, it remains useful in evaluating the fetal condition in special circumstances such as hydrops and infection.
Collapse
Affiliation(s)
- A Antsaklis
- First Department of Obstetrics and Gynaecology, Alexandra Maternity Hospital, University of Athens, Athens, Greece
| | | | | | | | | |
Collapse
|
17
|
Nanal R, Kyle P, Soothill PW. A classification of pregnancy losses after invasive prenatal diagnostic procedures: an approach to allow comparison of units with a different case mix. Prenat Diagn 2003; 23:488-92. [PMID: 12813763 DOI: 10.1002/pd.623] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pregnancy loss rates after prenatal invasive procedures such as amniocentesis (Amnio), chorionic villous sampling (CVS) and fetal blood sampling (FBS) vary with an underlying indication for the procedure and due to different background risk of miscarriage. Loss rates need to be quantified and available for counselling. We developed a classification of pregnancy losses that will help in calculating procedure-related pregnancy loss rates and allow comparison between units with a different case mix. METHODS The procedure-related pregnancy loss rate was obtained by subtracting the losses in pregnancies with known lethal conditions and those occurring more than two weeks after the procedure from total pregnancy losses. RESULTS Out of 436 CVSs, there were 18 losses. Of these, 14 had a known lethal condition and 3 occurred after 2 weeks of CVS. In only one case, there was no known lethal abnormality and the loss occurred within 2 weeks. Thus, the total pregnancy loss rate was 4.1% and the procedure-related loss rate was 0.23% (95% CI; 0.0061-1.28). The procedure-related loss rates for Amnio 0.7% (95% CI; 0.2-1.8) and FBS 1.19 (95% CI; 0.14-4.23) were calculated in a similar way. CONCLUSIONS We present a method of recording pregnancy loss after prenatal invasive procedures, which would be useful for benchmarking comparison between units and pre-procedural counselling.
Collapse
Affiliation(s)
- Rashmi Nanal
- Fetal Medicine Research Unit, University of Bristol, St Michael's Hospital, Bristol, UK
| | | | | |
Collapse
|