Procedure-Related Complications after Genetic Amniocentesis and Chorionic Villus Sampling (original) (raw)

Ultraschall Med 2013; 34(4): 345-348
DOI: 10.1055/s-0032-1312939

© Georg Thieme Verlag KG Stuttgart · New York

Komplikationen nach genetischer Amniozentese und Chorionzottenbiopsie

Further Information

Publication History

16 February 2012

08 May 2012

Publication Date:
21 June 2012 (online)

Abstract

Purpose: Amniocentesis (AC) and chorionic villus sampling (CVS) play an important role in the diagnosis of genetic anomalies. The aim of this study was to evaluate presentable numbers of procedure-related complications of genetic interventions in a tertiary referral hospital.

Materials and Methods: The pregnancy outcome of women who underwent genetic AC or CVS during 2003 – 2010 at the Department of Obstetrics and Gynecology, Medical University of Graz, Austria, was analyzed retrospectively. The primary outcome was miscarriage or membrane rupture after an invasive procedure. Only singleton gestations were included.

Results: 1,569 AC procedures and 334 CVS procedures (234 transabdominal, 99 transcervical, 1 with undocumented route) were performed. Of these, 57 cases were excluded from further analysis because of severe anomalies. Complete outcome data were available for 93.17 % of cases. In 164 (8.89 %) cases the pregnancy was terminated due to genetic anomalies or severe malformations. In the remaining collective 10 of 1,342 (0.75 %) AC procedures, 3 of 150 (2.00 %) transabdominal CVS procedures and 2 of 64 (3.13 %) transcervical CVS procedures lead to complications resulting in miscarriage < 24 weeks (n = 13) or rupture of membranes (n = 2) within 2 weeks after procedure. Complication rates were significantly higher after CVS than after AC (OR 3.19).

Conclusion: Over an observation period of seven years, the complication rates after AC, transabdominal CVS and transcervical CVS were 0.75 %, 2.00 % and 3.13 %, respectively. These results are comparable to recent international investigations.

Zusammenfassung

Ziel: Invasive pränatale Untersuchungen, wie Amniozentese (AC) und Chorionzottenbiopsie (CVS), spielen eine entscheidende Rolle in der Diagnostik genetischer Anomalien. Ziel der vorliegenden Studie ist die Ermittlung repräsentativer Zahlen über die Komplikationen nach genetischen Eingriffen in einem Tertiärzentrum.

Material und Methoden: In einer retrospektiven Analyse wurde das Outcome der an der Universitätsklinik für Frauenheilkunde und Geburtshilfe in Graz zwischen 2003 und 2010 betreuten Einlingsschwangerschaften, bei denen eine genetische AC oder CVS durchgeführt wurde, evaluiert. Primäres Outcome war das Auftreten einer Fehlgeburt oder eines Blasensprungs nach einem invasiven Eingriff.

Ergebnisse: Von den 1569 AC und 334 CVS (234 transabdominal, 99 transzervikal, 1 mit undokumentiertem Zugang) wurden 57 Fälle wegen schwerer kongenitaler Anomalien ausgeschlossen. Vollständige Daten konnten in 93,17 % erhoben werden. In 164 (8,89 %) Fällen wurde wegen genetischer oder struktureller Fehlbildungen ein Schwangerschaftsabbruch durchgeführt. Im restlichen Kollektiv kam es in 10 von 1342 (0,75 %) AC, 3 von 150 (2,00 %) transabdominalen CVS und 2 von 64 (3,13 %) transzervikalen CVS zu Komplikationen, die zu einer Fehlgeburt vor 24 SSW (n = 13) oder einem vorzeitigen Blasensprung (n = 2) innerhalb von 2 Wochen nach dem Eingriff führten. Die Komplikationsraten nach CVS waren höher als nach AC (OR 3,19).

Schlussfolgerung: Über einen 7-jährigen Beobachtungszeitraum betrugen die Komplikationsraten nach AC, transabdominaler und transzervikaler CVS 0,75 %, 2,00 % und 3,13 %. Dies ist vergleichbar mit neueren internationalen Untersuchungen.

Key words

obstetrcis - pregnancy - amniocentesis - chorionic villus - sampling

• References

• 1 Spencer K, Souter V, Tul N et al. A screening program for trisomy 21 at 10 – 14 weeks using fetal nuchal translucency, maternal serum free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol 1999; 13: 231-237
• 2 Tabor A, Vestergaard CH, Lidegaard O. Fetal loss rate after chorionic villus sampling and amniocentesis: an 11-year national registry study. Ultrasound Obstet Gynecol 2009; 34: 19-24
• 3 Hagen A, Entezami M, Gasiorek-Wiens A et al. The impact of first trimester screening and early fetal anomaly scan on invasive testing rates in women with advanced maternal age. Ultraschall in Med 2011; 32: 302-306
• 4 Jacobson CB, Barter RH. Intrauterine diagnosis and management of genetic defects. Am J Obstet Gynecol 1967; 99: 796-807
• 5 Hahnemann N, Mohr J. Genetic diagnosis in the embryo by means of biopsy from extra-embryonic membrane. Bull Eur Soc Hum Genet 1968; 2: 23-29
• 6 Tabor A, Philip J, Madsen M et al. Randomised controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet 1986; 1: 1287-1293
• 7 Rhoads GG, Jackson LG, Schlesselman SE et al. The safety and efficacy of chorionic villus sampling for early prenatal diagnosis of cytogenetic abnormalities. N Engl J Med 1989; 320: 609-617
• 8 Smidt-Jensen S, Permin M, Philip J et al. Randomised comparison of amniocentesis and transabdominal and transcervical chorionic villus sampling. Lancet 1992; 340: 1237-1244
• 9 Muller F, Thibaud D, Poloce F et al. Risk of amniocentesis in women screened positive for Down syndrome with second trimester maternal serum markers. Prenat Diagn 2002; 22: 1036-1039
• 10 Seeds JW. Diagnostic mid trimester amniocentesis: how safe?. Am J Obstet Gynecol 2004; 191: 607-615
• 11 Kong CW, Leung TN, Leung TY et al. Risk factors for procedure-related fetal losses after mid-trimester genetic amniocentesis. Prenat Diagn 2006; 26: 925-930
• 12 Eddleman KA, Malone FD, Sullivan L et al. Pregnancy loss rates after midtrimester amniocentesis. Obstet Gynecol 2006; 108: 1067-1072
• 13 Caughey AB, Hopkins LM, Norton ME. Chorionic villus sampling compared with amniocentesis and the difference in the rate of pregnancy loss. Obstet Gynecol 2006; 108: 612-616
• 14 Towner D, Currier RJ, Lorey FW et al. Miscarriage risk from amniocentesis performed for abnormal maternal serum screening. Am J Obstet Gynecol 2007; 196: 608. e1-e5
• 15 Odibo AO, Gray DL, Dicke JM et al. Revisiting the fetal loss rate after second-trimester genetic amniocentesis: a single center’s 16-year experience. Obstet Gynecol 2008; 111: 589-595
• 16 Nicolaides KH. First-trimester screening for chromosomal abnormalities. Semin Perinatol 2005; 29: 190-194
• 17 Luthgens K, Hoopmann M, Alkier R et al. First-Trimester Screening for Trisomies 18 and 13 with the Combined Use of the Risk Algorithms for Trisomy 21, 18 and 13. Ultraschall in Med 2012; in press
• 18 ACOG Practice Bulletin No. 27: Clinical Management Guidelines for Obstetrician-Gynecologists. Prenatal diagnosis of fetal chromosomal abnormalities. Obstet Gynecol 2001; 97: S1-S12
• 19 ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol 2007; 109: 217-227
• 20 Bindra R, Heath V, Liao A et al. One-stop clinic for assessment of risk for trisomy 21 at 11–14 weeks: a prospective study of 15 030 pregnancies. Ultrasound Obstet Gynecol 2002; 20: 219-225
• 21 Philip J, Silver RK, Wilson RD et al. Late first-trimester invasive prenatal diagnosis: results of an international randomized trial. Obstet Gynecol 2004; 103: 1164-1173
• 22 Grobman WA, Auger M, Shulman LP et al. The association between chorionic villus sampling and preeclampsia. Prenat Diagn 2009; 29: 800-803
• 23 Khalil A, Akolekar R, Pandya P et al. Chorionic villus sampling at 11 to 13 weeks of gestation and hypertensive disorders in pregnancy. Obstet Gynecol 2010; 116: 374-380
• 24 Odibo AO, Singla A, Gray DL et al. Is chorionic villus sampling associated with hypertensive disorders of pregnancy?. Prenat Diagn 2010; 30: 9-13
• 25 Alfirevic Z, Sundberg K, Brigham S. Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database Syst Rev 2003; 3: CD003252
• 26 Chueh JT, Goldberg JD, Wohlferd MM et al. Comparison of transcervical and transabdominal chorionic villus sampling loss rates in nine thousand cases from a single center. Am J Obstet Gynecol 1995; 173: 1277-1282
• 27 Mujezinovic F, Alfirevic Z. Procedure-related complications of amniocentesis and chorionic villous sampling: a systematic review. Obstet Gynecol 2007; 110: 687-694
• 28 Tabor A, Alfirevic Z. Update on procedure-related risks for prenatal diagnosis techniques. Fetal Diagn Ther 2010; 27: 1-7
• 29 Alfirevic Z. Who should be allowed to perform amniocentesis and chorionic villus sampling?. Ultrasound Obstet Gynecol 2009; 34: 12-13
• 30 Agarwal K, Alfirevic Z. Pregnancy Loss after Chorionic Villus Sampling and Genetic Amniocentesis in Twin Pregnancies – a Systematic Review. Ultrasound Obstet Gynecol 2011; DOI: 10.1002/uog.10152.