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Læknablaðið - 01.03.2014, Qupperneq 23

Læknablaðið - 01.03.2014, Qupperneq 23
LÆKNAblaðið 2014/100 151 ENGLISH SUMMARY introduction: Amniocentesis and chorionic villus sampling (CVS) are methods for fetal chromosomal diagnosis. Pregnant women aged ≥35 years have been offered amniocentesis in Iceland for over 35 years. The main testing indication was maternal age until 1998, when universal early screening was introduced. We examined outcome and fetal loss following amniocentesis and CVS in singleton and twin pregnancies, age distribution changes, reasons for the procedures and fetal karyotype diagnoses. Material and methods: Retrospective quantitative study on women who had amniocentesis and CVS (n=2323) in the Prenatal Diagnosis Unit at Landspitali University Hospital during 1998-2007. Unit files and individual case and maternity records were used to retrieve information on the indications and on maternal age, type of procedure, outome of pregnancy, and the fetal karyotype. Results: The number of procedures was substantially reduced from over 500 to just over 100 per year, with a proportional shift to CVS. Procedure-related fetal loss was 22/2323 (0.9%), with no significant difference between amniocentesis (0.8%) and CVS (1.3%). The diffe- rence decreased in the latter half of the study period to 0.7% and 0.8%, respectively. Age-related reasons decreased from 81.2% to 30.8%. Conclusion: The fetal loss incidence rates indicated that amniocentesis and CVS have the same safety level as elsewhere. Complications were uncommon. With CVS fetal screening was moved to an earlier time in pregnancy. Early screening has changed the maternal age profile and is available to all women on request. The information obtained can be used to improve service information. Fetal loss after amniocentesis and chorionic villus sampling in iceland Kristin Rut Haraldsdottir, Helga Gottfredsdottir, Reynir Tomas Geirsson keywords: Amniocentesis, chorion villus sampling, miscarriage, fetal loss, singelton pregnancy, twins. Correspondence: Kristín Rut Haraldsdóttir, krruthar@landspitali.is 1Faculty of Nursing, Department of Midwifery, University of Iceland, 2Women´s Clinic, Landspitali University Hospital, 3Faculty of Medicine, University of Iceland, Reykjavik, Iceland. Heimildir 1. Jóhannsson JH. Litningarannsóknir til fósturgreiningar. Læknablaðið 2001; 87: 451-3. 2. Tabor A, Madsen M, Obel E, Philip J, Bang J, Nörgaard- Pedersen B. Randomised controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet 1986; 1: 1287-93. 3. Harðardóttir H. Þróun fósturgreiningar. Læknablaðið 2001; 87: 399-400. 4. Cullen MT, Gabrielli S, Green JJ, Rizzo N, Mahoney MJ, Salafia, C, et.al. Diagnosis and significance of cystic hygroma in the first trimester. Prenat Diagn 1990; 10: 643- 51. 5. Nicolaides KH, Azar G, Byrne D, Mansur C, Marks K. Fetal nuchal translucency: ultrasound screening for chromosomal defects in first trimester of pregnancy. BMJ 1992; 304: 867-9. 6. Szabo J, Gellen J. Nuchal fluid accumulation in trisomy-21 detected by vaginal sonography in first trimester. Lancet 1990; 336: 1133. 7. Nicolaides KH, Sebire NJ, Snijders RJM. The 11-14 seek scan. The diagnosis of fetal abnormalities. Parthenon Publishing Group, New York 1999. 8. Gaudry P, Grange G, Lebbar A, Choiset A, Girard S, Goffinet F, et.al. Fetal loss after amniocentesis in a series of 5,780 procedures. Fetal Diagn Ther 2008; 23: 217-21. 9. Tabor A, Vestergaard CH, Lidegaard O. Fetal loss rate after chorionic villus sampling and amniocentesis: an 11-year national registry study. Ultrasound Obstet Gynecol 2009; 34: 19-24. 10. Mujezinovic F, Alfirevic Z. Procedure-Related Complications of Amniocentesis and Chorionic Villous Sampling: A Systematic Review. Obstet Gynecol 2007; 110: 687-94. 11. Tabor A, Alfirevic Z. Update on Procedure-Related Risks for Prenatal Diagnosis Techniques. Fetal Diagn Ther 2010; 27: 1-7. 12 Lög um fæðingar- og foreldraorlof nr. 95/2000. Andvana fæðing og fósturlát. althingi.is 13. Bjarnadóttir RI, Garðarsdóttir G, Smárason AK, Pálsson GI. Skýrsla frá Fæðingaskráningunni fyrir árið 2010. Kvennadeild og vökudeild Barnaspítala Hringsins, Landspítali Háskólasjúkrahús, Reykjavík 2011. 14. Lander T. Neonatal and perinatal mortality: country, regional and global estimates 2006. World Health Organization 2006. 15. Cahill AG, Macones GA, Stamilio DM, Dicke JM, Crane JP, Odibo AO. Pregnancy loss rate after mid-trimester amniocentesis in twin pregnancies. Am J Obstet Gynecol 2009; 200: 257, e1-6. 16. Simonazzi G, Curti A, Farina A, Pilu G, Bovicelli L, Rizzo N. Amniocentesis and chorionic villus sampling in twin gestations: which is the best sampling technique? Am J Obstet Gynecol 2010; 202: 365. 17. Royal College of Obstetricians and Gynaecologists. Amniocentesis and chorionic villus sampling. Green-top Guideline nr. 8. June. RCOG Press, London 2010. 18. Cebesoy FB, Balat O, Pehlivan S, Kutlar I, Dikensoy E, Ugur MG. Is pregnancy loss after amniocentesis related to the volume of amniotic fluid obtained? Arch Gynecol Obstet 2009; 279: 357-60. 19. Marttala J, Ranta JK, Kaijomaa M, Nieminen P, Laitinen P, Kokkonen H, et. al. More invasive procedures are done to detect each case of Down´s syndrome in younger women. Acta Obstet Gynecol Scand 2011; 90: 642-7. 20. Grande M, Arigita M, Borobio V, Jimenez JM, Fernandez S, Borrell A. First-trimester detection of structural abnor- malities and the role of aneuploidy markers. Ultrasound Obstet Gynecol 2012; 39: 157-63. R A N N S Ó K N
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