1
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Parker MJR, James DK, Davies T, McDermott A. Diagnostic amniocentesis before 16 weeks. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619109013527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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2
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Abstract
Although amniocentesis was first reported in 1882, the technique was not in widespread clinical practice until the 1970's. The reason for this slow uptake was that there were few indications for performing the procedure until fetal karyotyping from amniotic fluid cells became possible in 1966. Currently fetal karyotyping is the commonest indication for the technique and amniocentesis has become the mainstay of antenatal diagnosis.
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3
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MacManus CF, Tipping NE, Wilson DJ. A Rho-dependent actin purse-string is involved in wound repair in the early chick amnion following surgical puncture. Wound Repair Regen 2006. [DOI: 10.1111/j.1524-475x.2005.00089.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Brambati B, Tului L, Camurri L, Guercilena S. Early second trimester (13 to 20 weeks) transabdominal chorionic villus sampling (TA-CVS): a safe and alternative method for both high and low risk populations. Prenat Diagn 2002; 22:907-13. [PMID: 12378575 DOI: 10.1002/pd.435] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess feasibility, effectiveness and risk of prenatal diagnosis by TA-CVS at 13-14 and 15-20 weeks' gestation. METHODS CVS was performed transabdominally by free-hand single needle insertion technique under continuous ultrasound visualization on 1844 pregnant women, aged 18 to 48, at 13 to 20 weeks' gestation, whose primary indication was chromosomal anomalies and single gene defects in 85% and 15% of cases, respectively Clinical follow-up of women undergoing TA-CVS at 13 to 20 weeks' was prospectively obtained; the population was split in two groups of 13-14 (series B) and 15-20 weeks' (series C) gestation. Statistical evaluation included a group of TA-CVS cases performed at 11-12 weeks (series A). RESULTS Sampling was feasible in 98.2%, 99.1% and 95.8% of cases of series A, B and C, respectively. Sampling was successful in all cases of the three series and a second insertion was required in 1.5%, 1.3% and 0.9%, respectively. A trend towards lower fetal loss rate is apparent (1.02%, 0.86%, and 0.46 in series A, B, and C, respectively), although differences were not statistically significant. No post-procedural complications were reported for series B and C, while spotting was present in 1.8% of cases for series A. Karyotyping was totally successful by short term culture and was also available by long term culture in 99% of cases for series A, B and C when the amount of chorionic tissue was more than 15 mg. CONCLUSION TA-CVS appears highly effective and safe and might be offered as a valuable alternative to early as well as mid-trimester amniocentesis.
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Affiliation(s)
- Bruno Brambati
- First Department of Obstetrics and Gynaecology, University of Milan, Italy.
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5
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Abstract
The prenatal diagnosis of fetal genetic disease has become a routine part of obstetric care. Pregnancies at risk are identified by a number of factors, including maternal age, positive serum screening, a history of a previous affected child, a parental chromosome rearrangement or an ultrasound-identified anomaly. Invasive diagnostic testing can be performed in the first trimester by chorionic villus sampling or in the second trimester by amniocentesis. Both procedures are safe, with an equivalent 0.5% risk of procedure-induced pregnancy loss. When performed prior to the routine sampling window of 15 weeks, amniocentesis may increase the risk of talipes equinovarus, the highest risk being encountered prior to 13 weeks' gestation. When chorionic villus sampling is performed prior to 9 weeks' gestation, there may be an increased risk of limb reduction defects. The laboratory analysis of both procedures is reliable. Chorionic villus sampling has a 1-2% incidence of confined placental mosaicism, requiring additional evaluation in some cases.
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6
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Jauniaux E, Pahal GS, Rodeck CH. What invasive procedure to use in early pregnancy? Best Pract Res Clin Obstet Gynaecol 2000; 14:651-62. [PMID: 10985936 DOI: 10.1053/beog.2000.0102] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As scientific knowledge and medicine advance so do the expectations of the general public. Advances in molecular biology, ultrasonography, access to the early gestational sac and prenatal diagnosis have helped both drive and meet these expectations. We discuss the use, advantages, potential risks and complications of invasive prenatal diagnostic procedures in early pregnancy. All invasive procedures should be performed under continuous ultrasound guidance by experienced operators. Within this context, mid-trimester amniocentesis remains the safest invasive procedure. Chorionic villus sampling (CVS) and early amniocentesis (EA) are associated with a higher risk of subsequent pregnancy loss. There is also a 10-fold increase in the risk of mosaicism with CVS compared to amniocentesis. Both CVS and EA can induce fetal structural defects and should be abandoned as routine invasive tests. Patient counselling should include an evaluation of the risk associated with each individual procedure but also the operator's personal complication rate.
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Affiliation(s)
- E Jauniaux
- Academic Department of Obstetrics and Gynaecology, University College London Medical School, 86-96 Chenies Mews, London, WC1E 6HX, UK
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7
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Abstract
Twenty years after midtrimester genetic amniocentesis was first used, first trimester invasive prenatal procedures were introduced. Chorionic villous sampling presents some disadvantages that entitled many centers to look into an alternative for first trimester diagnosis. Early amniocentesis (EA) can be performed effectively, as shown over the years in many observational studies and partially randomized and randomized trials. Recently, a multicenter randomized trial (Canadian Early and Midtrimester Amniocentesis Trial) reported a higher total pregnancy loss, a significant increased incidence of musculoskeletal foot deformities, a significant increased culture failure rate, and an increased postamniocentesis rate of leakage in the EA group compared with midtrimester amniocentesis. These results concerning EA procedures from 11w(+0) to 12w(+6) should be included in any pre-EA counseling. However, further trials have started to evaluate EA procedures between 13w(+0) to 14w(+6).
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Affiliation(s)
- M F Delisle
- Department of Obstetrics, University of British Columbia, BC Women's Hospital, Vancouver, Canada
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8
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Nagel HTC, Vandenbussche FPHA, Keirse MJNC, Oepkes D, Oosterwijk JC, Beverstock G, Kanhai HHH. Amniocentesis before 14 completed weeks as an alternative to transabdominal chorionic villus sampling: a controlled trial with infant follow‐up. Prenat Diagn 1998. [DOI: 10.1002/(sici)1097-0223(199805)18:5<465::aid-pd325>3.0.co;2-#] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hélène T. C. Nagel
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Marc J. N. C. Keirse
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan C. Oosterwijk
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Geoffrey Beverstock
- Department of Clinical Cytogenetics, Leiden University Medical Centre, Leiden, The Netherlands
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9
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Brambati B, Tului L, Cislaghi C, Alberti E. First 10 000 chorionic villus samplings performed on singleton pregnancies by a single operator. Prenat Diagn 1998. [DOI: 10.1002/(sici)1097-0223(199803)18:3<255::aid-pd255>3.0.co;2-c] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Tharmaratnam S, Sadek S, Steele EK, Harper MA, Nevin NC, Dornan JC. Transplacental early amniocentesis and pregnancy outcome. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1998; 105:228-30. [PMID: 9501792 DOI: 10.1111/j.1471-0528.1998.tb10058.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The effect on pregnancy outcome of transplacental needle insertion was studied in 401 consecutive women attending for early amniocentesis between 10 and 14 completed weeks of pregnancy. Transplacental early amniocentesis was associated with a significantly higher incidence (P < 0.001) of blood-stained amniotic fluid taps but a lower incidence (not significant; P > 0.05) of pregnancy loss and miscarriages. Women in the nontransplacental early amniocentesis group had a significantly higher (P < 0.01) incidence of late procedure-related antenatal complications, such as preterm rupture of membranes or preterm labour. Our study showed that transplacental early amniocentesis is a safe procedure; contrary to present recommendations, the study also showed that avoiding the placenta during early amniocentesis is an unnecessary practice.
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11
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Greenough A, Naik S, Yuksel B, Thompson PJ, Nicolaides KH. First-trimester invasive procedures and congenital abnormalities. Acta Paediatr 1997; 86:1220-3. [PMID: 9401517 DOI: 10.1111/j.1651-2227.1997.tb14850.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A prospective study was undertaken to determine whether first-trimester amniocentesis or chorion villus sampling was associated with an increased incidence of congenital anomalies. The infants of mothers who had undergone first-trimester amniocentesis (EA) (n = 352), chorion villus sampling (CVS) (n = 348) or no invasive antenatal procedure (controls) (n = 264) were examined at a median age of 5 months. Both the EA and CVS groups had a higher proportion of infants with congenital anomalies (n = 18 and n = 22, respectively) than the control group (n = 4) (p < 0.01). Certain of the abnormalities, however, affected only single infants. Compression abnormalities were more common in the EA group than in the controls (p < 0.05), but not in the CVS group. The isolated limb abnormalities which occurred were minor anomalies affecting the digits and were seen in both the CVS (n = 6) and EA (n = 3) groups. First-trimester invasive procedures are thus associated with an excess of congenital anomalies.
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Affiliation(s)
- A Greenough
- Department of Child Health, King's College Hospital, London, UK
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12
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Sundberg K, Lundsteen C, Philip J. Early filtration amniocentesis for further investigation of mosaicism diagnosed by chorionic villus sampling. Prenat Diagn 1996; 16:1121-7. [PMID: 8994248 DOI: 10.1002/(sici)1097-0223(199612)16:12<1121::aid-pd6>3.0.co;2-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In 44 pregnancies where chorionic villus sampling (CVS) had shown mosaicism, early amniocentesis using a filter technique was carried out with the purpose of clarifying the fetal karyotype and reducing the waiting time for a final karyotype. Since the filter technique increases the cell yield of the amniotic fluid sample, it was hypothesized that this technique could be applied as soon as the mosaic CVS result was available, without compromising the culturing of the amniotic fluid cells. The mean gestational age at amniocentesis was 12.5 weeks and the mean gestational age at the time of the final karyotype was 13.9 weeks. All amniotic fluid sampling procedures and cultures were successful. Four pregnancies were terminated due to abnormal karyotypes (9.1 per cent). Two spontaneous abortions occurred in the second trimester (5.0 per cent), and one infant was lost at term due to unexplained intrapartum death. The total fetal loss rate was 7.5 per cent. This loss rate is concordant with other reported series where the outcome of pregnancies with placental mosaicism has been evaluated. We conclude that early amniocentesis with the filtration technique is a useful method for follow-up on CVS, mosaicism, providing results prior to 14 weeks of gestation.
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Affiliation(s)
- K Sundberg
- Department of Clinical Genetics, Juliane Marie Center, National University Hospital, Copenhagen, Denmark
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13
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Abstract
In this study we report the results of 181 ultrasound-guided genetic amniocenteses performed at 10-12 weeks of gestation and describe the indication, technical problems, amniotic fluid volume, culture success and timing, abortion and fetal loss rate, and perinatal results. Amniotic fluid was obtained in 98.4 per cent of the cases; at the first attempt, in 167 out of 181. The culture success rate was 94.5 per cent, and the fetal loss rate within 2 weeks was 0.5 per cent (one case with a sonographic abnormality). The total fetal loss rate during pregnancy was 1.6 per cent. A comparison of our data and those of other published series shows no significant differences, either with respect to this period of gestation (10-12 weeks) or with respect to the traditionally called early amniocentesis' (12-14 weeks) or conventional amniocentesis (15 weeks or more). The mean culture time was just a few days longer in some of the series, and in some cases, there was also a lower success rate after culture, particularly when amniocentesis was carried out at 10 weeks or less. We conclude that amniocentesis performed at 10-12 weeks is feasible, safe, and easy to perform, and provides a real benefit to the pregnant woman.
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14
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Abstract
Chorionic villus sampling (CVS) retains its great advantage over mid-trimester amniocentesis by producing early results. Moreover, rapid analytical techniques reduce significantly the waiting time between sampling and diagnosis, while recombinant DNA technology and human gene mapping progress amplify enormously the spectrum of the indications. The recent inclusion in the prenatal diagnosis package of screening tests based on DNA analysis for the major genetic diseases (i.e. cystic fibrosis, fragile-X mental retardation syndrome) may efficiently contribute to prevent the genetic disease. The role of CVS in twin pregnancy has been investigated and compared to amniocentesis. Although these techniques are equally safe, CVS should be considered the approach of choice for a number of technical advantage and in relation to selective fetal reduction in discordant twins. Recent reports have substantially contributed on the hypothetical relationship between limb reduction defects (LRDs) and chorion biopsy. The analysis of LRDs among more than 130,000 CVS reported to WHO CVS-Registry has been unable to find out any relationship between sampling and fetal malformations, including LRDs. In conclusion, first trimester CVS should be considered the gold standard procedure for prenatal diagnosis of genetic diseases.
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Affiliation(s)
- B Brambati
- First Institute of Obstetrics and Gynaecology, University of Milan, Italy
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15
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Abstract
Early amniocentesis at less than 14 weeks gestation is becoming more common in prenatal diagnosis populations. Randomized studies are minimal and have not had the power to determine the accuracy and safety of the procedure compared to chorionic villus sampling or mid-trimester amniocentesis. Procedures at 11+0-12+6 weeks should be considered experimental. This clinical review considers the ethics, embryology, and clinical experience (cytogenetics, AFP, AChE, procedure and cytogenetic failures, spontaneous and therapeutic pregnancy losses, congenital anomalies) of early amniocentesis.
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Affiliation(s)
- R D Wilson
- British Columbia Women's Hospital, University of British Columbia, Vancouver, Canada
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16
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Rousseau O, Boulot P, Lefort G, Nagy P, Bachelard B, Bonifacj C, Hedon B, Laffargue F, Viala J. Amniocentesis before 15 weeks' gestation: technical aspects and obstetric risks. Eur J Obstet Gynecol Reprod Biol 1995. [DOI: 10.1016/0028-2243(95)80010-p] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Abstract
Literature concerning early genetic amniocentesis, obtained before 14-15 weeks of gestation, has been examined and compared. Key figures of post-procedural spontaneous fetal losses have been compared as well as cytogenetic data from the published series. Cytogenetically more samples fail to grow in the early weeks, but the diagnostic accuracy seems to be comparable with that of amniocentesis obtained in the later weeks. A sampling method, improving the cell yield by means of filtration, has been developed in order to lower the risk of culture failure and reduce the reporting time in the gestational weeks 11 to 13. The filter technique is under evaluation in a randomized trial. Detection of neural tube defects with early amniotic fluid sampling is possible, but whether the detection rate is comparable to that of standard amniocentesis remains to be seen. Although the safety of early amniocentesis has not yet been evaluated in a randomised study, data from almost 5,000 cases suggest that the procedure related loss rate is approximately 1%, and thus the same as for standard amniocentesis and chorionic villus sampling.
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Affiliation(s)
- K Sundberg
- Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Denmark
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18
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Crandall BF, Kulch P, Tabsh K. Risk assessment of amniocentesis between 11 and 15 weeks: comparison to later amniocentesis controls. Prenat Diagn 1994; 14:913-9. [PMID: 7534922 DOI: 10.1002/pd.1970141004] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We studied 693 consecutive early amniocenteses (prior to 15 weeks) and found a spontaneous abortion rate to 28 weeks' gestation of 1.5 per cent. A control group of women having standard amniocentesis (15-20 weeks) experienced a 0.6 per cent fetal loss in the same period. There were no other apparent differences between the two groups. Early amniocentesis results are generally available 4-6 weeks before standard amniocentesis and 1-3 weeks after chorionic villus sampling (CVS). Alpha-fetoprotein (AFP) can be accurately assayed in 11- to 15-week amniotic fluid samples but additional studies are necessary to determine the accuracy of neural tube defect (NTD) detection. Including the present study, over 5800 early amniocenteses have been reported and the results suggest that this is a relatively safe prenatal diagnostic test and an alternative to CVS and later amniocentesis.
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Affiliation(s)
- B F Crandall
- Department of Psychiatry, UCLA School of Medicine 90024-6969
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19
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Spencer K, Aitken DA, Crossley JA, McCaw G, Berry E, Anderson R, Connor JM, Macri JN. First trimester biochemical screening for trisomy 21: the role of free beta hCG, alpha fetoprotein and pregnancy associated plasma protein A. Ann Clin Biochem 1994; 31 ( Pt 5):447-54. [PMID: 7530437 DOI: 10.1177/000456329403100504] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The potential efficacy of screening for trisomy 21 in the first trimester, using maternal serum markers alpha fetoprotein, free beta human chorionic gonadotropin, unconjugated oestriol and pregnancy associated plasma protein A, was studied in an unselected population of women between the seventh and fourteenth week of gestation. Using a combination of alpha fetoprotein and free beta human chorionic gonadotropin, 53% of affected pregnancies could be identified at a false positive rate of 5%. Unconjugated oestriol and pregnancy associated plasma protein A levels were lower in cases of trisomy 21, but their inclusion with other markers did not significantly improve detection rate. Monitoring the same pregnancies also in the second trimester showed that screening in the first trimester identified the same cases as in the second. We conclude that first trimester screening using free beta human chorionic gonadotropin and alpha fetoprotein, is a viable possibility and will lead to detection rates in excess of 50%. Prospective studies are needed to confirm these observations.
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Affiliation(s)
- K Spencer
- Clinical Biochemistry Department, Oldchurch Hospital, Romford, Essex, UK
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20
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Nicolaides K, Brizot MDL, Patel F, Snijders R. Comparison of chorionic villus sampling and amniocentesis for fetal karyotyping at 10-13 weeks' gestation. Lancet 1994; 344:435-9. [PMID: 7914564 DOI: 10.1016/s0140-6736(94)91769-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We did a prospective study of women with singleton viable pregnancies at 10-13 weeks' gestation who requested first-trimester fetal karyotyping because of advanced maternal age, parental anxiety, or family history of chromosomal abnormality. Women were counselled as to the available options of non-invasive screening or invasive testing by mid-trimester amniocentesis, early amniocentesis (EA), or chorionic villus sampling (CVS), or randomisation to EA or CVS at 10-13 weeks. EA was done in 731 patients (493 by choice and 238 by randomisation) and CVS in 570 (320 by choice and 250 by randomisation). Both procedures were done by transabdominal ultrasound-guided insertion of a 20-gauge needle. The rate of successful sampling was the same for both procedures (97.5%). Spontaneous loss (intrauterine or neonatal death) was significantly higher after EA (total group mean = 5.3%, 95% CI 3.8-7.2; randomised subgroup mean = 5.9%, 3.3-9.7) than after CVS (total group: mean = 2.3%, 1.2-3.9; randomised subgroup: mean = 1.2%, 0.3-3.5). The gestation at delivery and birthweight of the infants after EA and CVS were similar. In the EA group the incidence of talipes equinovarus (1.63%), was higher than in the CVS group (0.56%), but this difference was not significant.
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Affiliation(s)
- K Nicolaides
- Harris Birthweight Research Centre for Fetal Medicine, King's College Hospital Medical School, Denmark Hill, London, UK
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21
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Eiben B, Goebel R, Hansen S, Hammans W. Early amniocentesis--a cytogenetic evaluation of over 1500 cases. Prenat Diagn 1994; 14:497-501. [PMID: 7937588 DOI: 10.1002/pd.1970140615] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report our cytogenetic experience of 1554 early amniocenteses between weeks 11 and 14 of gestation, of which 44 per cent were performed prior to week 14. The mean culture time was 14.5 days. Karyotyping was successful in 99.7 per cent of cases. In 9.9 per cent of cases, there was pseudomosaicism with a high rate of loss of an X-chromosome and structural aberration of chromosome 1, which may be due to the Chang medium. The mosaic rate was 0.5 per cent. The overall aberration rate was 2.8 per cent. Our data confirm the reliability of early amniocentesis, which is a serious alternative to standard amniocentesis and chorionic villus sampling (CVS).
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Affiliation(s)
- B Eiben
- Institut für Klinische Genetik und Frauenklinik, Evangelisches Krankenhaus Oberhausen, Germany
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22
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Calhoun BC, Brehm W, Bombard AT. Early genetic amniocentesis and its relationship to respiratory difficulties in paediatric patients: a report of findings in patients and matched controls 3-5 years post-procedure. Prenat Diagn 1994; 14:209-12. [PMID: 8052570 DOI: 10.1002/pd.1970140312] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study evaluates the long-term pulmonary complications of 25 children from a prospective, matched-control, pilot study evaluating short-term complications of early (11-14 weeks' gestation) versus traditional (15 weeks' gestation and later) genetic amniocentesis. Five children in the early amniocentesis group were found to have various respiratory difficulties, a morbidity rate comparable to that of paediatric patients in the general population. These data identify the need for larger, multicentre trials.
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Affiliation(s)
- B C Calhoun
- Department of Obstetrics and Gynecology, Keesler Medical Center, Biloxi, Mississippi
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23
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Abstract
A number of biochemical markers in maternal serum have been proposed for first trimester screening for Down's syndrome. The most promising four are pregnancy associated plasma protein A (PAPP-A), the free beta sub-unit of human chorionic gonadotrophin (hCG) (free beta glycoprotein sub-unit), unconjugated oestriol (uE3) and alpha-fetoprotein (AFP). An analysis of the published literature suggests that 70% of affected pregnancies could be detected for a 5% false-positive rate if the four markers are used in combination with maternal age and assumed to be independent measures of risk. This is a level of performance that is similar to second trimester screening. It is, however, a tentative estimate because of the assumption of independence and the possibility that the effect may be exaggerated by publication bias. Further research is needed before such screening is introduced. Other first trimester markers which have been studied include total hCG, free alpha-hCG, CA125, PLAP and SP1 but they either look unpromising or there are too few data available to determine their value. The timing of antenatal diagnosis by means of chorion villus sampling should be delayed until after 10 weeks of pregnancy because of the risk of causing limb defects. Screening need not, therefore, be performed before about 9 or 10 weeks of pregnancy.
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Affiliation(s)
- N J Wald
- Wolfson Institute of Preventive Medicine, St Bartholomew's Hospital Medical College, London, UK
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24
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Rebello MT, Abas A, Nicolaides K, Coleman DV. Maternal contamination of amniotic fluid demonstrated by DNA analysis. Prenat Diagn 1994; 14:109-12. [PMID: 8183847 DOI: 10.1002/pd.1970140206] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
DNA from 16 sets of samples comprising DNA from uncultured amniotic fluid cells, cultured amniotic fluid cells, fetal tissue, and maternal blood was analysed by the polymerase chain reaction (PCR) with AC-repeat primers. The analysis was performed to investigate the presence of contaminating maternal cells in amniotic fluid which would affect the reliability of DNA studies for prenatal diagnosis. In three sets, maternal contamination of uncultured amniotic fluid cells was detected. In one of the three sets, maternal contamination was present in both uncultured and cultured amniotic fluid cells. The use of amniotic fluid cells as a source of DNA for prenatal diagnosis should be limited to cases where the purity of the DNA can be demonstrated prior to the diagnostic test being performed. This limitation in the use of amniotic fluid DNA also extends to other forms of diagnosis relying on the purity of amniotic fluid samples, particularly the new in situ hybridization methods currently being developed.
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Affiliation(s)
- M T Rebello
- Cytogenetics Unit, St Mary's Hospital Medical School, London, U.K
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25
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Abstract
Prenatal diagnosis is now offered to the majority of pregnant women in Europe and the United States. Advances in obstetric and laboratory techniques mean that increasing numbers of conditions can be diagnosed prenatally; indeed, gene carriers can be identified before pregnancy in some cases. Current obstetric and laboratory techniques for prenatal screening and diagnosis of genetic disorders are discussed.
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26
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Sundberg K, Smidt-Jensen S, Lundsteen C, Agerbaek K, Philip J. Filtration and recirculation of early amniotic fluid. Evaluation of cell cultures from 100 diagnostic cases. Prenat Diagn 1993; 13:1101-10. [PMID: 8177830 DOI: 10.1002/pd.1970131205] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Due to the low cell concentration, cultures from early amniotic fluid specimens usually require 2-3 weeks in culture prior to karyotyping. The purpose of this study was to evaluate the culture quality of amniotic fluid cells from early pregnancy, obtained by a new filter technique. The hypothetical advantage of the technique was that the increased cell yield might reduce the culture time before karyotyping. Culture quality was assessed by the number of colonies, the percentage of colonies containing mitoses in filter and control cultures, and the culture time. The setting was a consecutive clinical trial. One hundred samples were obtained from ongoing pregnancies at 11-14 weeks of gestation (mean 12.8 weeks). By circulating a mean of 26 ml of amniotic fluid through a cell filter system leading the cell-free fluid back to the amniotic cavity, the cell yield was increased in the sample of 7 ml corresponding to the dead space of the filter system. The culture results were compared with control cultures from 5 ml samples drawn from the same pregnancies prior to recirculation. The cultures from the first flushing of the filter system yielded 2.6 times more colonies and in total 4.2 times more colonies were found in the three cultures grown from each filter sample when compared with the control cultures. Moreover, the filter cultures showed significantly more colonies with mitoses. The mean culture time was 8.0 days for the filter cultures, from which the karyotypes were analysed. The controls would have needed more time in culture to fulfil the diagnostic criteria for karyotyping. One case of 47,XY,+21 was found; the rest had normal karyotypes. We conclude that the filter technique improves the culture quality of early amniotic fluid samples and allows early arrest of the cultures.
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Affiliation(s)
- K Sundberg
- Department and Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Denmark
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Abstract
The detection of fetal abnormality is a major component of routine antenatal care. A variety of techniques are now in use, although these are constantly being modified in the pursuit of more accurate and earlier detection. In this paper we draw attention to the distinction between screening and diagnostic tests, and describe the techniques which have been most commonly used in the UK: serum-screening for neural tube defects; screening for Down's syndrome; ultrasound scanning; amniocentesis and chorionic villus sampling.
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Lockwood DH, Neu RL. Cytogenetic analysis of 1375 amniotic fluid specimens from pregnancies with gestational age less than 14 weeks. Prenat Diagn 1993; 13:801-5. [PMID: 8278310 DOI: 10.1002/pd.1970130903] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Our laboratory has received 1375 early amniotic fluid (EA) specimens during the past 5-year period for cytogenetics analysis. The gestational ages of the EA specimens were less than 14 weeks as estimated by ultrasound. The average volume of specimen received was 16 ml. Specimens were typically received in two collection tubes and cultured in Chang A and in supplemented MEM media using the in situ technique. Of the 1375 EA specimens received, 1356 were successfully cultured and yielded results. Abnormal results were found in 67 (4.9 per cent) of the cases. Nineteen specimens (1.4 per cent) failed to yield a result. The mean turn-around time (TAT) for all EA specimens was 8.28 days. In 1991, the average TAT for the EA specimens was 8.00 days compared with a TAT of 6.59 days for all specimens received over 14 weeks gestational age. The number of EA specimens received has increased from 1.5 per month in 1986 to 57 per month in 1991. In summary, our experience with EA specimens for cytogenetic analysis has demonstrated that the success rate is 98.6 per cent and that an increasing number of obstetricians are performing early amniocentesis as they seek to provide their patients with earlier results and an alternative to chorionic villus sampling.
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Bombard AT, Naef RW. REPRODUCTIVE GENETICS FOR COUPLES OLDER THAN 40 YEARS OF AGE. Obstet Gynecol Clin North Am 1993. [DOI: 10.1016/s0889-8545(21)00519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Wathen NC, Campbell DJ, Kitau MJ, Chard T. Alphafetoprotein levels in amniotic fluid from 8 to 18 weeks of pregnancy. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1993; 100:380-2. [PMID: 7684255 DOI: 10.1111/j.1471-0528.1993.tb12984.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to ascertain the normal range of amniotic fluid alphafetoprotein (AFP) levels from 8 to 18 weeks of pregnancy. DESIGN Amniotic fluid samples obtained by amniocentesis were analysed by radioimmunoassay for AFP. From 8 to 12 weeks, fluid was obtained by transvaginal amniocentesis prior to termination of pregnancy. Samples from 13 to 18 weeks were obtained from amniotic fluid specimens submitted for cytogenetic analysis. SETTING A tertiary referral prenatal diagnostic service. SUBJECTS Two hundred thirty-seven women between 8 and 18 weeks gestation. RESULTS High levels of AFP were present in amniotic fluid at 8 weeks (median 83.0 kU/ml), falling rapidly to 11 weeks (median 19.9 kU/ml) (P < 0.01). Levels then rose to a peak at 13 weeks (median 30.7 kU/ml), thereafter falling to 18 weeks. CONCLUSIONS A single coherent view of the levels of AFP from 8 to 18 weeks of pregnancy is presented for the first time. The rapid changes and complex pattern of AFP levels in early pregnancy suggest that interpretation of amniotic fluid AFP levels in the diagnosis of neural tube defects may be more difficult between 8 and 13 weeks of pregnancy than in the second trimester.
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Affiliation(s)
- N C Wathen
- Department of Gynaecology, St Bartholomew's Hospital, West Smithfield, London, UK
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32
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Kennerknecht I, Krämer S, Grab D, Terinde R. Evaluation of amniotic fluid cell filtration: an experimental approach to early amniocentesis. Prenat Diagn 1993; 13:247-55. [PMID: 8506228 DOI: 10.1002/pd.1970130404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Prior to a prospective application of amniotic fluid (AF) cell filtration to early amniocentesis, we tested the technique on a surplus from mid-trimester samples. By using the same sample size of 5 ml in experiments with a filter and in routine diagnostic procedures (control), we evaluated an optimal filter system. The prolonged culture time of filtered cells and the reduced number of clones are most probably due to mechanical stress (filtration pressure), whereas loss of the cells by adhesion to the filter system, and an AF-free culture medium (growth factors) are suggested to be less important. The AF cells are very sensitive to mechanical stress. Slow filtration (< or = ml AF/min) through filters with a high porosity and the largest possible pore size should be preferred. A mixed cellulose ester filter membrane with a pore size of 5.0 microns proved to be the most efficient, allowing harvest of the filtered cells after only a slight prolongation of the culture time (+2.4 days) compared with unfiltered aliquots. A filter set with a bypass connected by three-way taps allows cell filtration during either aspiration or reinjection of the AF. Cell filtration after amniocentesis and consecutive reverse flushing of the membrane with the appropriate amount of culture medium proved to be the best with regard to easy handling and reducing the risk of bacterial contamination.
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Abstract
Four hundred and thirty early amniocenteses (EAC) from 10 to 14 weeks' gestation were compared with 300 routine amniocenteses (RAC) from 15 weeks' gestation (control A) and 733 routine amniocenteses from 16 to 18 weeks' gestation (control B) with regard to success rates, various growth parameters, and cytogenetic results. Using both in situ and trypsinization techniques, the success rate was 99.8 per cent for EAC versus 100 per cent for RAC. The average turn-around time for establishing a diagnosis was 8.4 days in EAC versus 8.3 days in 15 weeks' specimens (n.s.) and 7.7 days in 16 to 18 weeks' specimens (p < 0.0001) for the last 200 samples. The banding quality of early specimens compared favourably with that of controls (both 500-550 bphs) and was much better than that in long-term cultured chorionic villus sampling (CVS) (350-400 bphs). For level I and level II mosaicism, no statistically significant differences were noted between EAC and control group A. Comparing EAC with control group B, a significant increase in the number of numerical and structural single cell aberrations was observed (p < 0.025 and p << 0.001, respectively), whereas for multiple cell aberrations only the increase in numerical aberrations was statistically significant (p << 0.001) (chi 2-test). Clinical problems arising from the detection of mosaicism were solved in all cases by investigating parallel cultures. It is concluded that early amniocentesis is a reliable procedure which permits prenatal diagnosis of numerical and structural chromosome aberrations to a high standard.
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Affiliation(s)
- S Kerber
- Institute of Human Genetics, University of Hamburg, Germany
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Djalali M, Barbi G, Kennerknecht I, Terinde R. Introduction of early amniocentesis to routine prenatal diagnosis. Prenat Diagn 1992; 12:661-9. [PMID: 1438059 DOI: 10.1002/pd.1970120807] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
With growing awareness of the problems associated with prenatal cytogenetic diagnoses after CVS, attempts have been made to provide early amniocentesis as an alternative to CVS. Since 1990, at our clinic the gestational age limit for routine diagnostic amniocentesis has been successively lowered, first to 14 and then to 13 weeks of gestation. Thus, 811 prenatal diagnoses were performed after early amniocentesis at 13 weeks (n = 217) and at 14 weeks of gestation (n = 594). No problems were encountered. Culture failure was never observed in the early samples. Using the criteria 'number of colonies' and 'culture duration until harvest', early samples taken at 14 weeks did not differ significantly from the controls after standard amniocentesis performed at 15 and 16 weeks, respectively, whereas a minority of samples taken at 13 weeks experienced some delay in culturing. However, in each group at least 85 per cent of samples led to a diagnosis fulfilling our standard criteria of a safe diagnosis (at least 20 metaphases of at least five colonies from at least one primary culture after trypsinization) within 15 days. Some differences between the different groups can be recognized: culture duration of less than 11 days tends to be increasing after standard amniocentesis, whereas long culture duration (more than 20 days) is more often associated with early amniocentesis. However, this trend is only minimal and did not result in an increased risk of missing a diagnosis.
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Affiliation(s)
- M Djalali
- Abteilung Klinische Genetik der Universität, Ulm, Germany
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35
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Redmond RM, Graham CA, Kelly ED, Coleman M, Nevin NC. Prenatal exclusion of Norrie's disease. Br J Ophthalmol 1992; 76:491-3. [PMID: 1390533 PMCID: PMC504324 DOI: 10.1136/bjo.76.8.491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We report on the use of DNA marker probes and linkage analysis to exclude Norrie's disease in the male fetus of a high risk carrier. There are no clinical markers in females carrying the Norrie's disease gene; thus DNA linkage analysis is an essential technique in the management of families 'at-risk' for this severe ophthalmic disease. The principles of DNA linkage are discussed.
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Affiliation(s)
- R M Redmond
- Department of Ophthalmology, Queen's University, Belfast
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Campbell J, Cass P, Wathen N, Stone R, Wald N. First-trimester amniotic fluid and extraembryonic coelomic fluid acetylcholinesterase electrophoresis. Prenat Diagn 1992; 12:609-12. [PMID: 1508851 DOI: 10.1002/pd.1970120707] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Acetylcholinesterase (AChE) gel electrophoresis was performed on samples of amniotic fluid and extraembryonic coelomic fluid obtained by high resolution transvaginal ultrasound-guided amniocentesis from 38 women between 8 and 12 weeks of pregnancy. AChE was positive in 33 per cent (12/36) of the amniotic fluid samples; the percentage of positive results decreased as gestation advanced. AChE was positive in 32 per cent (9/28) of the extraembryonic coelomic fluid samples. In 81 per cent (21/26) of matched samples, the AChE results were identical in the two fluids. Amniotic fluid and extraembryonic coelomic fluid AChE electrophoresis cannot be used to diagnose neural tube defects prior to 12 weeks of gestation.
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Affiliation(s)
- J Campbell
- Combined Academic Departments of Obstetrics, Gynaecology and Reproductive Physiology, St Bartholomew's Hospital, London, U.K
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37
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Kennerknecht I, Baur-Aubele S, Grab D, Terinde R. First trimester amniocentesis between the seventh and 13th weeks: evaluation of the earliest possible genetic diagnosis. Prenat Diagn 1992; 12:595-601. [PMID: 1508849 DOI: 10.1002/pd.1970120705] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Amniocentesis performed at the 12th week and later gives reliable results. The procedure can be performed using regimens developed for mid-trimester amniotic fluid (AF) cells. Extension to the 10th-11th week is, in principle, feasible. However, the high cytogenetic failure rate is a difficulty and despite a high clone count, the culture time is prolonged. The problem of the relatively high loss of AF could be overcome by cell filtration techniques and replacement of the fluid. Because of the short turnover rate of the AF, this may be unnecessary or replacement with an isotonic solution may be sufficient. (Pseudo)mosaicism appears to occur more frequently in early than in late amniocentesis. As yet, data are too sparse to allow a comparison with chorionic villus sampling. There are no reliable follow-up data from which to estimate the abortion rate and the number of embryonic malformations.
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Hanson FW, Tennant F, Hune S, Brookhyser K. Early amniocentesis: outcome, risks, and technical problems at less than or equal to 12.8 weeks. Am J Obstet Gynecol 1992; 166:1707-11. [PMID: 1615978 DOI: 10.1016/0002-9378(92)91560-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE It is the purpose of this report to evaluate our experience with amniocentesis at less than or equal to 12 weeks' gestation. STUDY DESIGN Medical records of 936 patients at less than or equal to 12.8 weeks' gestation undergoing genetic amniocentesis between Oct. 1, 1986, and June 30, 1990, were evaluated for gestational age, indication, frequency of needle insertion, amniocentesis complications, and pregnancy outcome. RESULTS There were seven miscarriages within 2 weeks of amniocentesis (0.7%), 21 miscarriages before 28 weeks (2.2%), and four stillbirths or neonatal deaths (0.4%), resulting in a total postprocedural loss rate of 3.4%. There were 26 chromosomally abnormal fetuses (2.8%). The spontaneous abortion rate in ultrasonographically normal pregnancies at less than 14 weeks, not undergoing amniocentesis, has been estimated at 2.1% to 3.2%. CONCLUSION Amniocentesis at 12 weeks is a viable option for patients desiring earlier prenatal genetic diagnostic information.
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Affiliation(s)
- F W Hanson
- Department of Obstetrics and Gynecology, University of California, Davis
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Jørgensen FS, Bang J, Lind AM, Christensen B, Lundsteen C, Philip J. Genetic amniocentesis at 7-14 weeks of gestation. Prenat Diagn 1992; 12:277-83. [PMID: 1614985 DOI: 10.1002/pd.1970120407] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Genetic amniocentesis performed at 7-14 weeks of gestation was studied in a series of 138 patients of whom 50 wanted termination of pregnancy (less than or equal to 12 weeks). The material for analysis consisted of 132 samples due to two sampling failures and four samples being handled incorrectly. Forty-eight samples (36 per cent) were taken at 7-12 weeks of gestation, mainly transvaginally (36/48: 75 per cent). The success rate of culture and karyotyping increased with the duration of pregnancy, but was only satisfactory from week 11 onwards. The time until harvest was then 14-15 days. The transvaginal approach is easy to perform and was accepted by the women, but we experienced bacterial or fungal overgrowth in 17 per cent of these samples, whereas no infection occurred in the samples taken transabdominally (n = 96). We conclude that genetic amniocentesis is feasible from week 11, but further studies concerning side effects, especially focusing on the procedure-related abortion risk, should be carried out before early amniocentesis is routinely applied.
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Affiliation(s)
- F S Jørgensen
- Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Denmark
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40
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Viscarello RR, Gollin YG, Hobbins JC. Alternate Methods of First-Trimester Diagnosis. Obstet Gynecol Clin North Am 1991. [DOI: 10.1016/s0889-8545(21)00257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Neilson JP, Gosden CM. First trimester prenatal diagnosis: chorion villus sampling or amniocentesis? BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1991; 98:849-52. [PMID: 1911603 DOI: 10.1111/j.1471-0528.1991.tb13504.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hackett GA, Smith JH, Rebello MT, Gray CT, Rooney DE, Beard RW, Loeffler FE, Coleman DV. Early amniocentesis at 11-14 weeks' gestation for the diagnosis of fetal chromosomal abnormality--a clinical evaluation. Prenat Diagn 1991; 11:311-5. [PMID: 1896417 DOI: 10.1002/pd.1970110506] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Early amniocentesis between 11 and 14 weeks' gestation was offered to 110 women at risk of a chromosomally abnormal fetus due to maternal age. Four were found to be unsuitable for the procedure, and 106 early amniocenteses were performed. In 102 cases, clear amniotic fluid was obtained with a single tap. There were two dry taps and two bloodstained taps; sampling was repeated in three of these cases before 15 weeks. In the fourth case, placental biopsy was performed at 16 weeks. Thus, we were able to obtain a satisfactory sample in all but three cases (2.8 per cent). Karyotyping of cells harvested from the early amniotic fluid samples was successful in all the 105 cases. Cell culture from the initial samples revealed a normal karyotype in 99 cases, two balanced translocations, two tetraploid karyotypes, and two cases of pseudomosaicism. Of the 105 pregnancies successfully sampled, there have been two losses to date (1.8 per cent). Two further patients presented with premature rupture of membranes, both pregnancies having successful outcomes. Sixty-two babies have delivered to date, with four congenital anomalies. There were no respiratory problems. Twenty-nine pregnancies are continuing without known complications, and details are not yet available on the remaining 12. The results indicate that early amniocentesis may replace the traditional test at 15-17 weeks.
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Affiliation(s)
- G A Hackett
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, U.K
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Wathen NC, Cass PL, Kitau MJ, Chard T. Human chorionic gonadotrophin and alpha-fetoprotein levels in matched samples of amniotic fluid, extraembryonic coelomic fluid, and maternal serum in the first trimester of pregnancy. Prenat Diagn 1991; 11:145-51. [PMID: 1710066 DOI: 10.1002/pd.1970110303] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Separately identified samples of amniotic fluid and extraembryonic coelomic fluid obtained by high resolution transvaginal ultrasound-guided amniocentesis from 32 women between 7 and 12 weeks of pregnancy were analysed for human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP). There was a highly significant difference between the hCG levels in amniotic fluid (median level 6.3 U/ml; range 1.6-310.0 U/ml) and those in extraembryonic coelomic fluid (median level 400.0 U/ml; range 135.0-2250.0 U/ml) (p less than 0.001; Mann-Whitney U-test). The levels of AFP were very similar in amniotic fluid (median 26.0 kU/ml; range 10.0-116.5 kU/ml) and extraembryonic coelomic fluid (median level 24.1 kU/ml; range 12.4-94.4 kU/ml).
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Affiliation(s)
- N C Wathen
- Combined Academic Department of Obstetrics, Gynaecology, St Bartholomew's Hospital, London, U.K
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Rebello MT, Gray CT, Rooney DE, Smith JH, Hackett GA, Loeffler FE, Horwell DH, Beard RW, Coleman DV. Cytogenetic studies of amniotic fluid taken before the 15th week of pregnancy for earlier prenatal diagnosis: a report of 114 consecutive cases. Prenat Diagn 1991; 11:35-40. [PMID: 2027852 DOI: 10.1002/pd.1970110107] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
One hundred and fourteen samples of amniotic fluid taken before 15 weeks of gestation were cultured for cytogenetic studies. The results of culturing these early amniotic fluid (EAF) samples were compared with the results of culturing 114 standard amniotic fluid (SAF) samples taken after 15 weeks of gestation matched for maternal age and received in the laboratory within the same week. Cell culture was successful in all 114 of the EAF samples and in 111 SAF samples. There was no significant difference in the days to harvesting and days to reporting in the two groups. Three samples of SAF failed to grow and two EAF samples produced tetraploid karyotypes, so that in these five cases amniocentesis had to be repeated. These problems were attributed to toxicity of a fungicide used in the culture medium. Pseudo-mosaicism was noted in two EAF samples and one SAF sample; and maternal cell contamination was noted in one EAF and one SAF sample. Thus, culturing and karyotyping cells harvested from EAF and SAF are similar, indicating that EAF samples from 12-14-week pregnancies could be used for prenatal diagnosis.
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Affiliation(s)
- M T Rebello
- Department of Cytogenetics, St Mary's Hospital, London, U.K
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45
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Besley GT, Broadhead DM, Nevin NC, Nevin J, Dornan JC. Prenatal diagnosis of mucolipidosis II by early amniocentesis. Lancet 1990; 335:1164-5. [PMID: 1971899 DOI: 10.1016/0140-6736(90)91171-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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