Fetal loss following second trimester amniocentesis. Who is at greater risk? How to counsel pregnant women?

Theodora, Marianna; Antsaklis, Aris; Antsaklis, Panos J.; Blanas, K.; Daskalakis, Georgios; Sindos, Michael; Mesogitis, S.; Papantoniou, Nikolaos

doi:10.3109/14767058.2015.1012061

Cited by 19 publications

(18 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Uterine leiomyomas, uterine scar (after uterine surgery) and pathological placental location are associated with higher hCG concentration. Based on this assumption, in a recent study the presence of uterine leiomyomas was found to increase the number of false‐positive results from Bi‐test and Triple test . The reason for the hCG increase seems to be linked to an impaired maternal–placental circulation due to trophoblast implantation in the uterus with leiomyomas, suggested by the observation of decreased impedance in uterine–placental circulation on US color Doppler in early pregnancy in women with uterine fibroids.…”

Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

Myoma and myomectomy: Poor evidence concern in pregnancy

Milazzo¹,

Catalano²,

Badia³

et al. 2017

J of Obstet and Gynaecol

103

View full text Add to dashboard Cite

Aim: Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. Methods: Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. Results: Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. Conclusions: Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.

show abstract

Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

Myoma and myomectomy: Poor evidence concern in pregnancy

Milazzo¹,

Catalano²,

Badia³

et al. 2017

J of Obstet and Gynaecol

103

View full text Add to dashboard Cite

show abstract

“…Additionally, although controversial, some studies have identified some risk factors for fetal loss after amniocentesis in singleton pregnancies, such as maternal age, perforation of the placenta, vaginal bleeding, previous abortions, and abnormal color of the amniotic fluid 7‐11 . No studies have explored such risk factors in pregnant women with twins.…”

Section: Introductionmentioning

confidence: 99%

Comparison of spontaneous fetal loss rates between women with singleton and twin pregnancies after mid‐trimester amniocentesis ‐ A historical cohort study

et al. 2020

View full text Add to dashboard Cite

Objective To assess and compare fetal loss rates before 28 weeks of singleton and twin pregnancies after mid‐trimester amniocentesis. Method This historic cohort study included 13 773 women with singletons and 426 women with twins undergoing mid‐trimester amniocentesis from 1/2015 to 3/2017. Pregnancies resulting in termination or selective reduction before 28 weeks were excluded, as well as twin gestations undergoing single‐puncture amniocentesis. Fetal loss rates were compared between singleton and twins taking into account maternal characteristics, amniocentesis procedure, and fetal chromosomal abnormalities. Results The rates of fetal chromosomal abnormalities were similar in singleton and twin gestations (1.13% vs 0.70%, P = .253). No difference was found in maternal or fetal characteristics, or amniocentesis procedure between the two groups. The fetal loss rate was significantly higher in twin compared with singleton pregnancies (1.91% vs 0.24%, P < .001, RR = 8.25 [95% CI: 4.51 to 15.09]). The fetal loss rate between monochorionic twins and dichorionic twins was similar (1.80% vs 1.78%, P = 1.000). Conclusions Twin pregnancies have higher risk of fetal loss after mid‐trimester amniocentesis, which cannot be explained by differences in rates of fetal chromosomal abnormalities, maternal characteristic, or amniocentesis technique.

show abstract

“…All publications included were observational cohorts and five enrolled a general obstetric population(Table 1) 15-19 while four were restricted to women undergoing amniocentesis(Table 2). 20-23 Three of the four studies among women undergoing amniocentesis reported leiomyoma presence increased risk of loss after the procedure by an estimated factor between 2.5 and 8.0 (Table 2). Since these studies were limited to special high-risk populations and required participant to have an ongoing pregnancy at the time of procedure, we describe these studies in the qualitative synthesis and exclude them in the quantitative analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Since these studies were limited to special high-risk populations and required participant to have an ongoing pregnancy at the time of procedure, we describe these studies in the qualitative synthesis and exclude them in the quantitative analysis. Five studies were classified as good quality 15, 17, 19, 21, 23 and four as poor quality 16, 18, 20, 22 based on AHRQ standards for quality grading (Appendix 3, available online at http://links.lww.com/xxx). …”

Section: Resultsmentioning

confidence: 99%

Leiomyomas in Pregnancy and Spontaneous Abortion

Sundermann

Edwards

Bray

et al. 2017

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

Structured Summary Objective To systematically review studies reporting risk of spontaneous abortion among pregnant women of typical reproductive potential with and without uterine leiomyomas. Data Sources We searched Pub Med, Embase, Web of Science, and ClinicalTrials.gov for publications from January 1970 to December 2016. Method of Study Selection We excluded studies that did not use imaging to uniformly document leiomyoma status of all participants, did not have a comparison group without leiomyomas, or primarily included women seeking care for recurrent miscarriage, infertility care or assisted reproductive technologies. Tabulation, Integration, and Results Two authors independently reviewed eligibility, extracted data, and assigned overall quality ratings based on predetermined criteria. Of 1,469 articles identified, nine were eligible. Five enrolled general obstetric populations and four included women undergoing amniocentesis. In five studies in general obstetric populations thatincluded21,829 pregnancies (1,394 women with leiomyomas and 20,435 without), only one adjusted for potential confounders. This meta-analysis revealed no increase in risk of spontaneous abortion among those with leiomyomas compared to those without (11.5% compared with 8.0%; Risk Ratio [RR]: 1.16, 95% Confidence Interval [CI]: 0.80 to 1.52). When bias from confounding was estimated for non-adjusted studies, the aggregate calculated risk ratio was 0.83 (95% CI 0.68–0.98). Conclusion Leiomyoma presence was not associated with increased risk of spontaneous abortion in an analysis of more than 20,000pregnant women. Failure of prior studies to adjust for confounders may have led to the common clinical belief that leiomyomas are a risk factor for spontaneous abortion.

show abstract

Fetal loss following second trimester amniocentesis. Who is at greater risk? How to counsel pregnant women?

Abstract: Amniocentesis is a safe-invasive procedure for prenatal diagnosis with total FLR of 1.19% in our institution during the study period. The present study has emphasized the significance of certain risk factors for adverse outcome and therefore the need to individualize the risk.

Cited by 19 publications

References 19 publications

Myoma and myomectomy: Poor evidence concern in pregnancy

Myoma and myomectomy: Poor evidence concern in pregnancy

Comparison of spontaneous fetal loss rates between women with singleton and twin pregnancies after mid‐trimester amniocentesis ‐ A historical cohort study

Leiomyomas in Pregnancy and Spontaneous Abortion

Contact Info

Product

Resources

About