Procedure-related fetal losses in transplacental versus nontransplacental genetic amniocentesis

Allan T. Bombard, Judith F. Powers, Suzanne Carter, Alan Schwartz, Harold M. Nitowsky

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

OBJECTIVE: We hypothesize that loss rates after amniocentesis do not differ in transplacentaland nontransplacental taps performed by experienced operators. STUDY DESIGN: Subjects were 1000 women undergoing second-trimester amniocentesis: 745 were referred for maternal age; 132 for positive maternal serum α-fetoprotein screens, 41 indicating a risk for fetal neural tube defect, 91 indicating a risk for fetal chromosome abnormality; and 123 were referred for other reasons. All procedures were videotaped. The placenta was anterior in 518 cases; in 306 of these the needle went through the placenta. All pregnancies were prospectively evaluated through delivery. RESULTS: There were 13 losses among the 1000 procedures (1.3%). The transplacental losses occurred from 4 to 71 days after procedure, median 26.5 days; the nontransplacental losses from 12 days after procedure to term, median 25 days. The loss rate was essentially similar in the two categories: six transplacental (1.96%) and seven nontransplacental 91%) (relative risk 1.52 [95% confidence limits 0.84 to 2.75], p = 0.23). If the three patients with elevated maternal serum α-fetoprotein values were excluded from data analysis, the loss rates in the two groups were virtually identical (relative risk 0.98 [95% confidence limits 0.38 to 2.54], p = 1.0000). CONCLUSION: Transplacental amniocentesis does not appear to increase the fetal loss rate in the hands of experienced surgeons. Moreover, in view of the time span between amniocentesis and loss in both groups, a procedural cause seems questionable.

Original languageEnglish (US)
Pages (from-to)868-872
Number of pages5
JournalAmerican Journal of Obstetrics and Gynecology
Volume172
Issue number3
DOIs
StatePublished - 1995

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Amniocentesis
Fetal Proteins
Placenta
Mothers
Neural Tube Defects
Maternal Age
Second Pregnancy Trimester
Serum
Chromosome Aberrations
Needles
Pregnancy

Keywords

  • Genetic amniocentesis
  • placenta
  • prenatal diagnosis

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Procedure-related fetal losses in transplacental versus nontransplacental genetic amniocentesis. / Bombard, Allan T.; Powers, Judith F.; Carter, Suzanne; Schwartz, Alan; Nitowsky, Harold M.

In: American Journal of Obstetrics and Gynecology, Vol. 172, No. 3, 1995, p. 868-872.

Research output: Contribution to journalArticle

Bombard, Allan T. ; Powers, Judith F. ; Carter, Suzanne ; Schwartz, Alan ; Nitowsky, Harold M. / Procedure-related fetal losses in transplacental versus nontransplacental genetic amniocentesis. In: American Journal of Obstetrics and Gynecology. 1995 ; Vol. 172, No. 3. pp. 868-872.
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abstract = "OBJECTIVE: We hypothesize that loss rates after amniocentesis do not differ in transplacentaland nontransplacental taps performed by experienced operators. STUDY DESIGN: Subjects were 1000 women undergoing second-trimester amniocentesis: 745 were referred for maternal age; 132 for positive maternal serum α-fetoprotein screens, 41 indicating a risk for fetal neural tube defect, 91 indicating a risk for fetal chromosome abnormality; and 123 were referred for other reasons. All procedures were videotaped. The placenta was anterior in 518 cases; in 306 of these the needle went through the placenta. All pregnancies were prospectively evaluated through delivery. RESULTS: There were 13 losses among the 1000 procedures (1.3{\%}). The transplacental losses occurred from 4 to 71 days after procedure, median 26.5 days; the nontransplacental losses from 12 days after procedure to term, median 25 days. The loss rate was essentially similar in the two categories: six transplacental (1.96{\%}) and seven nontransplacental 91{\%}) (relative risk 1.52 [95{\%} confidence limits 0.84 to 2.75], p = 0.23). If the three patients with elevated maternal serum α-fetoprotein values were excluded from data analysis, the loss rates in the two groups were virtually identical (relative risk 0.98 [95{\%} confidence limits 0.38 to 2.54], p = 1.0000). CONCLUSION: Transplacental amniocentesis does not appear to increase the fetal loss rate in the hands of experienced surgeons. Moreover, in view of the time span between amniocentesis and loss in both groups, a procedural cause seems questionable.",
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N2 - OBJECTIVE: We hypothesize that loss rates after amniocentesis do not differ in transplacentaland nontransplacental taps performed by experienced operators. STUDY DESIGN: Subjects were 1000 women undergoing second-trimester amniocentesis: 745 were referred for maternal age; 132 for positive maternal serum α-fetoprotein screens, 41 indicating a risk for fetal neural tube defect, 91 indicating a risk for fetal chromosome abnormality; and 123 were referred for other reasons. All procedures were videotaped. The placenta was anterior in 518 cases; in 306 of these the needle went through the placenta. All pregnancies were prospectively evaluated through delivery. RESULTS: There were 13 losses among the 1000 procedures (1.3%). The transplacental losses occurred from 4 to 71 days after procedure, median 26.5 days; the nontransplacental losses from 12 days after procedure to term, median 25 days. The loss rate was essentially similar in the two categories: six transplacental (1.96%) and seven nontransplacental 91%) (relative risk 1.52 [95% confidence limits 0.84 to 2.75], p = 0.23). If the three patients with elevated maternal serum α-fetoprotein values were excluded from data analysis, the loss rates in the two groups were virtually identical (relative risk 0.98 [95% confidence limits 0.38 to 2.54], p = 1.0000). CONCLUSION: Transplacental amniocentesis does not appear to increase the fetal loss rate in the hands of experienced surgeons. Moreover, in view of the time span between amniocentesis and loss in both groups, a procedural cause seems questionable.

AB - OBJECTIVE: We hypothesize that loss rates after amniocentesis do not differ in transplacentaland nontransplacental taps performed by experienced operators. STUDY DESIGN: Subjects were 1000 women undergoing second-trimester amniocentesis: 745 were referred for maternal age; 132 for positive maternal serum α-fetoprotein screens, 41 indicating a risk for fetal neural tube defect, 91 indicating a risk for fetal chromosome abnormality; and 123 were referred for other reasons. All procedures were videotaped. The placenta was anterior in 518 cases; in 306 of these the needle went through the placenta. All pregnancies were prospectively evaluated through delivery. RESULTS: There were 13 losses among the 1000 procedures (1.3%). The transplacental losses occurred from 4 to 71 days after procedure, median 26.5 days; the nontransplacental losses from 12 days after procedure to term, median 25 days. The loss rate was essentially similar in the two categories: six transplacental (1.96%) and seven nontransplacental 91%) (relative risk 1.52 [95% confidence limits 0.84 to 2.75], p = 0.23). If the three patients with elevated maternal serum α-fetoprotein values were excluded from data analysis, the loss rates in the two groups were virtually identical (relative risk 0.98 [95% confidence limits 0.38 to 2.54], p = 1.0000). CONCLUSION: Transplacental amniocentesis does not appear to increase the fetal loss rate in the hands of experienced surgeons. Moreover, in view of the time span between amniocentesis and loss in both groups, a procedural cause seems questionable.

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