Procedure-related risk of miscarriage following chorionic villus sampling and amniocentesis

Journal article

Beta, J., Zhang, W., Geris, S., Kostiv, V. and Akolekar, R. 2019. Procedure-related risk of miscarriage following chorionic villus sampling and amniocentesis. Ultrasound in Obstetrics and Gynecology. 54 (4), pp. 452-457. https://doi.org/10.1002/uog.20293
AuthorsBeta, J., Zhang, W., Geris, S., Kostiv, V. and Akolekar, R.
Abstract

Objective:
The objective of our study was to estimate the procedure-related risks of miscarriage following CVS and amniocentesis in a large unselected screened and to determine whether these risks are consistent with those reported in systematic reviews and meta-analysis.

Methods:
This was a retrospective cohort study undertaken at a large Fetal Medicine Unit in the United Kingdom during the period of January 2009 to May 2018. We included all singleton pregnancies that booked at our unit before 20 weeks after excluding those with multiple pregnancies, major fetal defects, terminations and lost to follow-up. We estimated the risk of miscarriage in those that had a CVS or amniocentesis as well as those that did not have any invasive procedure, to estimate the procedure-related risk as a risk-difference (95% confidence interval [CI]). Univariate and multivariate regression analysis was used to derive odds ratios (OR) (95%CI) and determine which maternal and pregnancy characteristics provided a significant contribution in prediction of miscarriage and whether CVS or amniocentesis provided a significant independent.

Results:
During the study period, there were 45,120 singleton pregnancies, including 1,546 that had an invasive procedure. We excluded 1,429 pregnancies (3.2%), due to fetal defects, termination of pregnancy or those with missing outcomes. In pregnancies that underwent CVS, the risk of miscarriage was 1.5% (13/861), compared to 1.2% (476/39,152) in pregnancies that did not have a procedure (p=0.437). In pregnancies that underwent an amniocentesis, the risk of miscarriage was 0.8% (3/375), compared to 1.2% (491/42,463) in those that did not (p=0.520). Univariate and multivariate regression analysis demonstrated that there was no significant prediction to the risk of miscarriage from CVS (p=0.399; p=0.592, respectively) or amniocentesis (p=0.543; p=0.550, respectively). The risk of procedure-related loss attributed to CVS was 0.29% (95%CI: -0.53-1.12) and that following amniocentesis was -0.36% (95%CI: -1.26-0.55), which was not significantly different from those that did not have any procedure.

Conclusion:
The procedure-related risks of miscarriage following CVS and amniocentesis are considerably lower than currently quoted. The estimates of risks based on our study are 0.29% for CVS and -0.36 for amniocentesis.

KeywordsProcedure-related risk; Chorionic villus sampling; Amniocentesis; Miscarriage; Fetal demise
Year2019
JournalUltrasound in Obstetrics and Gynecology
Journal citation54 (4), pp. 452-457
PublisherWiley
ISSN0960-7692
Digital Object Identifier (DOI)https://doi.org/10.1002/uog.20293
Official URLhttp://doi.org/10.1002/uog.20293
Publication dates
Online06 Sep 2019
Publication process dates
Accepted30 Mar 2019
Deposited21 May 2020
Accepted author manuscript
Output statusPublished
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Dragan, I., Georgiou, T., Prodan, N., Akolekar, R. and Nicolaides, K. H. 2017. Screening for pre-eclampsia using sFlt-1/PlGF ratio cut-off of 38 at 30-37 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 49 (1), pp. 73-77. https://doi.org/10.1002/uog.17301
Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2016. Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (3), pp. 308-315. https://doi.org/10.1002/uog.14898
Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2016. Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (2), pp. 194-202. https://doi.org/10.1002/uog.14928
Screening for trisomies by cell-free DNA testing of maternal blood: consequences of a failed result
Revello, R., Sarno, L., Ispas, A., Akolekar, R. and Nicolaides, K. H. 2016. Screening for trisomies by cell-free DNA testing of maternal blood: consequences of a failed result. Ultrasound in Obstetrics and Gynecology. 47 (6), pp. 698-704. https://doi.org/10.1002/uog.15851
Metformin versus placebo in obese pregnant women without diabetes mellitus
Syngelaki, A., Nicolaides, K. H., Balani, J., Hyer, S., Akolekar, R., Kotecha, R., Pastides, A. and Shehata, H. 2016. Metformin versus placebo in obese pregnant women without diabetes mellitus. New England Journal of Medicine. 374, pp. 434-43. https://doi.org/10.1056/NEJMoa1509819
Prospective first-trimester screening for trisomies by cell-free DNA testing of maternal blood in twin pregnancy
Sarno, L., Revello, R., Hanson, E., Akolekar, R. and Nicolaides, K. H. 2016. Prospective first-trimester screening for trisomies by cell-free DNA testing of maternal blood in twin pregnancy. Ultrasound in Obstetrics and Gynecology. 47 (6), pp. 705-11. https://doi.org/10.1002/uog.15913
Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks
Mastrodima, S., Akolekar, R., Yerlikaya, G., Tzelepis, T. and Nicolaides, K. H. 2016. Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 613-617. https://doi.org/10.1002/uog.17289
Prediction of stillbirth from maternal demographic and pregnancy characteristics
Yerlikaya, G., Akolekar, R., McPherson, K., Syngelaki, A. and Nicolaides, K. H. 2016. Prediction of stillbirth from maternal demographic and pregnancy characteristics. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 607-612. https://doi.org/10.1002/uog.17290
Endoscopic placental laser coagulation in dichorionic and monochorionic triplet pregnancies
Peeva, G., Chaveeva, P., Gil Guevara, E., Akolekar, R. and Nicolaides, K. H. 2016. Endoscopic placental laser coagulation in dichorionic and monochorionic triplet pregnancies. Fetal Diagnosis and Therapy. 40 (3), pp. 174-180. https://doi.org/10.1159/000443792
Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks
Akolekar, R., Tokunaka, M., Ortega, N., Syngelaki, A. and Nicolaides, K. H. 2016. Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 624-630. https://doi.org/10.1002/uog.17295
Prediction of stillbirth from placental growth factor at 11-13 weeks
Akolekar, R., Machuca, M., Mendes, M., Paschos, V. and Nicolaides, K. H. 2016. Prediction of stillbirth from placental growth factor at 11-13 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 618-623. https://doi.org/10.1002/uog.17288
Prediction of stillbirth from placental growth factor at 19-24 weeks
Aupont J. E., Akolekar, R., Illian, A., Neonakis, S. and Nicolaides, K. H. 2016. Prediction of stillbirth from placental growth factor at 19-24 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 631-635. https://doi.org/10.1002/uog.17229
Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2015. Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (2), pp. 203-209. https://doi.org/10.1002/uog.15663