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Prenatal Diagnosis May 2012Using published data, we sought to determine the amniocentesis-related loss rate in twin gestations. (Review)
Review
OBJECTIVE
Using published data, we sought to determine the amniocentesis-related loss rate in twin gestations.
METHODS
We searched the PUBMED database using keywords "amniocentesis", "twin" and "twins" to identify articles evaluating genetic amniocentesis in twin gestations published from January 1970 to December 2010. Random effects models were used to pool procedure-related loss rates from included studies.
RESULTS
The definition of "loss" varied across the 17 studies identified (Table 1). The pooled procedure-related loss rate at < 24 weeks was 3.5% (95% confidence interval [CI] 2.6-4.7) (Figure 2). Pooled loss rates at < 28 weeks (Figure 4) and to term (Figure 5) could not be calculated due to unacceptable heterogeneity of available data. Seven studies included a control (no amniocentesis) group and reported a pooled odds ratio for total pregnancy loss among cases of 1.8 (95% CI 1.2-2.7) (Figure 3). Only 1 study reported procedure-related loss rates by chorionicity (7.7% among monochorionics vs 1.4% among controls; p 0.02).
CONCLUSION
Analysis of published data demonstrated a pooled amniocentesis-related loss rate of 3.5% in twin gestations < 24 weeks. Pooled loss rates within other post-amniocentesis intervals or other gestational age windows and the impact of chorionicity on procedure-related loss rates cannot be determined from published data.
Topics: Amniocentesis; Female; Humans; Pregnancy; Twins
PubMed: 22028248
DOI: 10.1002/pd.2897 -
The National Medical Journal of India 1992
Topics: Amniocentesis; Clinical Protocols; Female; Humans; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Specimen Handling
PubMed: 1304245
DOI: No ID Found -
Current Opinion in Obstetrics &... Apr 2010To review available data on the technique and education of amniocentesis. (Review)
Review
PURPOSE OF REVIEW
To review available data on the technique and education of amniocentesis.
RECENT FINDINGS
Literature shows many tools facilitating training for amniocentesis. These models can be either bought or hand made. Initial teaching should ideally be part of a specific curriculum. Reports of fetal loss due to amniocentesis differ greatly among authors, varying from 0.13 to 2.2%.
SUMMARY
Developing an adapted curriculum for amniocentesis training is important and emphasizes the usefulness of a standardize technique. Available data on the risks of amniocentesis should help counseling women/couples.
Topics: Amniocentesis; Clinical Competence; Education, Medical, Continuing; Female; Humans; Obstetrics; Pregnancy
PubMed: 20098324
DOI: 10.1097/GCO.0b013e32833723a0 -
Archives of Gynecology and Obstetrics May 2022Third trimester amniocentesis is often performed when indications arise after 24 weeks of gestation-typically to investigate new sonographic findings, and might be...
PURPOSE
Third trimester amniocentesis is often performed when indications arise after 24 weeks of gestation-typically to investigate new sonographic findings, and might be related to pre-term birth. Scarcity of data exists concerning the risks of third-trimester amniocentesis in twin pregnancies.
METHODS
A retrospective cohort study of all twin gestations that underwent amniocentesis in a tertiary hospital between 2007 and 2016. Outcomes and procedure-related complications were compared between third-trimester (≥ 24 weeks) and mid-trimester amniocentesis (16-23 weeks). Primary outcome was defined as membrane rupture within four weeks of procedure. Logistic regression analysis was utilized to adjust results to potential confounders.
RESULTS
Overall, 185 eligible women were included, of them, 28 (15.1%) underwent third-trimester amniocentesis and 157 (84.9%) underwent mid-trimester amniocentesis. Women in the third-trimester amniocentesis group were younger and presented higher frequencies of intra-uterine growth restriction (31.5 vs. 35.3, p < 0.001, and 28% vs. 10% p = 0.015, respectively). The prevalence of membrane rupture within 4 weeks of the procedure was significantly higher in the third-trimester amniocentesis group (31% vs. 1%, p < 0.001). Delivery rates after third-trimester amniocentesis within 1, 2 and 4 weeks of the procedure were 11%, 14.8% and 52%, respectively, versus 0% following mid-trimester amniocentesis (p < 0.001). Gestational age at delivery was similar between the groups (35.7 vs. 36.4 gestational weeks, p = 0.34). In multivariate analysis, gestational age at amniocentesis was found to be an independent risk factor for premature rupture of membranes within 4 weeks of the procedure.
CONCLUSION
Third trimester amniocentesis in twin pregnancies is associated with significantly higher rates of procedure-related membrane rupture compared to mid-trimester amniocentesis.
Topics: Amniocentesis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnancy, Twin; Retrospective Studies
PubMed: 34529104
DOI: 10.1007/s00404-021-06242-0 -
Clinical Obstetrics and Gynecology Dec 1981Amniocentesis is a relatively safe and reliable procedure. However, there probably is a slightly increased risk of fetal loss following amniocentesis (approximately... (Review)
Review
Amniocentesis is a relatively safe and reliable procedure. However, there probably is a slightly increased risk of fetal loss following amniocentesis (approximately 0.5%). Other risks are minimal. Amniocentesis should be performed by obstetrician-gynecologists familiar with both the indications for the technique of second-trimester genetic amniocentesis. Recent social trends, including the increased availability of medical information to the lay public and the interest of many women in delaying childbearing, will increase public demand for antenatal diagnosis. It is important that obstetrician-gynecologists prepare to meet these demands.
Topics: Adult; Amniocentesis; Canada; Female; Fetal Death; Genetic Diseases, Inborn; Humans; Pregnancy; Pregnancy, Multiple; Prenatal Diagnosis; Rh-Hr Blood-Group System; Risk; Ultrasonography; United Kingdom; United States
PubMed: 6800677
DOI: 10.1097/00003081-198112000-00003 -
Prenatal Diagnosis Dec 1995Early amniocentesis at less than 14 weeks gestation is becoming more common in prenatal diagnosis populations. Randomized studies are minimal and have not had the power... (Review)
Review
Early amniocentesis at less than 14 weeks gestation is becoming more common in prenatal diagnosis populations. Randomized studies are minimal and have not had the power to determine the accuracy and safety of the procedure compared to chorionic villus sampling or mid-trimester amniocentesis. Procedures at 11+0-12+6 weeks should be considered experimental. This clinical review considers the ethics, embryology, and clinical experience (cytogenetics, AFP, AChE, procedure and cytogenetic failures, spontaneous and therapeutic pregnancy losses, congenital anomalies) of early amniocentesis.
Topics: Amniocentesis; Biomarkers; Congenital Abnormalities; Cytogenetics; Ethics, Medical; Female; Fetal Diseases; Humans; Pregnancy; Pregnancy Trimester, First; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 8710766
DOI: 10.1002/pd.1970151307 -
American Journal of Perinatology May 2024Approximately, 2% of women who undergo chorionic villi sampling (CVS) will subsequently undergo amniocentesis due to placental mosaicism or sampling/laboratory...
OBJECTIVE
Approximately, 2% of women who undergo chorionic villi sampling (CVS) will subsequently undergo amniocentesis due to placental mosaicism or sampling/laboratory issues. Our objective was to compare obstetric outcomes in women who underwent both procedures with those who had CVS alone.
STUDY DESIGN
Retrospective case-control study of patients with singleton pregnancies undergoing invasive testing from 2010 to 2020 was performed. All women who underwent CVS followed by amniocentesis were compared with a control group who underwent CVS alone matched (2:1) for age and year of pregnancy. Women with pregnancy loss at <16 weeks were excluded from the control group. Pregnancies terminated for genetic abnormalities were excluded. Obstetric outcomes were compared between cases and controls. Student -test and Fisher's exact test were used for statistical comparison.
RESULTS
During the study period 2,539 women underwent CVS, and 66 (2.6%) subsequently underwent amniocentesis. The 66 cases were compared with 132 age-matched controls who underwent CVS alone. Mean maternal age was 36.8 ± 3.4 years, and 43% of women were nulliparous. Amniocentesis was performed due to sampling or laboratory issues in 33% of cases, placental mosaicism in 44%, and further diagnostic testing in 23%. There were no pregnancy losses or stillbirths in either group. Those who had two invasive procedures delivered at similar gestational ages and birthweights and did not have higher rates of adverse outcomes compared with those who underwent CVS alone.
CONCLUSION
Patients considering CVS who are concerned about the possibility that a second invasive procedure could be required should be reassured that this does not appear to be associated with higher rates of adverse outcomes. Due to study size, we cannot exclude the possibility of small differences in uncommon outcomes, such as pregnancy loss or stillbirth.
KEY POINTS
· Amniocentesis may be recommended after CVS due to mosaicism, sampling issues, or further testing.. · Amniocentesis after CVS is not associated with pregnancy loss or other adverse outcomes compared.. · Patients who have both CVS and amniocentesis deliver at similar gestational ages and birthweights..
Topics: Humans; Amniocentesis; Female; Pregnancy; Retrospective Studies; Adult; Chorionic Villi Sampling; Case-Control Studies; Mosaicism; Pregnancy Outcome
PubMed: 35240697
DOI: 10.1055/a-1787-6785 -
Obstetrics and Gynecology Jan 1977
Topics: Amniocentesis; Female; Humans; Pregnancy; Syringes
PubMed: 831162
DOI: No ID Found -
Twin Research and Human Genetics : the... Feb 2022The aim of this study was to determine the pregnancy loss rate of amniocentesis with double-needle insertions in twin pregnancies. This was a retrospective study of twin...
The aim of this study was to determine the pregnancy loss rate of amniocentesis with double-needle insertions in twin pregnancies. This was a retrospective study of twin pregnancies who underwent amniocentesis with double-needle insertion between 2010 and 2019 at a single center. The pregnancy loss rates were recorded as single or double fetal loss before 24 weeks' gestation and within 4 weeks after the procedure. Risk factors for pregnancy loss after amniocentesis were also assessed. A total of 678 twin pregnancies with amniocentesis were finally included. The pregnancy loss rates before 24 weeks' gestation and within 4 weeks after the procedure were 0.9% and 1.9%, respectively. Only one fetal loss was presumed to be a direct result of the procedure. All other cases were complicated by structural or chromosomal anomalies. Twin pregnancies with abnormal ultrasound findings had a significantly higher rate of pregnancy loss with a relative risk of 4.81 (95% CI [1.03, 22.2]). Our study showed a low pregnancy loss rate after amniocentesis in twin pregnancies with double-needle insertions technique of sampling, which can help decision making in prenatal screening and diagnosis for twin pregnancies.
Topics: Abortion, Spontaneous; Amniocentesis; Female; Gestational Age; Humans; Pregnancy; Pregnancy, Twin; Retrospective Studies
PubMed: 35249587
DOI: 10.1017/thg.2022.1 -
The Cochrane Database of Systematic... 2003A major disadvantage of second trimester amniocentesis is that the result is usually available only after 18 weeks' gestation. Chorionic villus sampling (CVS) and early... (Review)
Review
BACKGROUND
A major disadvantage of second trimester amniocentesis is that the result is usually available only after 18 weeks' gestation. Chorionic villus sampling (CVS) and early amniocentesis can be done between 9 and 14 weeks and offer an earlier alternative.
OBJECTIVES
The objective was to assess comparative safety and accuracy of second trimester amniocentesis, early amniocentesis, transcervical and transabdominal CVS.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register (March 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2002).
SELECTION CRITERIA
All randomised trials comparing amniocentesis and CVS.
DATA COLLECTION AND ANALYSIS
Two reviewers assessed eligibility and trial quality and performed data extraction. We analysed the data using RevMan software.
MAIN RESULTS
A total of 14 randomised studies have been included. In a low risk population with a background pregnancy loss of around 2%, a second trimester amniocentesis will increase this risk by another 1%. This difference did not reach statistical significance, but the increase in spontaneous miscarriages following second trimester amniocentesis compared with controls (no amniocentesis) did (2.1% versus 1.3%; relative risk (RR) 1.02 to 2.52). Early amniocentesis is not a safe early alternative to second trimester amniocentesis because of increased pregnancy loss (7.6% versus 5.9%; RR 1.29, 95% CI 1.03 to 1.61) and higher incidence of talipes compared to CVS (1.8% versus 0.2%; RR 6.43, 95% CI 1.68 to 24.64).Compared with second trimester amniocentesis, transcervical CVS carries a significantly higher risk of pregnancy loss (14.5% versus 11%; RR 1.40, 95% CI 1.09 to 1.81) and spontaneous miscarriage (12.9% versus 9.4%; RR 1.50, 95% CI 1.07 to 2.11). One study compared transabdominal CVS with second trimester amniocentesis and found no significant difference in the total pregnancy loss between the two procedures (6.3% versus 7%). Transcervical CVS is more technically demanding than transabdominal CVS with more failures to obtain sample and more multiple insertions.
REVIEWER'S CONCLUSIONS
Second trimester amniocentesis is safer than transcervical CVS and early amniocentesis. If earlier diagnosis is required, transabdominal CVS is preferable to early amniocentesis or transcervical CVS. In circumstances where transabdominal CVS may be technically difficult the preferred options are transcervical CVS in the first trimester or second trimester amniocentesis.
Topics: Amniocentesis; Chorionic Villi Sampling; Congenital Abnormalities; Female; Humans; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Randomized Controlled Trials as Topic
PubMed: 12917956
DOI: 10.1002/14651858.CD003252