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Acta Obstetricia Et Gynecologica... May 2023The global sequence of the pathogenesis of preterm labor remains unclear. This study aimed to compare amniotic fluid concentrations of extracellular matrix-related... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
The global sequence of the pathogenesis of preterm labor remains unclear. This study aimed to compare amniotic fluid concentrations of extracellular matrix-related proteins (procollagen, osteopontin and IL-33), and of cytokines (IL-19, IL-6, IL-20, TNFα, TGFβ, and IL-1β) in asymptomatic women with and without subsequent spontaneous preterm delivery.
MATERIAL AND METHODS
We used amniotic fluid samples of singleton pregnancy, collected by amniocentesis between 16 and 20 weeks' gestation, without stigmata of infection (i.e., all amniotic fluid samples were tested with broad-range 16 S rDNA PCR to distinguish samples with evidence of past bacterial infection from sterile ones), during a randomized, double-blind, placebo-controlled trial to perform a nested case-control laboratory study. Cases were women with a spontaneous delivery before 37 weeks of gestation (preterm group). Controls were women who gave birth at or after 39 weeks (full term group). Amniotic fluid concentrations of the extracellular matrix-related proteins and cytokines measured by immunoassays were compared for two study groups.
CLINICALTRIALS
gov: NCT00718705.
RESULTS
Between July 2008 and July 2011, in 12 maternal-fetal medicine centers in France, 166 women with available PCR-negative amniotic fluid samples were retained for the analysis. Concentrations of procollagen, osteopontin, IL-19, IL-6, IL-20, IL-33, TNFα, TGFβ, and IL-1β were compared between the 37 who gave birth preterm and the 129 women with full-term delivery. Amniotic fluid levels of procollagen, osteopontin, IL-19, IL-33, and TNFα were significantly higher in the preterm than the full-term group. IL-6, IL-20, TGFβ, and IL-1β levels did not differ between the groups.
CONCLUSIONS
In amniotic fluid 16 S rDNA PCR negative samples obtained during second-trimester amniocentesis, extracellular matrix-related protein concentrations (procollagen, osteopontin and IL-33), together with IL-19 and TNFα, were observed higher at this time in cases of later spontaneous preterm birth.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Male; Premature Birth; Amniotic Fluid; Pregnancy Trimester, Second; Tumor Necrosis Factor-alpha; Osteopontin; Interleukin-33; Interleukin-6; Procollagen; Amniocentesis; Cytokines; Transforming Growth Factor beta
PubMed: 36918342
DOI: 10.1111/aogs.14544 -
Journal of Clinical Medicine Jan 2023A fetus identified to be at risk for chromosomal abnormalities may benefit from identification of genetic defects through amniocentesis. Although the risks associated...
UNLABELLED
A fetus identified to be at risk for chromosomal abnormalities may benefit from identification of genetic defects through amniocentesis. Although the risks associated with amniocentesis are considered to be minimal, being an invasive procedure it is not completely without complications.
BACKGROUND AND OBJECTIVES
The current study aims to identify correlations between blood contamination of samples collected during amniocentesis and certain factors dependent on the instruments used (thickness of the needle used to aspirate the fluid), the location of the placenta, and uterine vascularity (more pronounced in multiparous patients).
MATERIALS AND METHODS
The study included 190 patients in the second trimester of pregnancy who met one of the criteria for invasive prenatal diagnosis (age over 35 years, high risk in first trimester screening, history of pregnancies with genetic abnormalities, etc.). The amniotic fluid samples collected from these patients were analyzed in terms of blood contamination of the amniotic fluid aspirated with maternal cells Results: Of the patients in whom the procedure was performed using 21 G size needles, 16 samples (13.33% of the total) were contaminated. None of the samples collected from patients where a 20 G needle was used were contaminated. There was a statistically significant association between the lack of contamination and the use of Doppler ultrasound in multiparous patients with anterior placenta in whom a 21-gauge needle was used for amniocentesis.
CONCLUSIONS
There is an increased rate of sample contamination (statistically significant) when using 21 G needle sizes and a significant difference in contamination between primiparous and multiparous patients, with contamination being more frequent in multiparous patients. The use of Doppler ultrasonography may benefit the procedure, as the contamination rate was significantly reduced when used during amniocentesis.
PubMed: 36675383
DOI: 10.3390/jcm12020454 -
Medicina (Kaunas, Lithuania) Oct 2022Sophisticated screening protocols for genetic abnormalities constitute an important component of current prenatal care, aiming to identify high-risk pregnancies and... (Review)
Review
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.
Topics: Pregnancy; Humans; Female; Chorionic Villi Sampling; Amniocentesis; Aneuploidy; Prenatal Diagnosis; Maternal Age
PubMed: 36295632
DOI: 10.3390/medicina58101472 -
Prenatal Diagnosis Jan 2021We aimed to assess the diagnostic yield of ultrasonography in the identification of the etiology of hydramnios, and the added value of MRI or amniocentesis.
INTRODUCTION
We aimed to assess the diagnostic yield of ultrasonography in the identification of the etiology of hydramnios, and the added value of MRI or amniocentesis.
METHODS
We conducted a single-center retrospective study including pregnancies with confirmed hydramnios (defined as deepest pocket ≥8 cm) between January 2013 and May 2017. Twin pregnancies, secondary hydramnios discovered after the diagnosis of a causal pathology, and pregnancies of unknown outcome were excluded. All pregnancies underwent a targeted scan, and selected cases underwent MRI or amniocentesis.
RESULTS
A total of 158 patients with confirmed hydramnios were included. Hydramnios was associated with a fetal pathology in 37 cases (23.4%), with diabetes in 39 (24.6%), isolated macrosomia in 16 (10.1%), and considered idiopathic in 66 (41.7%). Ultrasonography established a diagnosis of the underlying pathology in 73% of cases. Amniocentesis was done in 31 cases (20%) and it allowed diagnosis of chromosome anomalies, esophageal atresia, myotonic dystrophy congenital type, Prader-Willi syndrome, and Bartter syndrome. MRI was done in 15 cases (10%) and it allowed one additional diagnosis of esophageal atresia. The diagnostic yields of MRI and amniocentesis were 91.7% and 95.2%, respectively. There were five false positive diagnoses at ultrasonography, and one false positive diagnosis at MRI.
CONCLUSION
Hydramnios can be associated with a wide variety of underlying pathologies. Diagnostic ultrasound can attain a diagnosis in the majority of cases. Amniocentesis offers a valuable complementary assessment.
Topics: Adult; Amniocentesis; Diabetes, Gestational; Female; Humans; Polyhydramnios; Pregnancy; Pregnancy in Diabetics; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 32920845
DOI: 10.1002/pd.5825 -
Annals of Medicine Feb 2017To determine the value of early- or mid-trimester amniotic fluid levels of interleukin-6 (IL-6), matrix metalloproteinase-8 (MMP-8), and glucose for predicting preterm... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the value of early- or mid-trimester amniotic fluid levels of interleukin-6 (IL-6), matrix metalloproteinase-8 (MMP-8), and glucose for predicting preterm delivery.
METHODS
Randomized controlled trials and two-arm prospective, retrospective, cohorts, and case-controlled studies in which patients received early- or mid-trimester amniocentesis for karyotyping, and biomarker testing of the amniotic fluid was performed and delivery data were available were included in the analysis.
RESULTS
Outcome measures were the associations of amniotic fluid IL-6, MMP-8, and glucose levels with preterm delivery. Differences in means with 95% confidence intervals (CIs) were calculated. Of 288 articles identified, 14 were included in the meta-analysis with a total of 675 patients who had preterm birth and 2518 patients who had term births. The preterm-delivery group had significantly higher amniotic fluid IL-6 and MMP-8 levels, and a significantly lower glucose level than the term delivery group (IL-6: difference in means = 0.32, 95% CI: 0.22-0.43, p < 0.001; MMP-8: difference in means = 4.47, 95% CI: 0.83-8.11), p = 0.016; glucose: difference in means = -5.22, 95% CI: -8.19 to -2.26, p = 0.001) Conclusion: Early- or mid-trimester amniotic fluid IL-6, MMP-8, and glucose levels are useful for predicting the risk of preterm delivery. KEY MESSAGES Median amniotic fluid ferritin and IL-6 levels, and mean amniotic fluid ALP levels were higher in the preterm group. The preterm-delivery group had significantly higher amniotic fluid IL-6 and MMP-8 levels, and a significantly lower glucose level than the term-delivery group.
Topics: Adult; Amniocentesis; Amniotic Fluid; Biomarkers; Case-Control Studies; Female; Gestational Age; Glucose; Humans; Infant, Newborn; Interleukin-6; Matrix Metalloproteinase 8; Outcome Assessment, Health Care; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Pregnancy Trimesters; Premature Birth; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies
PubMed: 27494609
DOI: 10.1080/07853890.2016.1211789 -
Taiwanese Journal of Obstetrics &... Jul 2021This study aimed to compare the risks of amniocentesis between anteriorly located placentas and placentas in other locations and assess the factors that cause... (Comparative Study)
Comparative Study
OBJECTIVE
This study aimed to compare the risks of amniocentesis between anteriorly located placentas and placentas in other locations and assess the factors that cause procedure-related complications.
MATERIALS AND METHODS
We prospectively studied women with singleton pregnancies who underwent amniocentesis between 2014 and 2020. The amniocentesis puncture sites were determined using ultrasonography. Women were classified into two groups according to their placental location. Medical records were retrospectively reviewed and characteristics and complications were compared between the groups of patients with different placental locations.
RESULTS
During the study period, 629 women underwent amniocentesis. Three cases (0.5%) of premature rupture of membranes and one case (0.3%) of fetal loss within four weeks of amniocentesis were found. Puncture failure was observed in 14 cases (2.2%). Puncture failure included procedures with failure to obtain an adequate sample and procedures requiring more than three needle insertions. There was no significant difference in the frequency of puncture failure between the two groups. Logistic regression analysis revealed that uterine myoma (odds ratio [OR] 11.92; 95% CI, 3.04-45.17) and tenting membrane (OR 33.57; 95% CI, 6.45-178.41) were associated with puncture failure.
CONCLUSION
Anteriorly located placenta is not a risk factor for amniocentesis-related adverse outcomes. Instead, puncture failure frequently occurs in case of uterine myoma and tenting membrane. If puncture failure occurs, or if the puncture is difficult to perform, then the procedure should be considered technically difficult and postponed until it can be more easily performed.
Topics: Abortion, Spontaneous; Adult; Amniocentesis; Female; Fetal Membranes, Premature Rupture; Humans; Leiomyoma; Logistic Models; Odds Ratio; Placenta; Placenta Diseases; Pregnancy; Pregnancy Complications, Neoplastic; Prospective Studies; Retrospective Studies; Risk Factors; Uterine Neoplasms
PubMed: 34247808
DOI: 10.1016/j.tjog.2021.05.018 -
The Cochrane Database of Systematic... Oct 2014Fetal assessment following preterm prelabour rupture of membranes (PPROM) may result in earlier delivery due to earlier detection of fetal compromise. However, early... (Review)
Review
BACKGROUND
Fetal assessment following preterm prelabour rupture of membranes (PPROM) may result in earlier delivery due to earlier detection of fetal compromise. However, early delivery may not always be in the fetal or maternal interest, and the effectiveness of different fetal assessment methods in improving neonatal and maternal outcomes is uncertain.
OBJECTIVES
To study the effectiveness of fetal assessment methods for improving neonatal and maternal outcomes in PPROM. Examples of fetal assessment methods that would be eligible for inclusion in this review include fetal cardiotocography, fetal movement counting and Doppler ultrasound.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2014) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised controlled trials comparing any fetal assessment methods, or comparing one fetal assessment method to no assessment.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion into the review. The same two review authors independently assessed trial quality and independently extracted data. Data were checked for accuracy.
MAIN RESULTS
We included three studies involving 275 women (data reported for 271) with PPROM at up to 34 weeks' gestation. All three studies were conducted in the United States. Each study investigated different methods of fetal assessment. One study compared weekly endovaginal ultrasound scans with no assessment (n = 93), one compared amniocentesis with no assessment (n = 47), and one compared daily nonstress testing with daily modified biophysical profiling (n = 135). We were unable to perform a meta-analysis, but were able to report data from individual studies.There was no convincing evidence of increased risk of neonatal death in the group receiving endovaginal ultrasound scans compared with the group receiving no assessment (risk ratio (RR) 7.30, 95% confidence interval (CI) 0.39 to 137.54; one study, 92 women), or in the group receiving amniocentesis compared with the group receiving no amniocentesis (RR 1.00, 95% CI 0.07 to 15.00; one study, 44 women). For both these interventions, we inferred that there were no fetal deaths in the intervention or control groups. The study comparing daily nonstress testing with daily modified biophysical profiling did not report fetal or neonatal death. Primary outcomes of maternal death and serious maternal morbidity were not reported in any study. Overall, there were few statistically significant differences in outcomes between the comparisons.The overall quality of evidence is poor, because participant blinding was not possible for any study.
AUTHORS' CONCLUSIONS
There is insufficient evidence on the benefits and harms of fetal assessment methods for improving neonatal and maternal outcomes in women with PPROM to draw firm conclusions. The overall quality of evidence that does exist is poor.Further high-quality randomised controlled trials are required to guide clinical practice.
Topics: Amniocentesis; Female; Fetal Membranes, Premature Rupture; Fetal Monitoring; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic; Ultrasonography, Prenatal
PubMed: 25279580
DOI: 10.1002/14651858.CD010209.pub2 -
BMJ Open May 2019Invasive prenatal procedures (IPP) are core competencies in a Maternal-Fetal Medicine (MFM) fellowship training programme yet no standardised competency-based curriculum... (Review)
Review
INTRODUCTION
Invasive prenatal procedures (IPP) are core competencies in a Maternal-Fetal Medicine (MFM) fellowship training programme yet no standardised competency-based curriculum exists. This scoping review aims to provide a comprehensive understanding of the existing educational strategies for amniocentesis, chorionic villus sampling, fetal blood sampling and intrauterine blood transfusion. The objective is also to describe current gaps in the literature regarding evidence-based standards for training and assessment in IPP. Finally, we hope to encourage medical educators who are seeking to develop curricula based on competence by design to foster adaptive expertise through incorporating contextual variations in their teaching thus helping future MFM specialists to handle challenges and respond creatively to changing clinical circumstances and environmental variations.
METHODS AND ANALYSIS
Using the five-stage framework of Arksey and O'Malley's scoping review methodology as a guide, we will perform a systematic search in the Medline, Embase and Cochrane library databases to identify relevant studies on the educational strategies for IPP. We will include relevant English articles published after 1978. For a comprehensive search, we will explore websites and key journals, and hand-searched reference lists of key studies. Key studies are articles deemed relevant according to the specific inclusion and exclusion criteria. We will chart and sort data using a descriptive and thematic analysis approach.
ETHICS AND DISSEMINATION
This review will be the first to examine all forms of pedagogical strategies used in training invasive fetal procedures. As an analysis of pre-existing available data in the literature, this scoping review does not require ethical approval. We anticipate that results will identify research gaps as well as novel ideas for education strategies and assessment. Findings from this study will be disseminated through publication in a peer-reviewed journal, medical education and clinical conferences, and in knowledge translation settings, aiming to improve clinical practice and quality of care.
Topics: Amniocentesis; Blood Specimen Collection; Blood Transfusion, Intrauterine; Chorionic Villi Sampling; Curriculum; Fetal Blood; Humans; Obstetrics; Prenatal Diagnosis; Teaching
PubMed: 31133576
DOI: 10.1136/bmjopen-2018-024629 -
Fetal Diagnosis and Therapy 2020The prevalence of perinatal infection from maternal exposure is increasing. The prevalence of acute maternal infections identifies cytomegalovirus, parvovirus B19,... (Review)
Review
BACKGROUND
The prevalence of perinatal infection from maternal exposure is increasing. The prevalence of acute maternal infections identifies cytomegalovirus, parvovirus B19, toxoplasmosis, and varicella as the most common organisms and in the order of frequency. Maternal informed consent and understanding is required before intrauterine testing for fetal infectious and possible genetic risk assessment.
METHODS
This structured review of the reproductive published literature focuses on the risks of amniocentesis and cordocentesis diagnostic procedure-related fetal loss rates and fetal vertical transmission (VT) rates from published infected pregnant cohorts.
RESULTS
The total postprocedure fetal loss rate for diagnostic amniocentesis procedures, in limited infectious cohorts, is 1.5% and does not appear to be increased compared to "noninfected" amniocentesis cohorts using an estimated background spontaneous fetal loss rate (no procedure) of 0.65%. The "pooled" unintended fetal loss rate is from small infected population cohorts, but can be used for counseling purposes. Postcordocentesis fetal loss risk, in an infected cohort, is not possible to estimate due to limited data. The "biological spontaneous fetal loss rate" risk with a perinatal infection (positive or negative fetal anomalies) and no diagnostic procedure before 20 weeks of gestation is reviewed. The risk of VT in acute infection cohorts as a result of the intra-amniotic diagnostic procedure is not found to be increased.
CONCLUSION
The unintended "fetal loss" rate after amniocentesis for perinatal infected cohorts is similar to that of noninfected cohorts, but the estimate is based on limited infected cohorts. There was no procedure-based risk of fetal VT in the infected cohorts, but identification of postprocedure maternal bleeding into the amniotic cavity increases the potential risk. Maternal knowledge translation and an informed consent process with risk-benefit maternal/fetal risk counseling are required prior to any diagnostic amniocentesis procedure.
Topics: Amniocentesis; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Prenatal Diagnosis; Risk Factors
PubMed: 32564035
DOI: 10.1159/000508042 -
Archivos Argentinos de Pediatria Dec 2019The aim was to investigate the rates of respiratory and sleep disturbances in infants whose mothers experienced amniocentesis.
OBJECTIVE
The aim was to investigate the rates of respiratory and sleep disturbances in infants whose mothers experienced amniocentesis.
MATERIAL AND METHODS
Infants whose mothers have undergone midterm amniocentesis (between 16 and 20 weeks) and no invasive procedure (controls) were enrolled.
RESULTS
The study analyzed 50 infants whose mothers have undergone amniocentesis (amniocentesis group) and 47 controls. Amniocentesis group had higher incidence of sleep disturbances: 30 cases (60 %), compared with 11 controls (23.4 %) (P = 0.001). In the amniocentesis group there were 7 children (14 %) with asthma, while in the control group, asthma was confirmed in 1 child (2.1 %) (P = 0.032).
CONCLUSION
Our data triggers the hypothesis that associations between midterm amniocentesis, child's asthma and sleep disturbances may exist. These preliminary results reveal the importance of further studies and the need for the analysis of long term effects of invasive testing.
Topics: Adult; Amniocentesis; Asthma; Child, Preschool; Female; Humans; Incidence; Infant, Newborn; Male; Pregnancy; Pregnancy Trimester, Second; Sleep Wake Disorders
PubMed: 31758888
DOI: 10.5546/aap.2019.eng.401