Obstetrical Outcomes of Amniocentesis or Chorionic Villus Sampling in Dichorionic Twin Pregnancies

Abstract

Background Under certain situations, women with twin pregnancies may be counseled to undergo invasive prenatal diagnostic testing. Chorionic villus sampling and amniocentesis are the two generally performed invasive prenatal diagnostic tests. Studies comparing procedure-related fetal loss between first-trimester chorionic villus sampling and second-trimester amniocentesis in twin pregnancies are limited. This study aimed to evaluate the procedure-related fetal loss and the obstetrical outcomes of these two procedures, chorionic villus sampling and amniocentesis in twin pregnancies. Methods The data from dichorionic-diamniotic twin pregnancies on which first-trimester chorionic villus sampling (n = 54) or second-trimester amniocentesis (n = 170) was performed between December 2006 and January 2017 in a single center were retrospectively analyzed. The procedure-related fetal loss was classified as loss of one or all fetuses within 4 weeks of procedure, and overall fetal loss was classified as loss of one or all fetuses during the gestation. The groups were compared with respect to the procedure-related and obstetrical outcomes. Results The difference in proportion of procedure-related fetal loss rate (1.9% for chorionic villus sampling vs. 1.8% for amniocentesis; P = 1.000) and the overall fetal loss rate (7.4% for chorionic villus sampling vs. 4.7% for amniocentesis; P = 0.489) between the two groups was not significant. The mean gestational ages at delivery were not statistically significant. Conclusion Both the overall fetal loss rate and the procedure-related fetal loss rate of chorionic villus sampling and amniocentesis in dichorionic twin pregnancies had no statistical significance. Both procedures can be safely used individually.

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

“…In the literature, pregnancy loss rate is higher than expected. The pregnancy loss rate at any gestational age after amniocentesis varied from 2.68% to 9.30%, 8‐13 depending on performers' experience, gestational age of performance and different techniques. Specific outcome associated with procedure is important.…”

Risk of fetal loss following amniocentesis or chorionic villus sampling in twin pregnancy: systematic review and meta‐analysis

“…Table S2 shows the definition of overall fetal loss, the indication for invasive prenatal diagnosis and the exclusion criteria in each of the included studies. These 16 studies 9,10,23–36 included 3419 twin pregnancies undergoing an invasive procedure and 2517 twin pregnancies not undergoing invasive prenatal diagnosis. Twin pregnancies included both DC and MC pregnancies; however, we could not find any study reporting the occurrence of fetal loss exclusively in monoamniotic gestations.…”

“…Thirteen studies 9,10,23,25–33,36 (5012 pregnancies) reported the occurrence of fetal loss in twin pregnancies undergoing amniocentesis (the study of Antsaklis et al 34 . was not included due to risk of overlap of cases with the study of Daskalakis et al 29 …”

“…The rate of fetal loss before 24 weeks of gestation was 2.1% (95% CI, 1.4-2.9%; 59/2439) in twin pregnancies undergoing amniocentesis compared with 1.7% (95% CI, 0.8-2.9%; 31/1712) in those not undergoing amniocentesis (Figure 2b). When stratifying Kim (2019) 23 Krispin (2019) 10 Sperling (2019) 9 Lenis-Cordoba (2013) 25 Kan (2012) 26 Kalogiannidis (2011) 27 Simonazzi (2010) 28 Daskalakis (2009) 29 Supadilokluck (2009) 30 Hanprasertpong (2008) 31 Millaire (2006) 32 Tóth-Pál (2004) 33 Yukobowich ( 2001 Lenis-Cordoba (2013) 25 Kan (2012) 26 Kalogiannidis (2011) 27 Simonazzi (2010) 28 Daskalakis (2009) 29 Supadilokluck (2009) 30 Hanprasertpong (2008) 31 Millaire (2006) 32 Tóth-Pál (2004) 33 Yukobowich according to chorionicity, the rate of fetal loss before 24 weeks of gestation was 1.7% (95% CI, 0.8-2.8%; 26/1237) in DC and 1.2% (95% CI, 0.0-4.9%; 7/155) in MC pregnancies. The rate of fetal loss occurring within 4 weeks after the procedure was 2.1% (95% CI, 1.5-2.9%; 45/1932) in twin pregnancies undergoing amniocentesis compared with 1.8% (95% CI, 0.5-3.8%; 22/1172) in those not undergoing amniocentesis (Figure S1).…”

“…The search identified 323 articles, of which 27 were assessed with respect to their eligibility for inclusion and 16 were included in the systematic review (Table 1, Figure 1, Table S1) 9,10,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] . Table S2 shows the definition of overall fetal loss, the indication for invasive prenatal diagnosis and the exclusion criteria in each of the included studies.…”