Risk for fetal loss and prematurity after 12,413 second trimester amniocenteses in a single center

Theodora, Marianna; Antsaklis, Aris; Blanas, K.; Antsaklis, Panagiotis; Sindos, Michael; Mesogitis, S.; Papantoniou, Nikolaos

doi:10.1515/jpm-2014-0236

Cited by 12 publications

(15 citation statements)

References 18 publications

(27 reference statements)

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“…Our historical cohort study suggests that the rates of fetal loss after genetic amniocentesis are generally low, but they are significantly higher among twins that singletons. In previous studies, the reported rates of fetal losses ranged from 0.8% to 1.56% for singleton pregnancies, 5,6,12‐15 and 1.2% to 3.2% for twin pregnancies 3,16,17 . The possible reasons for these differences may be several.…”

Section: Discussionmentioning

confidence: 94%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 94%

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

et al. 2020

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“…The electronic search yielded 2943 potentially eligible citations, of which 2911 were excluded because they were a duplicate, case report or letter or they did not meet the inclusion criteria following review of the title or abstract, leaving 32 studies for full-text review. After the full-manuscript review, we finally considered 12 studies for amniocentesis 6,7,[9][10][11][19][20][21][22][23][24][25] and eight studies for CVS [6][7][8]10,11,[26][27][28] (four studies 6,7,10,11 reported on both procedures). Of those, one study 26 was eventually excluded, as it reported cumulative data for miscarriage and stillbirth, leaving 12 studies for amniocentesis and seven for CVS ( Figure 1).…”

Section: Data Search Resultsmentioning

confidence: 99%

“…Overall (I 2 = 70.1%; P < 0.0001) Corrado (2012) 25 Beta (2019) 11 Odibo (2008) 23 Muller (2002) 19 Bakker (2017) 7 Wulff (2016) 6 Kong (2006) 21 Theodora (2015) 9 Malan (2018) 10 Towner (2007) 22 Eddleman (2006) Malan (2018) 10 Akolekar (2011) 27 Wah (2017) 8 Beta (2019) 11 Odibo (2008) 28 Bakker (2017) for chromosomal abnormalities ( Table 1). The pooled risk RD (i.e.…”

Section: Favors Amniocentesis Favors Controlmentioning

confidence: 99%

“…When studies with similar risk levels between the amniocentesis and control groups were analyzed, there was no significant procedure-related risk (pooled RD, 0.12% (95% CI, −0.05 to 0.30%; I 2 = 44.1%)) following amniocentesis (Figure 3a). The procedure-related risk following CVS was non-significant when studies with similar level of risk 20 Malan (2018) 10 Wulff (2016) 6 Theodora (2015) 9 Muller (2002) 19 Beta (2019) 11 Subtotal (I 2 = 38.1%; P = 0.152) Kong (2006) 21 Towner (2007) 22 Bakker (2017) 7 Pitukkijronnakorn (2011) Subtotal (I 2 = 0.0%; P = 0.743) Subtotal (I 2 = 0.0%; P = 0.605) Wulff (2016) 6 Beta (2019) 11 Akolekar (2011) 27 Odibo (2008) 28 Wah (2017) between the CVS and the control groups were compared (pooled RD, −0.11% (95% CI, −0.29 to 0.08%); I 2 = 0%). In contrast, CVS was associated with a pooled procedure-related risk of 0.48% (95% CI, 0.17-0.78; I 2 = 0%) when studies with dissimilar level of risk between the intervention and control groups were analyzed (Figure 3b).…”

Section: Favors Amniocentesis Favors Controlmentioning

confidence: 99%

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Risk of miscarriage following amniocentesis or chorionic villus sampling: systematic review of literature and updated meta‐analysis

Salomon

Sotiriadis

Wulff

et al. 2019

Ultrasound in Obstet & Gyne

249

168

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Objective To estimate the procedure‐related risk of miscarriage after amniocentesis and chorionic villus sampling (CVS) based on a systematic review of the literature and an updated meta‐analysis. Methods A search of MEDLINE, EMBASE and The Cochrane Library was carried out to identify studies reporting complications following CVS or amniocentesis. Eligible for inclusion were large controlled studies reporting data for pregnancy loss prior to 24 weeks' gestation. Study authors were contacted when required to identify additional necessary data. Data for cases that had an invasive procedure and controls were inputted into contingency tables and the risk of miscarriage was estimated for each study. Summary statistics based on a random‐effects model were calculated after taking into account the weighting for each study included in the systematic review. Procedure‐related risk of miscarriage was estimated as a weighted risk difference from the summary statistics for cases and controls. Subgroup analyses were performed according to the similarity in risk levels for chromosomal abnormality between the invasive‐testing and control groups. Heterogeneity was assessed using the I2 statistic. Egger's bias was estimated to assess reporting bias in published studies. Results The electronic search yielded 2943 potential citations, from which 12 controlled studies for amniocentesis and seven for CVS were selected for inclusion in the systematic review. A total of 580 miscarriages occurred following 63 723 amniocentesis procedures, resulting in a weighted risk of pregnancy loss of 0.91% (95% CI, 0.73–1.09%). In the control group, there were 1726 miscarriages in 330 469 pregnancies with a loss rate of 0.58% (95% CI, 0.47–0.70%). The weighted procedure‐related risk of miscarriage following amniocentesis was 0.30% (95% CI, 0.11–0.49%; I2 = 70.1%). A total of 163 miscarriages occurred following 13 011 CVS procedures, resulting in a risk of pregnancy loss of 1.39% (95% CI, 0.76–2.02%). In the control group, there were 1946 miscarriages in 232 680 pregnancies with a loss rate of 1.23% (95% CI, 0.86–1.59%). The weighted procedure‐related risk of miscarriage following CVS was 0.20% (95% CI, −0.13 to 0.52%; I2 = 52.7%). However, when studies including only women with similar risk profiles for chromosomal abnormality in the intervention and control groups were considered, the procedure‐related risk for amniocentesis was 0.12% (95% CI, −0.05 to 0.30%; I2 = 44.1%) and for CVS it was −0.11% (95% CI, −0.29 to 0.08%; I2 = 0%). Conclusions The procedure‐related risks of miscarriage following amniocentesis and CVS are lower than currently quoted to women. The risk appears to be negligible when these interventions were compared to control groups of the same risk profile. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…Sequential systematic reviews (SRs) and meta-analyses (MAs), from 2015 to 2019, provided large data sources for procedure-related fetal loss assessments following intraamniotic diagnostic testing in noninfected diagnostically tested cohorts, generally for a fetal genetic evaluation [9][10][11][12][13][14][15][16][17][18][19]. The SRs/MAs [9,10,17,18] identified the amniocentesis procedure-related fetal loss risk at 0.11-0.35% (1 loss per 290-300 to 900) with a reported control spontaneous fetal loss rate of 0.58-0.67% (no procedure; approximately 1 per 150-170 pregnancies).…”

Section: Questionmentioning

confidence: 99%

Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

Wilson

2020

Fetal Diagn Ther

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Background: The prevalence of perinatal infection from maternal exposure is increasing. The prevalence of acute maternal infections identifies cytomegalovirus, parvovirus B19, toxoplasmosis, and varicella as the most common organisms and in the order of frequency. Maternal informed consent and understanding is required before intrauterine testing for fetal infectious and possible genetic risk assessment. Methods: This structured review of the reproductive published literature focuses on the risks of amniocentesis and cordocentesis diagnostic procedure-related fetal loss rates and fetal vertical transmission (VT) rates from published infected pregnant cohorts. Results: The total postprocedure fetal loss rate for diagnostic amniocentesis procedures, in limited infectious cohorts, is 1.5% and does not appear to be increased compared to "noninfected" amniocentesis cohorts using an estimated background spontaneous fetal loss rate (no procedure) of 0.65%. The "pooled" unintended fetal loss rate is from small infected population cohorts, but can be used for counseling purposes. Postcordocentesis fetal loss risk, in an infected cohort, is not possible to estimate due to limited data. The "biological spontaneous fetal loss rate" risk with a perinatal infection (positive or negative fetal anomalies) and no diagnostic procedure before 20 weeks of gestation is reviewed. The risk of VT in acute infection cohorts as a result of the intra-amniotic diagnostic procedure is not found to be increased. Conclusion: The unintended "fetal loss" rate after amniocentesis for perinatal infected cohorts is similar to that of noninfected cohorts, but the estimate is based on limited infected cohorts. There was no procedure-based risk of fetal VT in the infected cohorts, but identification of postprocedure maternal bleeding into the amniotic cavity increases the potential risk. Maternal knowledge translation and an informed consent process with risk-benefit maternal/fetal risk counseling are required prior to any diagnostic amniocentesis procedure.

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Risk for fetal loss and prematurity after 12,413 second trimester amniocenteses in a single center

Cited by 12 publications

References 18 publications

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

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

Risk of miscarriage following amniocentesis or chorionic villus sampling: systematic review of literature and updated meta‐analysis

Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

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