Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Studysetting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Studydesign: Retrospective descriptive study. StudysubjectsandMethods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure; threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful
References
[1]
American College of Obstetricians and Gynecologists (2007) ACOG Practice Bulletin No. 88: Invasive Prenatal Testing for Aneuploidy. Obstetrics & Gynecology, 110, 1459-1467.
[2]
Ghidini, A., Wilkins-Haug, L. and Barss, V.A. (2019) Chorionic Villus Sampling. https://www.uptodate.com/contents/chorionic-villus-sampling
[3]
Royal College of Obstetricians and Gynaecologists (2010) Amniocentesis and Chorionic Villus Sampling. Green Top Guideline No. 8. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/amniocentesis-and-chorionic-villus-sampling-green-top-guideline-no-8/
[4]
Young, C., von Dadelszen, P. and Alfirevic, Z. (2013) Instruments for Chorionic Villus Sampling for Prenatal Diagnosis. Cochrane Database of Systematic Reviews, No. 1, CD000114. https://doi.org/10.1002/14651858.cd000114.pub2
[5]
Mujezinovic, F. and Alfirevic, Z. (2011) Analgesia for Amniocentesis or Chorionic Villus Sampling. Cochrane Database of Systematic Reviews, No. 11, CD008580. https://doi.org/10.1002/14651858.cd008580.pub2
[6]
Wapner, R.J. (1997) Chorionic Villus Sampling. Obstetrics and Gynecology Clinics of North America, 24, 83-110. https://doi.org/10.1016/s0889-8545(05)70291-6
[7]
Ghi, A., Sotiriadis, P., Calda, F., Da Silva Costa, N., Raine-Fenning, Z. and Alfirevic, G. (2016) McGillivray International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) 2016. https://obgyn.onlinelibrary.wiley.com/authored-by/ContribRaw/International+Society+of+Ultrasound+in+Obstetrics+and+Gynecology+%28ISUOG%29
[8]
Iqbal, M.A., Manko, G.F., Trabin, J., Virelles, C. and Jackson, L. (1998) Cytogenetic Evaluation of 1000 Cases of Chorionic Villus Sampling. Annals of Saudi Medicine, 18, 506-510. https://doi.org/10.5144/0256-4947.1998.506
[9]
Brambati, B., Terzian, E. and Tognoni, G. (1991) Randomized Clinical Trial of Transabdominal versus Transcervical Chorionic Villus Sampling Methods. Prenatal Diagnosis, 11, 285-293. https://doi.org/10.1002/pd.1970110503
[10]
Habib, F. (2011) Antenatal Screening Strategies for down Syndrome: Analysis of Existing Protocols and Implications in the Kingdom of Saudi Arabia. British Journal of Medicine and Medical Research, 1, 105-121. https://doi.org/10.9734/bjmmr/2011/317
[11]
Silver, R.K., Russell, T.L., Kambich, M.P., Leeth, E.A., MacGregor, S.N. and Sholl, J.S. (1998) Midtrimester Amniocentesis. Influence of Operator Caseload on Sampling Efficiency. Journal of Reproductive Medicine, 43, 191-195.
[12]
Persutte, W.H. and Lenke, R.R. (1995) Failure of Amniotic-Fluid-Cell Growth: Is It Related to Fetal Aneuploidy? The Lancet, 345, 96-97. https://doi.org/10.1016/s0140-6736(95)90064-0
[13]
Firth, H. (1997) Chorion Villus Sampling and Limb Deficiency—Cause or Coincidence? Prenatal Diagnosis, 17, 1313-1330. https://doi.org/10.1002/(sici)1097-0223(199712)17:13<1313::aid-pd298>3.3.co;2-y
[14]
Bringman, J.J. (2014) Invasive Prenatal Genetic Testing: A Catholic Healthcare Provider's Perspective. The Linacre Quarterly, 81, 302-313. https://doi.org/10.1179/2050854914y.0000000022
[15]
Hogge, W.A., Schonberg, S.A. and Golbus, M.S. (1986) Chorionic Villus Sampling: Experience of the First 1000 Cases. American Journal of Obstetrics and Gynecology, 154, 1249-1252. https://doi.org/10.1016/0002-9378(86)90707-6
[16]
Alkuraya, F.S. and Kilani, R.A. (2001) Attitude of Saudi Families Affected with Hemoglobinopathies towards Prenatal Screening and Abortion and the Influence of Religious Ruling (Fatwa). Prenatal Diagnosis, 21, 448-451. https://doi.org/10.1002/pd.76
[17]
El‐Beshlawy, A., El‐Shekha, A., Momtaz, M., Said, F., Hamdy, M., Osman, O., et al. (2012) Prenatal Diagnosis for Thalassaemia in Egypt: What Changed Parents' Attitude? Prenatal Diagnosis, 32, 777-782. https://doi.org/10.1002/pd.3901
[18]
Jackson, L.G., Zachary, J.M., Fowler, S.E., Desnick, R.J., Golbus, M.S., Ledbetter, D.H., et al. (1992) A Randomized Comparison of Transcervical and Transabdominal Chorionic-Villus Sampling. New England Journal of Medicine, 327, 594-598. https://doi.org/10.1056/nejm199208273270903
[19]
Smidt-Jensen, S., Philip, J., Lundsteen, C., Permin, M., Zachary, J.M. and Fowler, S.E. (1992) Randomised Comparison of Amniocentesis and Transabdominal and Transcervical Chorionic Villus Sampling. The Lancet, 340, 1237-1244. https://doi.org/10.1016/0140-6736(92)92946-d
[20]
Planteydt, H. (1986) Amniotic Bands and Malformations in Child Born after Pregnancy Screened by Chorionic Villus Biopsy. The Lancet, 328, 756-757. https://doi.org/10.1016/s0140-6736(86)90283-7
[21]
Christiaens, G.C.M.L., van Baarlen, J., Huber, J. and Leschot, N.J. (1989) Fetal Limb Constriction: A Possible Complication of CVS. Prenatal Diagnosis, 9, 67-71. https://doi.org/10.1002/pd.1970090110
[22]
Firth, H.V., Boyd, P.A., Lindenbaum, R.H., Huson, S.M., Chamberlain, P. and Mackenzie, I.Z. (1991) Severe Limb Abnormalities after Chorion Villus Sampling at 56-66 Days’ Gestation. The Lancet, 337, 762-763. https://doi.org/10.1016/0140-6736(91)91374-4
[23]
Firth, H.V., Huson, S.M., Boyd, P.A., Chamberlain, P.F., MacKenzie, I. and Morriss-Kay, G.M. (1994) Analysis of Limb Reduction Defects in Babies Exposed to Chorionic Villus Sampling. The Lancet, 343, 1069-1071. https://doi.org/10.1016/s0140-6736(94)90182-1
[24]
Alfirevic, Z., Mujezinovic, F., Sundberg, K. and Brigham, S. (2003) Amniocentesis and Chorionic Villus Sampling for Prenatal Diagnosis. Cochrane Database of Systematic Reviews, No. 3, CD003252.
[25]
Rhoads, G.G., Jackson, L.G., Schlesselman, S.E., de la Cruz, F.F., Desnick, R.J., Golbus, M.S., et al. (1989) The Safety and Efficacy of Chorionic Villus Sampling for Early Prenatal Diagnosis of Cytogenetic Abnormalities. New England Journal of Medicine, 320, 609-617. https://doi.org/10.1056/nejm198903093201001