Fetal Loss Rate and Associated Risk Factors After Amniocentesis, Chorionic Villus Sampling and Fetal Blood Sampling

 

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Abstract

Purpose: To assess the total and procedure-related fetal loss rate and associated risk factors following amniocentesis (AC), chorionic villus sampling (CVS) and fetal blood sampling (FBS).

Materials and Methods: We performed a retrospective analysis of patients with invasive diagnostics from 1993 to 2011 in two tertiary referral centers. We aimed to classify pregnancy loss after an invasive procedure and included the time after the invasive procedure and the result of targeted ultrasound/karyotype analysis in the analysis. Fetal losses occurring within two weeks after an invasive procedure were classified as procedure-related.

Results: After excluding 1553 pregnancies with abnormal karyotype, fetal malformations and multiple insertions, 6256 cases were retrieved for final analysis. The total fetal loss rate was 1.5 %. The procedure-related fetal loss rate was 0.4 % for AC, 1.1 % for CVS and 0.4 % for FBS. Maternal vaginal bleeding in the first trimester was significantly associated with an increased procedure-related fetal loss rate (p= 0.008). The number of invasive procedures declined during the study period with increasing numbers of CVS in the first trimester.

Conclusion: In our population the procedure-related fetal loss rate was 0.4 % after AC and 1.1 % and 0.4 % after CVS and FBS, respectively. Different gestational ages at the time of invasive procedures might account in part for those differences. Vaginal bleeding during the first trimester is associated with increased procedure-related fetal loss. Overall, declining numbers of invasive procedures are the result of changing attitudes toward invasive procedures and more sophisticated noninvasive prenatal screening programs over the last 20 years.

Zusammenfassung

Ziel: Bestimmung der totalen und der eingriffbedingten fetalen Verlustrate sowie assoziierter Risikofaktoren nach Amniozentese (AC), Chorionzottenbiopsie (CVS) und Nabelschnurpunktion (FBS).

Material und Methoden: Wir führten an 2 Tertiärzentren eine retrospektive Untersuchung von Patienten durch, die eine pränatale invasive Diagnostik zwischen 1993 und 2011 erhielten. Zur Klassifizierung der Schwangerschaftsverluste nach invasiver Diagnostik flossen sowohl die Zeit nach dem invasiven Eingriff als auch Ergebnisse detaillierter Ultraschalluntersuchungen/Karyotypisierungen in die Auswertung mit ein. Schwangerschaftsverlust innerhalb von 2 Wochen nach invasiver Diagnostik wurde als eingriffbedingt definiert.

Ergebnisse: Nach Ausschluss von 1553 Schwangerschaften mit abnormalem Karyotyp, fetalen Fehlbildungen und Mehrfachpunktionen wurden 6256 Fälle zur Analyse eingeschlossen. Die totale Verlustrate lag bei 1,5 %. Die eingriffbedingte Verlustrate betrug 0,4 % für AC, 1,1 % für CVS und 0,4 % für FBS. Vaginale Blutung im ersten Trimenon war signifikant vergesellschaftet mit erhöhter eingriffbedingter Verlustrate (p= 0,008). Die Anzahl der invasiven Eingriffe nahm über den Zeitraum gesehen ab, bei zunehmender Anzahl von CVS im ersten Trimenon.

Schlussfolgerung: In unserem Studienkollektiv betrug die eingriffbedingte Verlustrate für AC 0,4 %, für CVS 1,1 % und 0,4 % für FBS. Die unterschiedlichen Schwangerschaftsalter zum Zeitpunkt der Eingriffe können zum Teil die Unterschiede zwischen den Verfahren erklären. Eine vaginale Blutung im ersten Trimenon war mit erhöhter eingriffbedingter Verlustrate vergesellschaftet. Die abnehmende Anzahl invasiver Eingriffe ist auf die veränderte Einstellung zu invasiver Diagnostik und zunehmend hoch differenzierte pränatale Screening-Programme der letzten 20 Jahre zurückzuführen.

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