The effect of diagnostic amniocentesis and its complications on early spontaneous abortion

Network meta-analysis of randomized controlled trials comparing the effectiveness of different treatments in reducing amniocentesis-associated pain and anxiety

OBJECTIVE

This network meta-analysis compared different methods to determine which is most efficient at lowering pain and anxiety in women undergoing amniocentesis.

METHOD

We looked through all published randomized controlled trials in the databases PubMed, Scopus, Web of Science, Cochrane, and EM base. Anxiety and pain were the predominant results. We used the R software version 4.2.1 to analyze the data.

RESULTS

We included a total of 20 studies, with sample sizes ranging from 60 to 570. Virtual reality was the most effective strategy for lowering pain during AC [MD = -1.30, 95% CI (-2.11, -0.49)]. In addition, paracetamol use was the most successful approach for lowering pain following AC [MD = -1.68, 95% CI (-1.99, -1.37)]. The use of H7 acupressure, however, was the strategy that significantly reduced anxiety following AC [SMD = -15.46, 95% CI (-17.77, -13.15)].

CONCLUSION

The most effective method for reducing pain is the combination of virtual reality with paracetamol. Whereas, the most effective way to reduce anxiety is to combine an ice gel pack with H7 acupressure before applying AC.

COMBINED FIRST TRIMESTER SCREENING FOR FETAL DOWN SYNDROME AT THE SPLIT UNIVERSITY HOSPITAL CENTER: A SEVEN-YEAR EXPERIENCE

The aim of this study was to present the results and to explore the success of combined screening at the Split University Hospital Center. A cross-sectional retrospective study was performed, including all pregnant women who underwent combined screening at the Split University Hospital Center from 2011 to 2017. Data were collected from the hospital archives. During the research period, a total of 6898 pregnant women underwent combined screening. With the high risk cut-off value set at 1:250, the sensitivity of combined screening was 81.0% and specificity 96.8% (AUC 0.929, 95% CI 0.859-1.000; p<0.001). The mean value of a priori risk of Down syndrome based on age was higher than the one calculated by combined screening (1:487.57 vs. 1:13216.9; p<0.001). The number of women who were a priori at a high risk of Down syndrome was significantly higher than the number of those at a high risk based on combined screening results (1457 vs. 239; p<0.001). With the increase in women's age, a statistically significant increase was detected in the mean value of a priori risk of Down syndrome, as well as in the risk based on combined screening results (p<0.001). Combined screening detected a high risk in 8.09% (118/1457) of pregnant women a priori at a high risk of Down syndrome, as well as in 2.22% (121/5441) of pregnant women a priori at a low risk of it. Thus, combined screening placed 121 pregnant women a priori at a low risk in the high-risk group. Down syndrome was subsequently confirmed in 17 (14.05%) women. Analysis of the combined screening results confirmed the validity of using the said fetal Down syndrome screening method in the study population of pregnant women.

Severe maternal thrombocytopenia and prenatal invasive procedures: still a grey zone

Management of severe thrombocytopenia, particularly of ITP, in pregnancy is mainly based on expert consensus and clinical experience while there are no clear indications about the minimum platelet count requested for prenatal diagnosis invasive procedures. Since the lack of specific recommendations we reported our clinical management of a patient suffering from severe thrombocytopenia, undergoing amniocentesis. Due to the anecdotic possibility of maternal and fetal bleeding in case of severe thrombocytopenia, prophylaxis with IVIG or even corticosteroids could be considered as a safer strategy to prevent post-procedural adverse outcomes.

Ultrasound Probe and Hand-Eye Calibrations for Robot-Assisted Needle Biopsy

In robot-assisted ultrasound-guided needle biopsy, it is essential to conduct calibration of the ultrasound probe and to perform hand-eye calibration of the robot in order to establish a link between intra-operatively acquired ultrasound images and robot-assisted needle insertion. Based on a high-precision optical tracking system, novel methods for ultrasound probe and robot hand-eye calibration are proposed. Specifically, we first fix optically trackable markers to the ultrasound probe and to the robot, respectively. We then design a five-wire phantom to calibrate the ultrasound probe. Finally, an effective method taking advantage of steady movement of the robot but without an additional calibration frame or the need to solve the AX=XB equation is proposed for hand-eye calibration. After calibrations, our system allows for in situ definition of target lesions and aiming trajectories from intra-operatively acquired ultrasound images in order to align the robot for precise needle biopsy. Comprehensive experiments were conducted to evaluate accuracy of different components of our system as well as the overall system accuracy. Experiment results demonstrated the efficacy of the proposed methods.

Novel Approach for Laparoscopically Placed Chronic Amniotic Fluid Catheters in Sheep

INTRODUCTION

Several fetal therapies involve repeated amniotic fluid intervention. We hypothesize that a minimally invasive approach can be used to safely implant an intrauterine catheter infusion system in a fetal ovine model for chronic use during pregnancy.

METHOD

Five pregnant sheep underwent operation between gestational days 110 and 115 (term 145 days). A Codman® implantable infusion pump was adapted for intrauterine use. The chamber was placed in the maternal flank and the tunneled catheter laparoscopically inserted into the amniotic cavity, secured with a pursestring. Three had an additional uterine anchoring suture. Ewes were sacrificed after natural delivery, and the uterus underwent gross and microscopic analyses.

RESULTS

There were no maternal mortalities, abortions, or preterm labor. Pumps were accessed and remained functional throughout gestation. Four ewes delivered healthy term lambs; the other delivered twins with failure to progress and demise. On necropsy, catheters secured with an anchoring suture remained in place, while the other 2 dislodged during labor. There was no chorioamnionitis by culture or histology.

CONCLUSION

Laparoscopically placed intra-amniotic infusion catheters were implanted safely and remained functional until delivery in an ovine model. This novel approach has promise in providing safe, durable amniotic fluid access for the potential treatment of fetal disease.

Non-Invasive Prenatal Fetal Blood Group Genotype and Its Application in the Management of Hemolytic Disease of Fetus and Newborn: Systematic Review and Meta-Analysis

Hemolytic disease of fetus and newborn (HDFN) imposes great healthcare burden being associated with maternal alloimmunization against parental-inherited fetal red blood cell antigens causing fetal anemia or death. Noninvasive prenatal analysis (NIPT) provides safe fetal RHD genotyping for early identification of risk pregnancies and proper management guidance. We aimed to conduct systematic review and meta-analysis on NIPT's beneficial application, in conjunction with quantitative maternal alloantibody analysis, for early diagnosis of pregnancies at risk. Search for relevant articles was done in; PubMed/Medline, Scopus, and Ovid (January 2006April 2020), including only English-written articles reporting reference tests and accuracy data. Nineteen eligible studies were critically appraised. NIPT was estimated highly sensitive/specific for fetal RHD genotyping beyond 11-week gestation. Amplifications from ≥2 exons are optimum to increase accuracy. NIPT permits cost-effectiveness, precious resources sparing, and low emotional stress. Knowledge of parental ethnicity is important for correct NIPT result interpretations and quantitative screening. Cut-off titer ≥8-up-to-32 is relevant for anti-D alloantibodies, while, lower titer is for anti-K. Alloimmunization is influenced by maternal RHD status, gravida status, and history of adverse obstetrics. In conclusion, NIPT allows evidence-based provision of routine anti-D immunoprophylaxis and estimates potential fetal risks for guiding further interventions. Future large-scale studies investigating NIPT's non-RHD genotyping within different ethnic groups and in presence of clinically significant alloantibodies are needed.

Evaluation of short-term safety of ultrasound-guided foetal fluid sampling in the dog (Canis lupus familiaris)

BACKGROUND

In humans, analysis of amniotic fluid is widely used for diagnostic and prognostic purposes. Amniocentesis has scarcely been used in veterinary medicine to date, despite a tremendous potential for clinical and research applications in dogs. Our study aimed to establish a safe method for foetal fluid sampling in female dogs.

METHODS

Two transabdominal ultrasound-guided methods were assessed: the "free hand" and the needle-guided bracket sampling. In addition, through a subsequent routinely scheduled ovariohysterectomy, fluid was directly collected. Samples from 98 conceptuses were collected at day 46.7 ± 7.5 of pregnancy.

RESULTS

The amount of fluid retrieved varied between 0.5 and 5.0 ml per collection. Macroscopic examination of the uterus and conceptuses identified 53% of the puncture sites. Neither fluid leakage nor foetal injury was detected, and six hematomas (5.8%) were visible. Ultrasound-guided foetal fluid collection was found to be potentially safe, and it can be performed by using either transabdominal method.

CONCLUSION

Foetal fluid collection is possible with relative ease and low short-term risk, and may open paths for diagnostic, therapeutic and research purposes in dogs. The procedure can provide new insights into prenatal clinical medicine, including diagnostics of foetal deaths, early identification of heritable diseases and so on.

The Significance of Apolipoprotein E Measurement in the Screening of Fetal Down Syndrome

Prenatal screening for Down syndrome (DS) is based on both noninvasive and invasive methods. Noninvasive, cell-free fetal DNA genetic tests are expensive, whereas biochemical methods remain imprecise. Amniocentesis is the most frequently used invasive diagnosis procedure, characterized by 99.8% diagnostic efficiency and less than 1% risk of miscarriage. The aim of this study was to evaluate the screening value of apolipoprotein E (ApoE) as a potential noninvasive biomarker for prenatal DS assessment. This study was conducted on a group of female patients who decided to undergo routine amniocentesis between the 15th and 18th week of pregnancy at the Department of Reproduction and Gynecological Endocrinology of the Medical University of Bialystok, Poland. For the purpose of this study, 20 women with DS fetuses were selected as the study group, and 20 healthy pregnant women with euploid fetus karyotypes as the control group. The plasma levels of ApoE were significantly higher in the study group compared to healthy subjects (p < 0.05). The area under the receiver operating characteristic (ROC) curve was 0.978 (p < 0.001), with the cut-off set to 1.37 mg/mL, which was characterized by 80% of sensitivity and 100% of specificity. The high sensitivity and specificity demonstrate the screening utility of maternal ApoE concentration in prenatal fetal DS screening.

Expression of TGF-β1 and miR-99a in serum of patients with early spontaneous abortion and correlation with hormone levels during pregnancy

Expression of TGF-β1 and miR-99a in patients with early spontaneous abortion and correlation with hormone levels during pregnancy were investigated. A total of 70 pregnant women with early spontaneous abortion diagnosed in Jining No. 1 People's Hospital from February 1, 2015 to May 1, 2018 were selected as the study group, and 83 normal pregnant women who chose abortion for non-medical reasons in the same period as the control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect TGF-β1 and the levels of serum β-HCG, progesterone and estrogen during pregnancy in the two groups, and RT-qPCR to detect the expression of miR-99a, and partial correlation analysis to analyze the correlation of TGF-β1 and miR-99a with the levels of serum β-HCG, progesterone and estrogen in the study group of patients. Expression of β-HCG was significantly lower in the study group than that in the control group, with a statistically significant difference (P<0.001), and that of progesterone was significantly lower in the study group than that in the control group, with a statistically significant difference (P<0.001). Expression of estrogen was significantly lower in the study group than that in the control group, with a statistically significant difference (P<0.001). The partial correlation analysis indicated that the levels of serum β-HCG, progesterone and estrogen were positively correlated with TGF-β1 (r=0.944, 0.868, 0.869, P<0.001), negatively correlated with the expression level of miR-99a (r=−0.944, −0.892, −0.891, all P<0.001). miR-99a was highly expressed in the serum of patients with early spontaneous abortion, but TGF-β1 expression was low. The expression levels of the two factors are related to hormone levels during pregnancy, which are expected to be new candidate molecular diagnostic markers in the diagnosis of early spontaneous abortion.

Non-invasive prenatal paternity testing using cell-free fetal DNA from maternal plasma: DNA isolation and genetic marker studies

Invasive prenatal paternity tests can result in miscarriage and congenital malformations; therefore, a non-invasive method of testing is preferable. However, little progress could be made in this field until the introduction of cell-free fetal DNA (cffDNA) in 2009. In this review, two aspects regarding the history and development of non-invasive prenatal paternity testing (NIPAT) are summarized: (1) extraction and enrichment of cffDNA and (2) genetic marker-based studies. Although column-based kits are used widely for NIPAT, some researchers have suggested that an automated method, such as magnetic extraction, generally has a higher cffDNA yield than that of manual column-based extraction; therefore, its popularity might increase in the near future. In addition, size- and methylation-based enrichment methods are expected to perform better than formaldehyde-based methods. On the other hand, single nucleotide polymorphism-based techniques have contributed to NIPAT, whereas the application of short tandem repeat testing has so far been restricted to pregnant women bearing male fetuses only. Additional methods and techniques are expected to be innovated to facilitate the forensic practice of NIPAT.