Technical factors in early amniocentesis predict adverse outcome. Results of the Canadian early (EA) versus mid-trimester (MA) amniocentesis trial

Abstract

The purpose of this study was to identify risk factors for fetal loss and other pregnancy complications associated with genetic amniocentesis. Data were acquired in the Canadian Early Amniocentesis Trial (CEMAT), a multicentred (12) prospective, randomized trial comparing continuous ultrasound‐guided early amniocentesis (EA) and mid‐trimester amniocentesis (MA) (CEMAT Group, 1998). Details of the procedure were recorded and analysed by allocation (EA versus MA), operator and centre, and correlated with pregnancy outcome. A total of 62 spontaneous pregnancy losses occurred between the procedure and 20 weeks' gestation among the 3691 patients who received their procedures within the allocated window (EA=53/1916, MA=9/1775). Technical factors correlating with these losses included procedures ‘judged to be difficult’ by the operator, and post‐procedure amniotic fluid leakage or bleeding. Maternal risk factors included maternal hypertension (fetal loss 11.1 per cent, compared with non‐hypertensive women, 2.6 per cent) increased body mass index (BMI) and gravidity of three or greater. Allocation to EA was predictive of fetal loss, as well as failed procedure, multiple needle insertions, amniotic fluid leakage, failed culture and talipes equinovarus, in excess compared with MA. In conclusion, in this large prospective randomized trial evaluating amniocentesis, specific maternal, fetal and procedural variables were found to be predictive of fetal loss and adverse pregnancy outcome. Performing amniocentesis before 13 weeks' gestation (EA) was the major predictive factor for adverse outcome. These data suggest that first‐trimester chorionic villus sampling (CVS) and MA will likely remain the invasive procedures of choice for evaluation of fetal karyotype. Copyright © 1999 John Wiley & Sons, Ltd.

Capillary-Like Network Formation by Human Amniotic Fluid-Derived Stem Cells Within Fibrin/Poly(Ethylene Glycol) Hydrogels

“…The application of AFSC to the repair of congenital defects in neonates is especially promising because AF is routinely collected when a congenital defect is detected, with minimal risk, 23,24 and AFSC-derived cell constructs are genetically matched to the patient, significantly reducing the risk of immunorejection. 11,25 Surgical treatment of congenital abnormalities is often complicated by insufficient available tissue at the time of repair, resulting in the use of synthetic materials and a corresponding high morbidity rate.…”

Antibiotic Prophylaxis before second‐trimester Genetic Amniocentesis (APGA): a single‐centre open randomised controlled trial

“…We set our primary outcome to within 4 weeks after the procedure on the basis of studies which reported that miscarriages happened at a median interval of 21.5 days after amniocentesis (Tabor et al, 1986); that foetal deaths were most common within the first 30 days after amniocentesis (Giorlandino et al, 1994); that rates of foetal death after 20 weeks of gestation were similar in women who had early amniocentesis and those who had midtrimester amniocentesis (Johnson et al, 1999); and that most foetal deaths (90.5%) occurred within 4 weeks of the procedure (Eddleman et al, 2006). We believed that a follow-up till birth was not suggested because it would have introduced a bias related to prognostic factors which differed from the short-term effect of amniocentesis.…”

Evaluación del potencial antibacterial in vitro de Croton lechleri frente a aislamientos bacterianos de pacientes con úlceras cutáneas

“…En total, la frecuencia de pérdidas fue del 4,9%. Otros estudios encontraron frecuencias más bajas, situadas en tormo del 4% (16), un 3,0% (17)(18)(19) o un 2,5% (5,20). Sin embargo, Schulman (21) encontró una frecuencia semejante (un 4,7%) y Nagel (11) reportó una frecuencia mayor (6,2%).…”