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Procedure-Related Complications of Amniocentesis and Chorionic Villous Sampling: A Systematic Review

Mujezinovic, Faris MD, MSc1; Alfirevic, Zarko MD, FRCOG2

Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000278820.54029.e3
Reviews
Abstract

OBJECTIVE: To compile a systematic review of complications related to genetic amniocentesis and chorionic villus sampling (CVS) to provide benchmark data for counseling and performance assessment of individual operators.

DATA SOURCES: We searched the MEDLINE database for articles published after January 1, 1995, that reported data for at least 100 women with singleton pregnancies with genetic amniocentesis after 14 weeks of pregnancy and reports of CVS carried out transabdominally between 10 and 14 weeks.

METHODS OF STUDY SELECTION: For amniocentesis, 29 articles fulfilled search criteria. Sixteen studies fulfilled search criteria for CVS.

TABULATION, INTEGRATION, AND RESULTS: After genetic amniocentesis, pooled pregnancy loss within 14 days was 0.6% (95% confidence interval [CI] 0.5–0.7), rising to 0.9% (95% CI 0.6–1.3) for pregnancy loss before 24 weeks and 1.9% (95% CI 1.4–2.5) for total pregnancy loss. Corresponding figures for CVS were 0.7%, 1.3%, and 2%. The data on multiple insertions showed large heterogeneity, ranging from 0.2% to 2.9% for amniocentesis (pooled risk 2.0%, 95% CI 0.9–3.6) and from 1.4% to 26.6% for CVS (pooled risk 7.8%, 95% CI 3.1–14.2). Only five amniocentesis studies provided controls, but none was matched for gestational age. Pooled relative risks for fetal loss before 28 weeks and total pregnancy loss were 1.46 (95% CI 0.86–2.49) and 1.25 (95% CI 1.02–1.53), respectively.

CONCLUSION: Although the risks of pregnancy loss are relatively low, lack of adequate controls tends to underestimate the true added risk of prenatal invasive procedures.

In Brief

Although the risk of pregnancy loss after prenatal invasive procedures is relatively low, lack of adequate controls tends to underestimate the true added risks.

Author Information

From the 1Department of Perinatology, University Clinical Center Maribor, Maribor, Slovenia; and 2Division of Perinatal and Reproductive Medicine, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom.

Corresponding author: Zarko Alfirevic, Division of Perinatal and Reproductive Medicine, University of Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, United Kingdom; e-mail: zarko@liv.ac.uk.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2007 The American College of Obstetricians and Gynecologists