Outcome After Second-Trimester Amniocentesis and First-Trimester Chorionic Villus Sampling for Prenatal Diagnosis in Multiple Gestations

Abstract

Purpose: The purpose of this study was to classify pregnancy loss and fetal loss as well as the influence of maternal risk factors in multiple pregnancies.

Methods and Materials: Details of the procedure and pregnancy outcome of all patients were extracted from the clinical audit database of two tertiary centers. The files were collected in the time from January 1993 to May 2011. The procedure-related pregnancy and fetal loss rate was classified as all unplanned abortions without important fetal abnormalities or obstetric complications within 14 days after AC and CVS.

Results: We had a total number of 288 multiple pregnancies with a total of 637 fetuses. After the exclusion of 112 pregnancies with abnormal karyotype or fetal abnormalities detected by ultrasound as well as cases of selective feticide, repeated invasive procedures and monochorionic-monoamniotic pregnancies, 176 pregnancies and 380 fetuses were left for final analysis. Overall 132 amniocenteses and 44 chorionic villous sampling procedures were performed. The total pregnancy loss rate was 8.0 % (14/176), 6.1 % (n = 8) for amniocentesis and 13.6 % (n = 6) for CVS. The procedure-related pregnancy loss rate was 3.4 %, 2.3 % after amniocentesis (3 cases) and 6.8 % after CVS (3 cases). There was no statistical significance between the two procedures (p = 0.15).

Conclusion: The procedure-related loss rate of 3.4 % can be compared to the rates in the literature. The higher loss rates in multiple pregnancies than in singleton pregnancies have to be discussed when counseling parents.

Zusammenfassung

Ziel: Bestimmung der eingriffsbedingten Schwangerschaft- und der fetalen Verlustrate nach Amniozentese (AC) und Chorionzottenbiopsie (CVS) sowie assoziierter Risikofaktoren bei Mehrlingsschwangerschaften.

Material und Methoden: Retrospektive Analyse aller Mehrlingsschwangerschaften, die eine invasive Diagnostik in 2 Tertiärzentren zwischen Januar 1993 und Mai 2011 erhielten. Schwangerschaftsverlust innerhalb von 2 Wochen nach invasiver Diagnostik wurde als eingriffsbedingt definiert.

Ergebnisse: Die Analyse umfasste 288 Mehrlingsschwangerschaften mit 637 Feten. Nach Ausschluss von 112 Schwangerschaften mit abnormalem Karyotyp, fetalen Fehlbildungen, monochorial-monamniote Schwangerschaften, Mehrfachpunktionen sowie Schwangerschaften mit selektivem Fetozid eines oder mehrerer Feten wurden 176 Schwangerschaften mit 380 Feten untersucht. Insgesamt wurden 132 Amniozentesen und 44 Chorionzottenbiopsien durchgeführt. Die totale Schwangerschaft-Verlustrate lag bei 8,0 %. Die eingriffsbedingte Schwangerschaft-Verlustrate betrug 3,4 %, 2,3 % für AC und 6,8 % für CVS. Die totale fetale Verlustrate betrug 6,0 %. Die eingriffsbedingte fetale Verlustrate lag bei 2,1 %, 1,4 % für AC und 4,0 % für CVS. Zwischen den beiden Verfahren zeigte sich keine Signifikanz (p = 0,15).

Schlussfolgerung: Die eingriffsbedingte Schwangerschaft-Verlustrate ist mit 3,4 % vergleichbar mit in der Literatur angegebenen Verlustraten. Die gegenüber Einlingsgraviditäten erhöhte fetale Verlustrate bei Mehrlingsschwangerschaften muss im Rahmen des elterlichen Aufklärungsgesprächs thematisiert werden.

Key words

pregnancy loss rate - fetal loss rate - chorionic villus sampling - amniocentesis

• References

• 1 Kogan MD, Alexander GR, Kotelchuck M et al. Trends in twin birth outcomes and prenatal care utilization in the United States, 1981-1997. JAMA 2000; 284: 335-341
• 2 Russell RB, Petrini JR, Damus K et al. The changing epidemiology of multiple births in the United States. Obstet Gynecol 2003; 101: 129-135
• 3 Powers WF, Kiely JL. The risks confronting twins: a national perspective. Am J Obstet Gynecol 1994; 170: 456-461
• 4 Derom R, Vlietinck R, Derom C et al. Perinatal mortality in the East Flanders Prospective Twin Survey (preliminary results). Eur J Obstet Gynecol Reprod Biol 1991; 41: 25-26
• 5 Wapner RJ. Genetic diagnosis in multiple pregnancies. Semin Perinatol 1995; 19: 351-362
• 6 Jenkins TM, Wapner RJ. The challenge of prenatal diagnosis in twin pregnancies. Curr Opin Obstet Gynecol. 2000; 12: 87-92
• 7 Tabor A, Alfirevic Z. Update on procedure-related risks for prenatal diagnosis techniques. Fetal Diagn Ther 2010; 27: 1-7
• 8 Mujezinovic F, Alfirevic Z. Procedure-related complications of amniocentesis and chorionic villous sampling: a systematic review. Obstet Gynecol 2007; 110: 687-694
• 9 Alfirevic Z, Sundberg K, Brigham S. Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database Syst Rev 2003; CD003252
• 10 Tabor A, Philip J, Madsen M et al. Randomised controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet 1986; 1: 1287-1293
• 11 Kozlowski P, Knippel A, Stressig R. Individual risk of fetal loss following routine second trimester amniocentesis: a controlled study of 20,460 cases. Ultraschall in Med 2008; 29 (2) 165-172
• 12 Enzensberger C, Pulvermacher C, Degenhardt J et al. Fetal Loss Rate and Associated Risk Factors After Amniocentesis, Chorionic Villus Sampling and Fetal Blood Sampling. Ultraschall in Med 2012; 33 (7) E75-E79
• 13 De Catte L, Liebaers I, Foulon W. Outcome of twin gestations after first trimester chorionic villus sampling. Obstet Gynecol 2000; 96: 714-720
• 14 Yukobowich E, Anteby EY, Cohen SM et al. Risk of fetal loss in twin pregnancies undergoing second trimester amniocentesis (1). Obstet Gynecol 2001; 98: 231-234
• 15 Millaire M, Bujold E, Morency AM et al. Mid-trimester genetic amniocentesis in twin pregnancy and the risk of fetal loss. J Obstet Gynaecol Can 2006; 28: 512-518 Erratum in: J Obstet Gynaecol Can 2006; 28: 677
• 16 Weisz B, Rodeck CH. Invasive diagnostic procedures in twin pregnancies. Prenat Diagn 2005; 25: 751-758
• 17 Supadilokluck S, Tongprasert F, Tongsong T et al. Amniocentesis in twin pregnancies. Arch Gynecol Obstet 2009; 280: 207-209
• 18 Cahill AG, Macones GA, Stamilio DM et al. Pregnancy loss rate after mid-trimester amniocentesis in twin pregnancies. Am J Obstet Gynecol 2009; 200: 257.e1-257.e6
• 19 Simonazzi G, Curti A, Farina A et al. Amniocentesis and chorionic villus sampling in twin gestations: which is the best sampling technique?. Am J Obstet Gynecol 2010; 202: 365.e1-365.e5
• 20 Aytoz A, De Catte L, Camus M et al. Obstetric outcome after prenatal diagnosis in pregnancies obtained after intracytoplasmic sperm injection. Hum Reprod 1998; 13: 2958-2961
• 21 Pergament E, Schulman JD, Copeland K et al. The risk and efficacy of chorionic villus sampling in multiple gestations. Prenat Diagn. 1992; 12: 377-384
• 22 Ko TM, Tseng LH, Hwa HL. Second-trimester genetic amniocentesis in twin pregnancy. Int J Gynaecol Obstet 1998; 61: 285-287
• 23 Pruggmayer MR, Jahoda MG, Van der Pol JG et al. Genetic amniocentesis in twin pregnancies: results of a multicenter study of 529 cases. Ultrasound Obstet Gynecol 1992; 2: 6-10
• 24 Hanprasertpong T, Kor-anantakul O, Prasartwanakit V et al. Outcome of second trimester amniocentesis in singleton pregnancy at Songklanagarind Hospital. J Med Assoc Thai 2011; 94: 1288-1292
• 25 Daskalakis G, Anastasakis E, Papantoniou N et al. Second trimester amniocentesis in assisted conception versus spontaneously conceived twins. Fertil Steril 2009; 91: 2572-2577
• 26 Ghidini A, Lynch L, Hicks C et al. The risk of second-trimester amniocentesis in twin gestations: a case-control study. Am J Obstet Gynecol 1993; 169: 1013-1016
• 27 Buscaglia M, Ghisoni L, Bellotti M et al. Genetic amniocentesis in biamniotic twin pregnancies by a single transabdominal insertion of the needle. Prenat Diagn 1995; 15: 17-19
• 28 Antsaklis A, Gougoulakis A, Mesogitis S et al. Invasive techniques for fetal diagnosis in multiple pregnancy. Int J Gynaecol Obstet 1991; 34: 309-314
• 29 Antsaklis A, Souka AP, Daskalakis G et al. Second-trimester amniocentesis vs chorionic villus sampling for prenatal diagnosis in multiple gestations. Ultrasound Obstet Gynecol 2002; 20: 476-481
• 30 Antsaklis A, Papantoniou N, Xygakis A et al. Genetic amniocentesis in women 20-34 years old: associated risks. Prenat Diagn 2000; 20: 247-250
• 31 Kollmann M, Haeusler M, Haas J et al. Procedure-Related Complications after Genetic Amniocentesis and Chorionic Villus Sampling. Ultraschall in Med 2012; DOI: 1.1055/s-0032-1312939.
• 32 Sperling L, Kiil C, Larsen LU et al. Naturally conceived twins with monochorionic placentation have the highest risk of fetal loss. Ultrasound Obstet Gynecol 2006; 28: 644-652
• 33 Yaron Y, Bryant-Greenwood PK, Dave N et al. Multifetal pregnancy reductions of triplets to twins: comparison with nonreduced triplets and twins. Am J Obstet Gynecol 1999; 180: 1268-1271
• 34 Agarwal K, Alfirevic Z. Pregnancy loss after chorionic villus sampling and genetic amniocentesis in twin pregnancies: a systematic review. Ultrasound Obstet Gynecol 2012; 40: 128-134
• 35 NICHD. National Registry for amniocentesis study group: midtrimester amniocentesis for prenatal diagnosis: safety and accuracy. JAMA 1976; 236: 1471-1476
• 36 Marthin T, Liedgren S, Hammar M. Transplacental needle passage and other risk-factors associated with second trimester amniocentesis. Acta Obstet Gynecol Scand. 1997; 76: 728-732
• 37 Ekelund CK, Jørgensen FS, Petersen OB. Danish Fetal Medicine Research Group et al. Impact of a new national screening policy for Down’s syndrome in Denmark: population based cohort study. BMJ 2008; 337 a2547 DOI: 10.1136/bmj.a2547.
• 38 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
• 39 Tabor A, Vestergaard CH, Lidegaard Ø. Fetal loss rate after chorionic villus sampling and amniocentesis: an 11-year national registry study. Ultrasound Obstet Gynecol 2009; 34: 19-24
• 40 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