Prenatal genetic testing by amniocentesis appears to result in a lower risk of fetal loss than chorionic villus sampling in singleton pregnancies achieved by intracytoplasmic sperm injection

Invasive prenatal diagnostic procedures 2005

Amniocentesis and Chorionic Villus Sampling have been the two most common prenatal diagnostic procedures for decades. There are wide variations in utilization, operator skills, quoted procedure risks, actual observed risks, and patient choices that come from highly variable counseling as to those risks. The compilation of published data suggests procedure risks of amniocentesis to be about 1/200 and in very skilled hands to be slightly lower. The risks of CVS in very experienced hands may also be about 1/200. Most studies comparing CVS to amniocentesis in skilled hands have found equivalency of risks. No well controlled studies support claims of amniocentesis risk at 1/1000 or lower. There is no increased risks of limb reduction defects following CVS at 10 weeks or greater, but there is an increase in Talipes from "Early Amniocentesis." In the first trimester CVS is the safer procedure.

Invasive fetal testing

PURPOSE OF REVIEW

Research on prenatal diagnosis and invasive fetal testing has continued at a rapid pace. Several studies that will have a profound impact on the way prenatal care will be provided to pregnant women have been published in the literature during the last year. These publications will be reviewed and their impact described.

RECENT FINDINGS

The main areas of interest in the recent literature covered in this review are first-trimester screening for aneuploidy, recent information on loss rates due to amniocentesis and chorionic villus sampling, and current work on invasive fetal therapy.

SUMMARY

It appears that first-trimester screening is at least comparable if not superior in efficacy to second-trimester serum screening. This will be a test that will be utilized increasingly by both low and high-risk patients for aneuploidy. Of utility to a much smaller number of patients, invasive fetal therapy for meningomyelocele repair, twin-to-twin transfusion syndrome and fetal cardiac malformations is being evaluated in a scientifically more rigorous manner.