Fetal loss after chorionic villus sampling in twin pregnancy.
Abortion, Spontaneous
/ epidemiology
Adult
Chorion
Chorionic Gonadotropin, beta Subunit, Human
/ blood
Chorionic Villi Sampling
/ adverse effects
Crown-Rump Length
Female
Gestational Age
Humans
Logistic Models
London
/ epidemiology
Nuchal Translucency Measurement
Pregnancy
Pregnancy Trimester, First
/ blood
Pregnancy, Twin
/ blood
Pregnancy-Associated Plasma Protein-A
/ analysis
Prenatal Diagnosis
/ statistics & numerical data
Risk Factors
Twins
/ statistics & numerical data
Ultrasonography, Prenatal
/ statistics & numerical data
first-trimester screening
invasive testing
miscarriage
stillbirth
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
12
05
2021
received:
13
04
2021
accepted:
17
05
2021
pubmed:
27
5
2021
medline:
15
12
2021
entrez:
26
5
2021
Statut:
ppublish
Résumé
To estimate the chorionic villus sampling (CVS)-related risk of fetal loss in twin pregnancy after adjustment for chorionicity, nuchal translucency thickness (NT), intertwin discordance in crown-rump length (CRL), maternal demographic characteristics and serum pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG). This was a multicenter study from eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. Data were obtained prospectively from women with twin pregnancy undergoing routine ultrasound examination at 11-13 weeks' gestation. Multivariable logistic regression analysis with backward stepwise elimination was used to examine whether CVS provided a significant independent contribution to the prediction of risk of fetal loss after adjusting for maternal and pregnancy characteristics, including maternal age, racial origin and weight, method of conception, smoking status, parity, chorionicity, intertwin discordance in CRL, fetal NT ≥ 95 The study population of 8581 twin pregnancies undergoing ultrasound examination at 11-13 weeks' gestation included 316 dichorionic and 129 monochorionic twins that had CVS. First, in twin pregnancies undergoing CVS, compared to those not undergoing CVS, there was a 2-fold increased risk of fetal loss at < 24 weeks' gestation and of loss at any stage in pregnancy. Second, the factors providing a significant independent contribution to the prediction of miscarriage or fetal loss in twin pregnancy were increased maternal weight, black racial origin, monochorionicity, and more so monoamnionicity, large intertwin discordance in CRL and increased fetal NT, and, in the case of fetal loss at any stage, there was also a contribution from assisted conception and low serum PAPP-A. Third, after adjustment for maternal and pregnancy characteristics, CVS did not provide a significant contribution to the risk of fetal loss. Fourth, in twin pregnancies that had CVS, there was no significant contribution to fetal loss from the number of intrauterine needle insertions or needle size. The 2-fold increased risk of fetal loss following CVS in twin pregnancy can, to a great extent, be explained by maternal and pregnancy characteristics rather than the invasive procedure itself. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Substances chimiques
Chorionic Gonadotropin, beta Subunit, Human
0
Pregnancy-Associated Plasma Protein-A
EC 3.4.24.-
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
48-55Subventions
Organisme : Fetal Medicine Foundation
Informations de copyright
© 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Références
Tabor A, Philip J, Madsen M, Bang J, Obel EB, Norgaard-Pedersen B. Randomised controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet 1986; 1: 1287-1293.
Smith-Jensen S, Permin M, Philip J, Lundsteen C, Zachary JM, Fowler SE, Grüning K. Randomised comparison of amniocentesis and transabdominal and transcervical chorionic villus sampling. Lancet 1992; 340: 1237-1244.
Akolekar R, Bower S, Flack N, Bilardo CM, Nicolaides KH. Prediction of miscarriage and stillbirth at 11-13 weeks and the contribution of chorionic villus sampling. Prenat Diagn 2011; 31: 38-45.
Wulff CB, Gerds TA, Rode L, Ekelund CK, Petersen OB, Tabor A; Danish Fetal Medicine Study Group. Risk of fetal loss associated with invasive testing following combined first-trimester screening for Down syndrome: a national cohort of 147 987 singleton pregnancies. Ultrasound Obstet Gynecol 2016; 47: 38-44.
Gil MM, Molina FS, Rodriguez-Fernandez M, Delgado JL, Carrillo MP, Jani J, Plasencia W, Stratieva V, Maiz N, Carretero P, Lismone A, Chaveeva P, Burgos J, Santacruz B, Zamora J, De Paco Matallana C. New approach for estimating risk of miscarriage after chorionic villus sampling. Ultrasound Obstet Gynecol 2020; 56: 656-663.
Salomon LJ, Sotiriadis A, Wulff CB, Odibo A, Akolekar R. Risk of miscarriage following amniocentesis or chorionic villus sampling: systematic review of literature and updated meta-analysis. Ultrasound Obstet Gynecol 2019; 54: 442-451.
Beta J, Zhang W, Geris S, Kostiv V, Akolekar R. Procedure-related risk of miscarriage following chorionic villus sampling and amniocentesis. Ultrasound Obstet Gynecol 2019; 54: 452-457.
De Catte L, Liebaers I, Foulon W, Bonduelle M, Van Assche E. First trimester chorionic villus sampling in twin gestations. Am J Perinatol 1996; 13: 413-417.
Aytoz A, De Catte L, Camus M, Bonduelle M, Van Assche E, Liebaers I, Van Steirteghem A, Devroey P. Obstetric outcome after prenatal diagnosis in pregnancies obtained after intracytoplasmic sperm injection. Hum Reprod 1998; 13: 2958-2961.
Brambati B, Tului L, Guercilena S, Alberti E. Outcome of first-trimester chorionic villus sampling for genetic investigation in multiple pregnancy. Ultrasound Obstet Gynecol 2001; 17: 209-216.
Kim MS, Ahn E, Lee SB, Moon MJ, Kang S. Obstetrical outcomes after first-trimester chorionic villus sampling in twin pregnancies: A retrospective case-control study. J Obstet Gynaecol Res 2019; 45: 1466-1471.
Agarwal K, Alfirevic Z. Pregnancy loss after chorionic villus sampling and genetic amniocentesis in twin pregnancies: a systematic review. Ultrasound Obstet Gynecol 2012; 40: 128-134.
Simonazzi G, Curti A, Farina A, Pilu G, Bovicelli L, Rizzo N. Amniocentesis and chorionic villus sampling in twin gestations: which is the best sampling technique? Am J Obstet Gynecol 2010; 202: 365.e1-5.
Antsaklis A, Souka AP, Daskalakis G, Kavalakis Y, Michalas S. Second-trimester amniocentesis vs. chorionic villus sampling for prenatal diagnosis in multiple gestations. Ultrasound Obstet Gynecol 2002; 20: 476-481.
Di Mascio D, Khalil A, Rizzo G, Buca D, Liberati M, Martellucci CA, Flacco ME, Manzoli L, D'Antonio F. Risk of fetal loss following amniocentesis or chorionic villus sampling in twin pregnancy: systemic review and meta-analysis. Ultrasound Obstet Gynecol 2020; 56: 647-655.
Litwinska E, Syngelaki A, Cimpoca B, Frei L, Nicolaides KH. Outcome of twin pregnancy with two live fetuses at 11-13 weeks' gestation. Ultrasound Obstet Gynecol 2020; 55: 32-38.
Litwinska E, Syngelaki A, Cimpoca B, Sapantzoglou I, Nicolaides KH. Intertwin discordance in fetal size at 11-13 weeks' gestation and pregnancy outcome. Ultrasound Obstet Gynecol 2020; 55: 189-197.
Cimpoca B, Syngelaki A, Litwinska E, Muzaferovic A, Nicolaides KH. Increased nuchal translucency at 11-13 weeks' gestation and outcome in twin pregnancy. Ultrasound Obstet Gynecol 2020; 55: 318-325.
Robinson HP, Fleming JE. A critical evaluation of sonar crown rump length measurements. Br J Obstet Gynaecol 1975; 82: 702-710.
Sepulveda W, Sebire NJ, Hughes K, Odibo A, Nicolaides KH. The lambda sign at 10-14 weeks as a predictor of chorionicity in twin pregnancies. Ultrasound Obstet Gynecol 1996; 7: 421-423.
Chaveeva P, Wright A, Syngelaki A, Konstantinidou L, Wright D, Nicolaides KH. First-trimester screening for trisomies in pregnancies with vanishing twin. Ultrasound Obstet Gynecol 2020; 55: 326-331.
Syngelaki A, Cimpoca B, Litwinska E, Akolekar R, Nicolaides KH. Diagnosis of fetal defects in twin pregnancies at routine 11-13-week ultrasound examination. Ultrasound Obstet Gynecol 2020; 55: 474-481.
Wright D, Kagan KO, Molina FS, Gazzoni A, Nicolaides KH. A mixture model of nuchal translucency thickness in screening for chromosomal defects. Ultrasound Obstet Gynecol 2008; 31: 376-383.
Kagan KO, Wright D, Spencer K, Molina FS, Nicolaides KH. First trimester screening for trisomy 21 by free beta-human chorionic gonadotropin and pregnancy associated plasma protein-A: impact of maternal and pregnancy characteristics. Ultrasound Obstet Gynecol 2008; 31: 493-502.
Madsen HN, Ball S, Wright D, Tørring N, Petersen OB, Nicolaides KH, Spencer K. A reassessment of biochemical marker distributions in trisomy 21-affected and unaffected twin pregnancies in the first trimester. Ultrasound Obstet Gynecol 2011; 37: 38-47.