Comparisons of pregnancy outcomes between twin pregnancies with and without second‐trimester amniocentesis

Abstract

Objective To assess the amniocentesis‐related pregnancy loss rate and preterm birth rate among twin pregnancies undergoing amniocentesis. Methods A retrospective cohort study was conducted at a tertiary center. The study group included twin pregnancies undergoing amniocentesis during 16 to 22 weeks of gestation. The control group was those not undergoing amniocentesis. All amniocenteses were performed by the MFM specialists. The main outcomes were the rate of pregnancy loss (before 24 weeks) and preterm birth. Results A total of 332 cases in the study group and 1188 controls were analyzed. The percentages of maternal age ≥35 years, high parity, and cases complicated with medical diseases were significantly higher in the study group. The pregnancy loss rate after the procedure tended to be higher, but not significant, in the study group (3.0% vs 2.2% P = .383). Likewise, the rate of preterm birth in the study group was higher, but not significant (70.5% vs 66.0% P = .130). Logistic regression analysis to adjust confounding factors showed no significance of amniocentesis on pregnancy loss and preterm birth. Conclusion Though amniocentesis in twin pregnancies has theoretical risk of pregnancy loss, it is relatively safe when performed by maternal–fetal medicine specialists. This information is useful for counseling, especially when performed by experienced hands.

Pregnancy Loss After Amniocentesis with Double-Needle Insertions in Twin Pregnancies

“…Only abnormal ultrasound findings were associated with increased risk, similar to that reported by Cahill et al (2009). Likewise, some other studies also reported that advanced maternal age, parity, conception mode and chorionicity did not influence pregnancy loss after amniocentesis (Cahill et al, 2009;Chen et al, 2020;Daskalakis et al, 2009;Dechnunthapiphat et al, 2020;Lenis-Cordoba et al, 2013). To the authors' knowledge, there are no earlier reports on cervical length as a risk factor in twin pregnancies after amniocentesis.…”

“…In the recent meta-analysis, the pooled rates of fetal loss in twin pregnancies after amniocentesis within 4 weeks and before 24 weeks' gestation were 45/1932 (2.1%, 95% CI [1.5, 2.9]) and 59/2439 (2.1%, 95% CI [1.4, 2.9]), respectively (Di Mascio et al, 2020). A more recent study of twin pregnancies not in the meta-analysis included 332 twin pregnancies undergoing amniocentesis, and the pregnancy loss rate before 24 weeks was 3.0% (Dechnunthapiphat et al, 2020). Chen et al (2020) reported that the pregnancy loss rate before 28 weeks in 418 twin pregnancies was 1.91%.…”

“…Pregnancy loss within 4 weeks after amniocentesis was stratified by advanced maternal age, conception mode, BMI, parity, chorionicity, placental position, cervical length and ultrasound results. We also estimated pregnancy loss rate before 24 weeks' gestation that underwent amniocentesis before 22 weeks' gestation as most published studies did (Antsaklis, 2002;Cahill et al, 2009;Daskalakis et al, 2009;Dechnunthapiphat et al, 2020;Kalogiannidis et al, 2011;Kan et al, 2012;Kim et al, 2019;Lenis-Cordoba et al, 2013;Millaire et al, 2006;Simonazzi et al, 2010;Toth-Pal et al, 2004) to help compare results. Follow-ups of pregnancy outcomes were informed by electronic medical records or by phone calls.…”

“…In the Cochrane database, the spontaneous miscarriage rate after amniocentesis in singleton gestations spans between 0.13% and 0.33%, while there are no data for twin gestations (Alfirevic et al, 2017). The risk of pregnancy loss in twin gestations reported in the last 20 years varies from 0% to 4.2% (Antsaklis et al, 2002;Cahill et al, 2009;Chen et al, 2020;Daskalakis et al, 2009;Dechnunthapiphat et al, 2020;Kalogiannidis et al, 2011;Kan et al, 2012;Kim et al, 2019;Krispin et al, 2019;Lenis-Cordoba et al, 2013;Millaire et al, 2006;Simonazzi et al, 2010;Sperling et al, 2019;Supadilokluck et al, 2009;Toth-Pal et al, 2004;Yukobowich et al, 2001). One recent systematic review demonstrated that the pooled pregnancy loss rate before 24 weeks and within 4 weeks after the amniocentesis procedure in twin pregnancies were 2.1% and 2.1%, respectively, which were as high as the background risk in twin pregnancy without undergoing the procedure (Di Mascio et al, 2020).…”

Foetal loss after chorionic villus sampling and amniocentesis in twin pregnancies: A multicentre retrospective cohort study

“…Since the most recent systematic review of procedure‐related loss in twin pregnancies, two further observational datasets have been published 5,15 . Dechnunthapiphat et al.…”