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. 2003:(3):CD003252.
doi: 10.1002/14651858.CD003252.

Amniocentesis and chorionic villus sampling for prenatal diagnosis

Z Alfirevic  1 , K Sundberg, S Brigham
Affiliations

Amniocentesis and chorionic villus sampling for prenatal diagnosis

Z Alfirevic et al. Cochrane Database Syst Rev. 2003.

Update in

Abstract

Background: A major disadvantage of second trimester amniocentesis is that the result is usually available only after 18 weeks' gestation. Chorionic villus sampling (CVS) and early amniocentesis can be done between 9 and 14 weeks and offer an earlier alternative.

Objectives: The objective was to assess comparative safety and accuracy of second trimester amniocentesis, early amniocentesis, transcervical and transabdominal CVS.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (March 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2002).

Selection criteria: All randomised trials comparing amniocentesis and CVS.

Data collection and analysis: Two reviewers assessed eligibility and trial quality and performed data extraction. We analysed the data using RevMan software.

Main results: A total of 14 randomised studies have been included. In a low risk population with a background pregnancy loss of around 2%, a second trimester amniocentesis will increase this risk by another 1%. This difference did not reach statistical significance, but the increase in spontaneous miscarriages following second trimester amniocentesis compared with controls (no amniocentesis) did (2.1% versus 1.3%; relative risk (RR) 1.02 to 2.52). Early amniocentesis is not a safe early alternative to second trimester amniocentesis because of increased pregnancy loss (7.6% versus 5.9%; RR 1.29, 95% CI 1.03 to 1.61) and higher incidence of talipes compared to CVS (1.8% versus 0.2%; RR 6.43, 95% CI 1.68 to 24.64).Compared with second trimester amniocentesis, transcervical CVS carries a significantly higher risk of pregnancy loss (14.5% versus 11%; RR 1.40, 95% CI 1.09 to 1.81) and spontaneous miscarriage (12.9% versus 9.4%; RR 1.50, 95% CI 1.07 to 2.11). One study compared transabdominal CVS with second trimester amniocentesis and found no significant difference in the total pregnancy loss between the two procedures (6.3% versus 7%). Transcervical CVS is more technically demanding than transabdominal CVS with more failures to obtain sample and more multiple insertions.

Reviewer's conclusions: Second trimester amniocentesis is safer than transcervical CVS and early amniocentesis. If earlier diagnosis is required, transabdominal CVS is preferable to early amniocentesis or transcervical CVS. In circumstances where transabdominal CVS may be technically difficult the preferred options are transcervical CVS in the first trimester or second trimester amniocentesis.

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References

References to studies included in this review

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    2. Collaborative Randomised trial to assess safety and fetal outcome of early and midtrimester amniocentesis. The Canadian Early and Mid-trimester Amniocentesis Trial (CEMAT) Group. Lancet. 1998;351(9098):242–7. - PubMed
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References to studies excluded from this review

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Additional references

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    1. Burton BK, Schultz CJ, Angle B, Burd LI. An increased incidence of haemangiomas in infants born following chorionic villus sampling (CVS) Prenatal Diagnosis. 1995;15:209–14. - PubMed
    1. Department of Obstetrics and Gynecology. Tietung Hospital, Anshan, China Fetal sex prediction by sex chromatin of chorionic cells during early pregnancy. Chinese Medical Journal. 1975;1:117–26. - PubMed
    1. Froster UG, Jackson L. Limb defects and chorionic villus sampling: results from an international registry, 1992-94. Lancet. 1996;347:489–94. - PubMed
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