The effect of diagnostic amniocentesis and its complications on early spontaneous abortion
Keywords:
Abortion, Amniocentesis, Complications, PregnancyAbstract
Introduction: The occurrence of early abortion after amniocentesis is a serious problem in the fields of obstetrics and gynecology, and it is always important to discover the factors influencing this phenomenon. The incidence rate has been reported in different studies, even up to about 10%. So far, no studies have been conducted in Iran on the effect of amniocentesis and related complications on early abortion. The aim of this study was to determine the effects of amniocentesis and relevant complications on the incidence of early abortion in pregnant women undergoing amniocentesis.
Methods: This cohort study was conducted between March 2014 and March 2016 on pregnant candidates for amniocentesis referred to the perinatology clinic at Ommol-Banin Hospital, Mashhad, Iran. Amniocentesis was performed for all patients with about 20-30cc in the same manner by a perinatologist. Maternal blood group, causes of amniocentesis, amniotic fluid profile (liquid color), status of inserting the needle through the placenta during amniocentesis, amniotic fluid leakage, and bleeding after amniocentesis were considered as exposure factors, and spontaneous abortion after amniocentesis until the end of the 20th week of pregnancy was taken as a consequence. Data were analyzed using IBM-SPSS version 20 via t-test and chi-square. Relative risk (RR) was calculated to determine the causal relationship of exposure with the consequences of spontaneous abortion during the first week after amniocentesis.
Results: This study was performed on 1000 pregnant women with mean age of 33.4±6.0 years (minimum 16, maximum 48 years). The incidence rate of spontaneous abortion after amniocentesis was obtained 1%. There was no association among causes of amniocentesis, maternal blood group, maternal underlying diseases, history of diseases associated with pregnancy, and spontaneous abortion. Based on the chi-square test, a significant statistical relationship was found between amniotic fluid leakage and spontaneous abortion (RR=15.37, p=0.001). There was also a significant statistical relationship between bleeding after amniocentesis and spontaneous abortion; so that in patients with more bleeding, spontaneous abortion was more prevalent (RR=6.83, P=0.001).
Conclusion: According to the results, it seems that amniotic fluid leakage and bleeding after amniocentesis should be considered as two serious complications of amniocentesis, which can cause the incidence of spontaneous abortion in pregnant patients undergoing amniocentesis.
References
Rapp R. Testing women, testing the fetus: The social impact of amniocentesis in America: Routledge;
Enzensberger C, Pulvermacher C, Degenhardt J, Kawacki A, Germer U, Gembruch U, et al. Fetal loss rate
and associated risk factors after amniocentesis, chorionic villus sampling and fetal blood sampling.
Ultraschall Med. 2012; 33(7): 75-9. doi: 10.1055/s-0031-1299388. PMID: 22623130.
Bakker M, Birnie E, Robles de Medina P, Sollie K, Pajkrt E, Bilardo CM. Total pregnancy loss after
chorionic villus sampling and amniocentesis - A cohort study. Ultrasound Obstet Gynecol. 2016. doi:
1002/uog.15986. PMID: 27255564.
Kollmann M, Haeusler M, Haas J, Csapo B, Lang U, Klaritsch P. Procedure-related complications after
genetic amniocentesis and chorionic villus sampling. Ultraschall Med. 2012; 34(4): 345-8. doi: 10.1055/s- 0032-1312939. PMID: 22723040.
Enzensberger C, Pulvermacher C, Degenhardt J, Kawecki A, Germer U, Weichert J, et al. Outcome after
second-trimester amniocentesis and first-trimester chorionic villus sampling for prenatal diagnosis in
multiple gestations. Ultraschall Med. 2014; 35(2): 166-72. doi: 10.1055/s-0032-1330700. PMID:
Pruggmayer M, Baumann P, Schütte H, Osmers R, Bartels I, Jovanovich V, et al. Incidence of abortion
after genetic amniocentesis in twin pregnancies. Prenat Diagn. 1991; 11(8): 637-40. doi:
1002/pd.1970110822. PMID: 1766936.
Lehmann LS. How can we improve amniocentesis decision-making? Isr J Health Policy Res. 2016; 5: 4.
doi: 10.1186/s13584-016-0060-0. PMID: 26855767, PMCID: PMC4743405.
Prefumo F, Jauniaux E. Amniocentesis for fetal karyotyping: the end of an era? BJOG. 2016; 123(1): 99.
doi: 10.1111/1471-0528.13497. PMID: 26715343.
Theodora M, Antsaklis A, Antsaklis P, Blanas K, Daskalakis G, Sindos M, et al. Fetal loss following
second trimester amniocentesis. Who is at greater risk? How to counsel pregnant women? J Matern Fetal
Neonatal Med. 2016; 29(4): 590-5. doi: 10.3109/14767058.2015.1012061. PMID: 25747948.
Palle C, Andersen JW, Tabor A, Lauritsen JG, Bang J, Philip J. Increased risk of abortion after genetic
amniocentesis in twin pregnancies. Prenatal diagnosis. 1983; 3(2): 83-9. doi: 10.1002/pd.1970030202.
PMID: 6622400.
Kong CW, Leung TN, Leung TY, Chan LW, Sahota DS, Fung TY, et al. Risk factors for procedure‐
related fetal losses after mid‐trimester genetic amniocentesis. Prenat Diagn. 2006; 26(10): 925-30. doi:
1002/pd.1528. PMID: 16838383.
Saltvedt S, Almström H. Fetal loss rate after second trimester amniocentesis at different gestational age.
Acta Obstet Gynecol Scand. 1999; 78(1): 10-4. doi: 10.1080/j.1600-0412.1999.780104.x. PMID: 9926885.
Kan AS, Lee CP, Leung KY, Chan BC, Tang MH, Chan VH. Outcome of twin pregnancies after
amniocentesis. J Obstet Gynaecol Res. 2012; 38(2): 376-82. doi: 10.1111/j.1447-0756.2011.01721.x.
PMID: 22229750.
Theodora M, Antsaklis A, Antsaklis P, Blanas K, Daskalakis G, Sindos M, et al. Fetal loss following
second trimester amniocentesis. Who is at greater risk? How to counsel pregnant women? J Matern Fetal
Neonatal Med. 2016; 29(4): 590-5. doi: 10.3109/14767058.2015.1012061. PMID: 25747948.
Andreasen E, Kristoffersen K. Incidence of spontaneous abortion after amniocentesis: influence of
placental localization and past obstetric and gynecologic history. Am J Perinatol. 1989; 6(2): 268-73. doi:
1055/s-2007-999589. PMID: 2653338.
Giorlandino C, Mobili L, Bilancioni E, D'Alessio P, Carcioppolo O, Gentili P, et al. Transplacental
amniocentesis: is it really a higher-risk procedure? Prenat Diagn. 1994; 14(9): 803-6. doi:
1002/pd.1970140907. PMID: 7845887.
Marthin T, Liedgren S, Hammar M. Transplacental needle passage and other risk-factors associated with
second trimester amniocentesis. Acta Obstet Gynecol Scand. 1997; 76(8): 728-32. doi:
3109/00016349709024337. PMID: 9348248.
Bombard AT, Powers JF, Carter S, Schwartz A, Nitowsky HM. Procedure-related fetal losses in
transplacental versus nontransplacental genetic amniocentesis. Am J Obstet Gynecol. 1995; 172(3): 868-72.
doi: 10.1016/0002-9378(95)90013-6. PMID: 7892877.
Crane JP, Kopta MM. Genetic amniocentesis: Impact of placental position upon the risk or pregnancy loss.
Am J Obstet Gynecol. 1984; 150(7): 813-6. doi: 10.1016/0002-9378(84)90454-X. PMID: 6391172.
Tabor A, Philip J, Madsen M, Bang J, Obel EB, Nørgaard-Pedersen B. Randomised controlled trial of
genetic amniocentesis in 4606 low-risk women. Lancet. 1986; 1(8493): 1287-93. doi: 10.1016/S0140- 6736(86)91218-3. PMID: 2423826.
Kappel B, Nielsen J, Brogaard Hansen K, Mikkelsen M, Therkelsen AJ. Spontaneous abortion following
mid‐trimester amniocentesis. Clinical significance of placental perforation and blood‐stained amniotic
fluid. Br J Obstet Gynaecol. 1987; 94(1): 50-4. doi: 10.1111/j.1471-0528.1987.tb02252.x. PMID: 3814555.
Hess LW, Anderson RL, Golbus MS. Significance of opaque discolored amniotic fluid at second-trimester
amniocentesis. Obstet Gynecol. 1986; 67(1): 44-6. PMID: 3940336.
Wapner RJ, Johnson A, Davis G, Urban A, Morgan P, Jackson L. Prenatal diagnosis in twin gestations: a
comparison between second-trimester amniocentesis and first-trimester chorionic villus sampling. Obstet
Gynecol. 1993; 82(1): 49-56. PMID: 8515925.
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