Incidence of Spontaneous Abortion After Amniocentesis: Influence of Placental Localization and Past Obstetric and Gynecologic History

Abstract

The influence of the localization of the placenta and some technical problems associated with the performance of amniocentesis (AC) on the incidence of spontaneous abortion (SA) after AC was evaluated in a prospective study comprising all women (2276) referred for AC at the University Hospital in Odense during a 7-year period. Women with predisposing factors for SA were excluded from this analysis, which comprised 1545 women. Of these, 1289 women had an AC and 256 were judged not to need an AC after ultrasonographic examination. The localization of the placenta per se had no influence on the incidence of SA. However, if the placenta was covering the whole anterior wall so that perforation of the placenta could not be avoided, or if more than one insertion was necessary, or there was macroscopic blood contamination in the amniotic fluid, the risk of SA was increased by a factor 4 to 5. The influence of previous obstetric or gynecologic complications on the incidence of SA was also examined. In this analysis the data from women with first trimester hemorrhage in the present pregnancy were included and the study population therefore consisted of 1594 women. Of these, 1318 had an AC, and 276 had ultrasound scanning only. Patients with one or more previous pregnancies with fetal loss had a significantly greater risk of SA after AC than patients with no previous pregnancies or successfully completed pregnancies. Two subgroups with special problems, namely, women with previous complaint of infertility of at least 2 years' duration and women with first trimester bleeding, also had an increased risk of SA.(ABSTRACT TRUNCATED AT 250 WORDS)

Revisiting the Fetal Loss Rate After Second-Trimester Genetic Amniocentesis

“…17 However, matched case-control studies have the disadvantages of introducing potential selection bias into the study and of not providing reliable incidence rates for some of the outcomes being studied because they are already fixed by the matching process. 18 Because the women in the amniocentesis group were enrolled at a significantly 5 4,502 28 or less 1.00 Randomized trial in low-risk women; used 18-gauge needle Andreasen (1989) 9 1,447 28 or less 1.40 Unmatched control; probably underpowered Tongsong (1998) 10 4,512 28 or less 0.40 Matched control; underpowered Antsaklis (2000) 11 9,020 28 or less 0.60 Unmatched control and limited to women between 20 and 34 years Muller (2002) earlier gestational age than those in the control group, we believed that this could bias the results in favor of a higher loss rate in the amniocentesis group compared with the control group, particularly because previous studies have shown that the higher miscarriage rates occur in the earlier gestational ages than later. 19 We explored this possibility by performing a nested case-control study by matching for gestational age at prenatal diagnosis.…”

Does bleeding affect fetal Doppler parameters during genetic amniocentesis?

“…It is debated whether transplacental needle passage significantly increases the rate of complications. Although some earlier reports did find an increase in fetal loss rates (7,8), many other studies have not found such an association (9)(10)(11). Although convincing evidence is not present in terms of fetal loss, it has been shown that transplacental needle passage may lead to certain procedural complications, such as aspiration of hemorrhagic amniotic fluid or fetomaternal hemorrhage (FMH) (10).…”

Invasive Prenatal Diagnosis: Amniocentesis

“…15,27 In the same way maternal age and abnormal maternal serum a fetoprotein measurements increase the risk for pregnancy loss. 19,[28][29][30][31] Vaginal bleeding during current pregnancy increase the risk of spontaneous abortion and pregnancy loss after amniocentesis in most of the series.…”

“…The number of needle placements, the aspiration of bloody fluid, and especially the observation of green or murky fluid are seen to be associated with a significantly increased risk of pregnancy loss after amniocentesis. 15,27,32,33,37 The number of needle insertions and bloody fluid are related directly to procedure technique, whereas murky or green fluid is not. Murky of green fluid is usually the result of previous intra-amniotic hemorrhage and this is the reason why it is definitely increasing the risk of fetal loss after amniocentesis.…”