Retrospektive Analyse von 1030 Chorionzottenbiopsien in Linz - Methodik, Risiken und Ergebnisse

Zusammenfassung

Fragestellung

1030 Chorionzottenbiopsien (CVS), die am Department für Pränatalmedizin der Landesfrauenklinik Linz durchgeführt worden waren, wurden einer retrospektiven Analyse unterzogen.

Methoden

Die 1030 Eingriffe - 781 im 1.Trimenon („early CVS“), 249 im 2. + 3. Trimenon („late CVS“) - wurden hinsichtlich Indikationen, Zugangsweg, Anzahl der Aspirationen, Erfolgsraten bei der Gewebsentnahme, Eingriffsrisiko, zytogenetischer bzw. molekulargenetischer Ergebnisse untersucht.

Ergebnisse

Die Abortrate betrug nach CVS im 1.Trimenon 2,4 % - dies ist nur geringfügig höher als die Spontanabortrate in der 10./11. SSW -, nach „late CVS“ 1,2 %. In 96 % war die Gewebsentnahme erfolgreich. Die Rate an pathologischen Befunden lag insgesamt bei 7 %.

Schlussfolgerungen

Die Chorionzottenbiopsie stellt eine sichere und rasche Methode für pränatale Chromosomenanalysen und molekulargenetische Abklärungen dar.

Summary

Objective

The objective of this study was to assess the safety and results of chorionic villous sampling.

Methods

We reviewed the indications, techniques, number of aspirations, success rates in obtaining specimens, risks and cytogenetic and molecular results of 781 early (first trimester) and 249 late (second and third trimester) chorionic villous sampling procedures performed at our institution.

Results

Sampling was successful in 96 % of procedures. The fetal loss rate after early and late chorionic villous sampling was 2.4 % and 1.2 %, respectively. Abnormal results were found in 7 % of tests.

Conclusions

The fetal loss rate after early CVS was only marginally higher than the spontaneous abortion rate in the tenth to eleventh week of pregnancy. Chorionic villous sampling is a safe and prompt technique for prenatal diagnosis.

Schlüsselwörter

Chorionzottenbiopsie - Methodik - Indikationen - Zugangsweg - Erfolgsrate - Risiko - Ergebnisse

Key words

Chorionic villous sampling - Methods - Indications - Success rate - Risks - Results

Literatur

• 1 Andersson J C, Smith A, Trent R J, Boogert A, Ellwood D A. Outcome of 1500 consecutive chorionic villus samplings.  Med J Aust. 1991;  155 (10) 657-661
• 2 Brambati B, Oldrini A. CVS for first-trimester fetal diagnosis.  Contemp Obstet Gynecol. 1985;  94-104
• 3 Brambati B, Tului L, Alberti E. Prenatal diagnosis by chorionic villus sampling.  Eur J Obstet Gynecol Reprod Biol. 1996;  65 (1) 11-16
• 4 Cederholm M, Axelsson O. A prospective comparative study on transabdominal chorionic villus sampling and amniocentesis performed at 10 - 13 week's gestation.  Prenat Diag. 1997;  17 (4) 311-317
• 5 Dumez Y, Dommergues M. Chorionic villi sampling using rigid forceps under ultrasound control.  Contrib Gynecol Obstet. 1986;  15 22-31
• 6 Firth H. Chorion villus sampling and limb deficiency - cause or coincidence?.  Prenat Diagn Dec. 1997;  17 (13) 1313-1330
• 7 Gustavii B. First-trimester chromosomal analysis of chorionic villi obtained by direct vision technique.  Lancet. 1983;  2 507-508
• 8 Hahnemann J M, Vejerslev L O. Accuracy of cytogenetic findings on chorionic villus sampling (CVS) - diagnostic consequences of CVS mosaicism and non-mosaic discrepancy in centres contributing to EUCROMIC 1986 - 1992.  Prenat Diag. 1997;  17 (9) 801-820
• 9 Holzgreve W, Miny P. Improved echogenicity of the catheter for chorionic villi sampling. Fraccaro M, Simoni G, Brambati B First Trimester Fetal Diagnosis. Berlin, Heidelberg, New York, Tokyo; Springer 1985: 63-64
• 10 Holzgreve W, Miny P. Entwicklung eines echogebenden Plastikkatheters. Holzgreve W, Miny P Chorionzottendiagnostik. Weinheim; VCH Verlagsgesellschaft, Edition Medizin 1987: 18-21
• 11 Lippman A, Tomkins D J, Shime J, Hamerton J L. Canadian multicentre randomized clinical trial of chorion villus sampling and amniocentesis.  Prenat Diag. 1992;  12 385-476
• 12 Mastroiacovo P, Tozzi A E, Agosti S, Bocchino G, Bovicelli L, Dalpra L, Carbone L D, Lituania M, Luttichau A, Mantegazza F. Transverse limb reduction defects after chorion villus sampling: a retrospective cohort study. GIDEF - Gruppo Italiano Diagnosi Embrio-Fetali.  Prenat Diagn. 1993;  13 (11) 1051-1056
• 13 Murer-Orlando M, Zahed L, Docherty Z. Prenatal diagnosis of chromosome abnormalities. A comparison of the results of various techniques, with special emphasis on mosaicism.  Genetica. 1990;  83 (1) 61-65
• 14 Nicolaides K H, Brizot M L, Patel F, Snijders R. Comparison of chorion villus sampling and early amniocentesis for karyotyping in 1492 singleton pregnancies.  Fetal Diagn Ther. 1996;  11 (1) 9-15
• 15 Podobnik M, Singer Z, Bulic M, Kukura V, Ciglar S. Transabdominal placental biopsy in the second and third trimester of pregnancy.  J Perinat Med. 1991;  19 (6) 455-463
• 16 Saura R, Longy M, Horovitz J, Grison O, Vergnaud A, Taine L, Maugey B. Risks of transabdominal chorionic villus sampling before the 12th week of amenorrhea.  Prenat Diag. 1990;  10 (7) 461-467
• 17 Smidt-Jensen S, Hahnemann N. Transabdominal fine needle biopsy from chorionic villi in the first trimester.  Prenat Diagn. 1984;  4 163-169
• 18 Sondergaard F. Transcervical chorion villous biopsy for prenatal diagnosis in the first trimester.  Ugeskr Laeger. 1989;  151 (45) 2977-2982
• 19 Stripparo L, Buscaglia M, Longatti L, Ghisoni L, Dambrosio F, Guerneri S, Rosella F, Lituania M, Cordone M, De Biasio P. Genetic amniocentesis: 505 cases performed before the sixteenth week of gestation.  Prenat Diagn. 1990;  10 (6) 359-364
• 20 Sundberg K, Bang J, Smid-Jensen S, Brocks V, Lundsteen C, Parner J, Keiding N, Philip J. Randomized study of risk of fetal loss related to early amniocentesis versus chorion villi sampling.  Lancet. 1997;  350 (9079) 697-703
• 21 Ward R HT, Modell B, Petrou M, Karagözlu F, Douratsos E. Method of sampling chorionic villi in first trimester of pregnancy under guidance of real time ultrasound.  Br Med J. 1983;  286 1542-1544