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

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