An evaluation of the chorionic villus sampling learning curve

Silver, Richard K.; MacGregor, Scott N.; Sholl, John S.; Hobart, Edward D.; Waldee, J. K.

doi:10.1016/0002-9378(90)91096-u

Cited by 31 publications

(14 citation statements)

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“…The importance of a technically skilled operator in the success rate of CVS was also recently addressed in other studies. [14][15][16] The cytogenetic analysis success rate of 99.6% obtained in the first attempt is comparable to other reports. 3 Through repeat CVS of failed samplings, the success rate reached 100%.…”

Section: Discussionsupporting

confidence: 83%

Cytogenetic Evaluation of 1000 Cases of Chorionic Villus Sampling

Ma¹,

Gf²,

Trabin³

et al. 1998

Ann Saudi Med

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Background: Chorionic villus sampling (CVS) is used routinely as a first trimester diagnostic procedure for fetal karyotyping in at-risk pregnancies. The success of the procedure is dependent on the experience of the operator performing it. The objective of this study was to determine the relationship between an operator-controlled clinical and laboratory setting and the safety and reliability of CVS service. Patients and Methods: One thousand patients had a CVS procedure for a variety of indications, such as advanced maternal age, previous child with chromosome abnormality, etc. Both transcervical and transabdominal procedures were performed, according to placental location and uterine environment. For cytogenetic diagnosis, direct and short-term cultures were set up according to standard laboratory protocol. Result: Cytogenetic results were obtained in 99.6% of studies with 94.5% normal (46, XX or 46, XY), with the remaining having a variety of numerical and structural chromosomal abnormalities. Maternal cell contamination was found in 2% of the first 262 cases, while the overall rate observed in the 1000 samples was 0.5%. Level II mosaicism was observed in 0.8% and level III mosaicism observed in 0.9% of cases, respectively. The overall rate of pregnancy loss of chromosomally normal pregnancies within 28 weeks of gestation was 2.8%. No limb reduction defects were seen in any infant post-CVS. Conclusion: Our record demonstrates that experienced operators can deliver a safe and reliable CVS service.

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Section: Discussionsupporting

confidence: 83%

Cytogenetic Evaluation of 1000 Cases of Chorionic Villus Sampling

Ma¹,

Gf²,

Trabin³

et al. 1998

Ann Saudi Med

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show abstract

“…Although our data do not allow conclusions on the exact benefit of prior experience on the learning process for IUT, we do agree with others suggesting that experience with less invasive procedures is indispensable before starting to perform more invasive and therapeutic ultrasound-guided procedures in fetal medicine [6][7][8] .…”

Section: Discussionmentioning

confidence: 40%

“…Generally, successful performance is not only influenced by the operator's skills and experience but also by factors related to the patient as well as to team performance [6,7] . New operators are able to perform diagnostic ultrasound-guided procedures without increase in complications if supervised by a limited number of experienced operators in a high-volume centralized care setting [7,8] .…”

Section: Introductionmentioning

confidence: 99%

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Quality Control for Intravascular Intrauterine Transfusion Using Cumulative Sum (CUSUM) Analysis for the Monitoring of Individual Performance

Lindenburg¹,

Wolterbeek

Oepkes³

et al. 2011

Fetal Diagn Ther

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Introduction: Intravascular intrauterine transfusion (IUT) is an effective and relatively safe method for the treatment of fetal anemia. Although implemented in centers all over the world in the 1980s, the length and strength of the learning curve for this procedure has never been studied. Cumulative sum (CUSUM) analysis has been increasingly used as a graphical and statistical tool for quality control and learning curve assessment in clinical medicine. We aimed to test the feasibility of CUSUM analysis for quality control in fetal therapy by using this method to monitor individual performance of IUT in the learning phase and over the long term. Methods: IUTs performed in the Dutch referral center for fetal therapy from 1987 to 2009 were retrospectively classified as successful or failed. Failed was defined as no net transfusion or the occurrence of life-threatening procedure-related complications. The CUSUM statistical method was used to estimate individual learning curves and to monitor long-term performance. Four operators who each performed at least 200 procedures were included. Results: Individual CUSUM graphs were easily assessed. Both operators pioneering IUT in the late 1980s had long learning phases. The 2 operators learning IUT in later years in an experienced team performed acceptably from the start and reached a level of competence after 34 and 49 procedures. Discussion: CUSUM analysis is a feasible method for quality control in fetal therapy. In an experienced setting, individual competence may be reached after 30 to 50 IUTs. Our data suggest that operators need at least 10 procedures per year to keep a level of competence.

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“…The most recent meta-analysis of studies that included a control group, including 8,899 women who use of small-gauge needles, and ultrasonographic guidance (32)(33)(34). There also is a significant learning curve associated with the safe performance of CVS (35,36), and most published data were collected in experienced, high-volume centers. Procedure-related loss rates may be different among health care providers with less cumulative experience.…”

Section: Chorionic Villus Samplingmentioning

confidence: 99%

Practice Bulletin No. 162

2016

Obstetrics &Amp; Gynecology

241

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Prenatal genetic diagnostic testing is intended to determine, with as much certainty as possible, whether a specific genetic disorder or condition is present in the fetus. In contrast, prenatal genetic screening is designed to assess whether a patient is at increased risk of having a fetus affected by a genetic disorder. Originally, prenatal genetic testing focused primarily on Down syndrome (trisomy 21), but now it is able to detect a broad range of genetic disorders. Although it is necessary to perform amniocentesis or chorionic villus sampling (CVS) to definitively diagnose most genetic disorders, in some circumstances, fetal imaging with ultrasonography, echocardiography, or magnetic resonance imaging may be diagnostic of a particular structural fetal abnormality that is suggestive of an underlying genetic condition.The objective of prenatal genetic testing is to detect health problems that could affect the woman, fetus, or newborn and provide the patient and her obstetrician-gynecologist or other obstetric care provider with enough information to allow a fully informed decision about pregnancy management. Prenatal genetic testing cannot identify all abnormalities or problems in a fetus, and any testing should be focused on the individual patient's risks, reproductive goals, and preferences. It is important that patients understand the benefits and limitations of all prenatal screening and diagnostic testing, including the conditions for which tests are available and the conditions that will not be detected by testing. It also is important that patients realize that there is a broad range of clinical presentations, or phenotypes, for many genetic disorders and that results of genetic testing cannot predict all outcomes. Prenatal genetic testing has many benefits, including reassuring patients when results are normal, identifying disorders for which prenatal treatment may provide benefit, optimizing neonatal outcomes by ensuring the appropriate location for delivery and the necessary personnel to care for affected infants, and allowing the opportunity for pregnancy termination.The purpose of this Practice Bulletin is to review the current status of prenatal genetic diagnostic testing and the evidence supporting its use. For information regarding screening for fetal aneuploidy, refer to Practice Bulletin No. 163, Screening for Fetal Aneuploidy.

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An evaluation of the chorionic villus sampling learning curve

Cited by 31 publications

References 9 publications

Cytogenetic Evaluation of 1000 Cases of Chorionic Villus Sampling

Cytogenetic Evaluation of 1000 Cases of Chorionic Villus Sampling

Quality Control for Intravascular Intrauterine Transfusion Using Cumulative Sum (CUSUM) Analysis for the Monitoring of Individual Performance

Practice Bulletin No. 162

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