Diagnosis of hydatidiform mole by transabdominal placental biopsy

Transabdominal placental biopsy in the second and third trimester of pregnancy

Transabdominal placental biopsy under ultrasound guidance was carried out in 260 cases in the second trimester and 50 cases in the third trimester of pregnancy. Placental tissue was aspirated using an 18 or 20 gauge needle. In a total of 310 placental biopsies in the second and third trimester, 100 were performed because of suspicious ultrasonographic findings. Placental biopsy is simple in the presence of severe oligohydramnios where fetal blood sampling is usually more difficult. Oligohydramnios and polyhydramnios were the ultrasonographic findings in 50% of cases and were found to be associated with 30% of abnormal chromosomal findings. There was one (0.3%) abortion within two weeks following placental biopsy. Placental biopsy did not affect the outcome of the pregnancy.

Benefits of placental biopsies for rapid karyotyping in the second and third trimesters (late chorionic villus sampling) in high-risk pregnancies

In a total of 301 placental biopsies in the second and third trimesters, 225 were performed because of suspicious ultrasonographic findings. In this group there was a high rate of aneuploidies (20%). As opposed to the alternative methods for rapid karyotyping, placental biopsies can easily be performed even in pregnancies with abnormal amounts of amniotic fluid. Oligohydramnios and polyhydramnios were key ultrasonographic findings in 38% of cases and were found to be associated with 22% of abnormal chromosomal findings. Suggestive ultrasonographic findings seem to justify the exclusive use of direct preparation.

Current method for first and second trimester prenatal diagnosis: transabdominal chorionic villi sampling

Transabdominal CVS (chorionic villi sampling) was performed in 40 patients belonging to first or second trimester of pregnancy with 97.5% success, using a double and later single needle technique with no immediate complications. Karyotyping by direct method was successful in 75% of samples thus indicating the feasibility of cytogenetic analysis using villus tissue from first and second trimesters of pregnancy. It is a safe, simple, rapid and practical method of prenatal diagnosis in first and second trimesters of pregnancy with a potentially lower risk for fetal and maternal complications.

Feasibility of placental biopsy in the second trimester for fetal diagnosis

Second-trimester prenatal diagnosis by placental biopsy was possible in 200 of 220 patients (90.9%) to whom it was offered to expedite cytogenetic analysis. Cytogenetic analysis was successful in 190 cases (95%) when the material obtained was greater than 2 mg. We found five chromosome abnormalities; 47,XX, +21 (two cases); 47,XY, +18 (one case); and 45,XX,t (D;G) (two cases). There was one abortion 4 weeks after the placental biopsy (0.4%). If further experience confirms the accuracy, safety, and reliability of this method beyond the first trimester, it can be offered to mothers to expedite the cytogenetic, biochemical, and deoxyribonucleic acid analysis.

Transabdominal chorionic villi sampling for first trimester fetal diagnosis. First 26 pregnancies followed to term

A consecutive series of 26 women followed to term after first trimester transabdominal chorionic villi sampling is presented. The clinical application of transabdominal chorionic villi sampling (TA-CVS) seems to have certain advantages, especially from the patients' point of view, but also in regard to successful sampling and to the complication ratio. The results in this clinical trial revealed no cases of abortions, no signs of placental damage and no cases of vaginal bleeding or infections.

Antenatal diagnosis

The diagnosis of genetic disease in utero in early pregnancy is a new and exciting development with important applications in the management of families with a high risk of producing a child with an hereditary disorder. Techniques currently under investigation are briefly reviewed and include sex chromatin, cytogenetic and biochemical studies on amniotic fluid cells and the biochemical composition of amniotic fluid. The study of amniotic fluid and its contained cells would seem to offer a promising and important approach to the prevention of genetic disease.