Iranian Society of Gynecology Oncology

Document Type : Original Research Article

Authors

1 Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran

2 Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran

3 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background and Objectives: Prenatal invasive procedures are used for diagnostic and therapeutic purposes.
The present study aimed to assess the indications and early complications of invasive diagnostic tests.
Materials and Methods: This retrospective descriptive study was conducted on 708 pregnant women who were referred for prenatal invasive tests in Tehran, Iran from May 2018 to April 2022. All medical records of the participants were reviewed and entered into the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The primary outcome was determining the frequent indications of invasive diagnostic tests and post-procedure complications.
Results: Six hundred and sixty-eight medical records were included. Amniocentesis procedure was performed for 624 (93.7%) and 44 cases (6.3%) underwent CVS. The most frequent indication for invasive prenatal procedures was a history of abnormal findings related to the first trimester biomarkers followed by the abnormal findings of the second trimester biochemical markers, a history of high nuchal translucency>99th percentile, and abnormal biomarkers of sequential test. Comparing post-procedure complications, the results showed no significant difference between the CVS and amniocentesis groups (P=0.845). In the amniocentesis group, 2 cases had shown spontaneous abortion and 3 leakage of amniotic fluid, as well as two cases in the CVS group, had reported vaginal bleeding.
Conclusion: Our results delineated that positive fetal aneuploidy screening tests together with increased nuchal translucency were the main indications of the invasive prenatal tests. Amniotic fluid leakage, vaginal bleeding, and spontaneous abortion should be considered as procedure-related complications.

Keywords

Main Subjects

1. Pooransari P, Shirazi M. Comparative Evaluation Between First and Second Trimester Aneuploidy Screening Tests with Amnio Synthesis Results. J Obstet Gynecol Cancer Res. 2020;5(2):68-71. [DOI:10.30699/jogcr.5.2.68]
2. Shirazi M, Sarmadi S, Niromanesh S, Rahimi Sharbaf F, Sahebdel B, Golshahi F, et al. Assessment of the Sensitivity and Specificity of Screening Tests Performed in the First and Second Trimester in the Pregnant Women. J Obstet Gynaecol Res. 2022;4(1):12-5. [DOI:10.30699/jogcr.4.1.12]
3. Özcan H, Uğur MG, Sucu S, Mustafa A, Bayramoğlu Tepe N, Balat Ö. Summary of 2185 prenatal invasive procedures in a single center: A retrospective analysis. Turk J Obstet Gynecol. 2017;14(2):114-20. [DOI:10.4274/tjod.36097] [PMID] [PMCID]
4. Daum H, Ben David A, Nadjari M, Zenvirt S, Helman S, Yanai N, et al. Role of late amniocentesis in the era of modern genomic technologies. Ultrasound Obstet Gynecol. 2019;53(5):676-85. [DOI:10.1002/uog.20113] [PMID]
5. Navaratnam K, Alfirevic Z. Amniocentesis and chorionic villus sampling: Green-top Guideline No. 8 July 2021: Green-top Guideline No. 8. BJOG. 2022;129(1):e1-e15. [DOI:10.1111/1471-0528.16821] [PMID]
6. Alfirevic Z, Navaratnam K, Mujezinovic F. Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database Syst Rev. 2017;2017(9):CD003252. [DOI:10.1002/14651858.CD003252.pub2] [PMID]
7. Connolly KA, Eddleman KA. Amniocentesis: A contemporary review. World Journal of Obstetrics and Gynecology. 5: Baishideng Publishing Group Inc.; 2016. p. 58-65. [DOI:10.5317/wjog.v5.i1.58]
8. He X, Chen A, Zhou J, Hong X, Li D. Maternal septic shock secondary to amniocentesis at mid-gestation. 2022.
9. Likar IP, Jere KS, Možina T, Verdenik I, Tul N. Pregnancy Loss After Amniocentesis and Chorionic Villus Sampling: Cohort Study. Zdr Varst. 2020;60(1):25-9. [DOI:10.2478/sjph-2021-0005] [PMID] [PMCID]
10. Hsu W-W, Hsieh C-J, Lee C-N, Chen C-L, Lin M-W, Kang J, et al. Complication rates after chorionic villus sampling and midtrimester amniocentesis: A 7-year national registry study. J Formos Med Assoc. 2019;118(7):1107-13. [DOI:10.1016/j.jfma.2019.03.006] [PMID]
11. Tzela P, Antonakopoulos N, Anastasopoulos P, Gourounti K. Karyotyping and Chromosomal Microarray Analysis in Women Requesting Amniocentesis for Isolated Sonographic Soft Markers or Advanced Maternal Age. Acta Inform Med. 2021;29(4):288-92. [DOI:10.5455/aim.2021.29.288-292] [PMID] [PMCID]
12. Li H, Mao Y, Jin J. The correlation between maternal age and fetal sex chromosome aneuploidies: a 8-year single institution experience in China. Mol Cytogenet. 2021;14(1):25. [DOI:10.1186/s13039-021-00545-2] [PMID] [PMCID]
13. Hsiao CH, Chen CH, Cheng PJ, Shaw SW, Chu WC, Chen RC. The impact of prenatal screening tests on prenatal diagnosis in Taiwan from 2006 to 2019: a regional cohort study. BMC Pregnancy Childbirth. 2022;22(1):23. [DOI:10.1186/s12884-021-04360-w] [PMID] [PMCID]
14. Bansal V, Jhaveri R. Prenatal Invasive Testing at a Tertiary Referral Center in India: A Report of 433 Cases Under a Single Operator. J Obstet Gynaecol India. 2022;72(1):47-58. [DOI:10.1007/s13224-021-01496-9] [PMID] [PMCID]
15. Okmen F, Ekici H, Hortu I, Imamoglu M, Arican D, Akın H, Sagol S. Comparison of indications and results of prenatal invasive diagnostic tests before and after the implementation of the use of cell-free fetal DNA: a tertiary referral center experience. J Assist Reprod Genet. 2020;37(8):2019-24. [DOI:10.1007/s10815-020-01825-3] [PMID] [PMCID]
16. Hui L, Hutchinson B, Poulton A, Halliday J. Population-based impact of noninvasive prenatal screening on screening and diagnostic testing for fetal aneuploidy. Genet Med. 2017;19(12):1338-45. [DOI:10.1038/gim.2017.55] [PMID]
17. Carbone L, Raffone A, Sarno L, Travaglino A, Saccone G, Gabrielli O, et al. Invasive prenatal diagnosis during COVID-19 pandemic. Arch Gynecol Obstet. 2022;305(3):797-801. [DOI:10.1007/s00404-021-06276-4] [PMID] [PMCID]
18. van der Meij KRM, de Groot-van Mooren M, Carbo EWS, Pieters MJ, Rodenburg W, Sistermans EA, et al. Uptake of fetal aneuploidy screening after the introduction of the non-invasive prenatal test: A national population-based register study. Acta Obstet Gynecol Scand. 2021;100(7):1265-72. [DOI:10.1111/aogs.14091] [PMID] [PMCID]
19. Tara F, Lotfalizadeh M, Moeindarbari S. The effect of diagnostic amniocentesis and its complications on early spontaneous abortion. Electron Physician. 2016;8(8):2787-92. [DOI:10.19082/2787] [PMID] [PMCID]
20. Bakker M, Birnie E, Robles de Medina P, Sollie KM, Pajkrt E, Bilardo CM. Total pregnancy loss after chorionic villus sampling and amniocentesis: a cohort study. Ultrasound Obstet Gynecol. 2017;49(5):599-606. [DOI:10.1002/uog.15986] [PMID]
21. Younesi S, Taheri Amin MM, Hantoushzadeh S, Saadati P, Jamali S, Modarressi M-H, et al. Karyotype analysis of amniotic fluid cells and report of chromosomal abnormalities in 15,401 cases of Iranian women. Sci Rep. 2021;11(1):19402. [DOI:10.1038/s41598-021-98928-3] [PMID] [PMCID]
22. Nicolaides KH, Brizot ML, Patel F, Snjders R. Comparison of chorion villus sampling and early amniocentesis for karyotyping in 1,492 singleton pregnancies. Fetal Diagn Ther. 1996;11(1):9-15. [DOI:10.1159/000264272] [PMID]
23. Ghidini A. Chorionic villus sampling. 2019.
24. Dey M, Sharma S, Aggarwal S. Prenatal screening methods for aneuploidies. N Am J Med Sci. 2013;5(3):182-90. [DOI:10.4103/1947-2714.109180] [PMID] [PMCID]
25. Lichtenbelt KD, Alizadeh BZ, Scheffer PG, Stoutenbeek P, Schielen PCJI, Page-Christiaens LCML, Schuring-Blom GH. Trends in the utilization of invasive prenatal diagnosis in The Netherlands during 2000-2009. Prenat Diagn. 2011;31(8):765-72. [DOI:10.1002/pd.2764] [PMID]
26. 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(4):442-51. [DOI:10.1002/uog.20353] [PMID]
27. Sanei Sistani S, Tardast A. Comparison of CVS and amniocentesis complications in patients referred to Ali Ibn Abitaleb Hospital of Zahedan. Res Med. 2021;45(3):86-91.
28. Devlieger R, Millar LK, Bryant-Greenwood G, Lewi L, Deprest JA. Fetal membrane healing after spontaneous and iatrogenic membrane rupture: A review of current evidence. Am J Obstet Gynecol. 2006;195(6):1512-20. [DOI:10.1016/j.ajog.2006.01.074] [PMID] [PMCID]
29. Mujezinovic F, Alfirevic Z. Procedure-related complications of amniocentesis and chorionic villous sampling: a systematic review. Obstet Gynecol. 2007;110(3):687-94. [DOI:10.1097/01.AOG.0000278820.54029.e3] [PMID]