孕早期（13 + 0至14 + 6周）和孕中期羊膜穿刺术报告：十年经验
A report of early (13 + 0 to 14 + 6 weeks) and mid-trimester amniocenteses: 10 years' experience.
作者信息
Centini G, Rosignoli L, Kenanidis A, Scarinci R, Petraglia F
机构信息
Prenatal Diagnosis Center, Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Siena, Italy.
出版信息
J Matern Fetal Neonatal Med. 2003 Aug;14(2):113-7. doi: 10.1080/jmf.14.2.113.117.
OBJECTIVE
To report in singleton pregnancies the post-procedure safety and maternal complications of early amniocenteses performed between 13 + 0 and 14 + 6 weeks of gestation and mid-trimester amniocenteses performed between 15 + 0 and 18 + 6 weeks of gestation.
METHODS
The study was carried out at the Prenatal Diagnosis Center, Siena University, Italy, during a 10-year period, following the Regional Protocol for Prenatal Diagnosis. Our study population included 3769 amniocenteses, 475 early and 3294 mid-trimester. Complications considered included miscarriage (immediately after the procedure and until 24 weeks of gestation), blood-stained amniotic fluid, failed cell culture, amniotic fluid leakage, preterm premature rupture of the membranes (PROM), preterm delivery and presence of neonatal talipes equinovarous.
RESULTS
Cytogenetic anomalies were found in 111 cases (2.9%), 18 occurring early and the other 93 in mid-trimester. Miscarriage occurred in two cases in the early amniocentesis group (0.4%) and in ten cases among the mid-trimester group (0.3%). The overall loss of pregnancies due to amniocentesis in this study was 0.3%. Amniotic fluid was stained in 1.2% in the early group and 0.9% in the mid-trimester group. Amniotic fluid leakage was noted in 1.4% and 1.2%, preterm PROM was noted in 3.3%) and 3%, and preterm delivery occurred in 8% and 7.6%, respectively. There were no cases of failed amniotic culture and no cases of talipes equinovarous documented.
CONCLUSIONS
The risks of early amniocentesis performed between 13 + 0 and 14 + 6 weeks appear to be comparable to those of mid-trimester amniocentesis and thus early amniocentesis could be offered to the parents, as an alternative to chorionic villus sampling, in order to obtain cytogenetic results earlier in pregnancy without a significantly increased risk for both mother and fetus. Further operators' experience with the method, based on long and accurate follow-up, and further studies are necessary to assess the safety of the method.
目的
报告单胎妊娠中，在妊娠13⁺⁰至14⁺⁶周进行的早期羊膜腔穿刺术以及在妊娠15⁺⁰至18⁺⁶周进行的孕中期羊膜腔穿刺术的术后安全性及母体并发症。
方法
本研究在意大利锡耶纳大学产前诊断中心开展，为期10年，遵循地区产前诊断方案。我们的研究人群包括3769例羊膜腔穿刺术，其中475例为早期穿刺，3294例为孕中期穿刺。所考虑的并发症包括流产（穿刺术后即刻至妊娠24周）、羊水血性、细胞培养失败、羊水渗漏、胎膜早破、早产以及新生儿马蹄内翻足。
结果
发现111例（2.9%）存在细胞遗传学异常，其中18例发生在早期，另外93例发生在孕中期。早期羊膜腔穿刺组有2例流产（0.4%），孕中期组有10例流产（0.3%）。本研究中因羊膜腔穿刺导致的妊娠总体丢失率为0.3%。早期组羊水血性发生率为1.2%，孕中期组为0.9%。羊水渗漏发生率分别为1.4%和1.2%，胎膜早破发生率分别为3.3%和3%，早产发生率分别为8%和7.6%。未记录到细胞培养失败及马蹄内翻足病例。
结论
在妊娠13⁺⁰至14⁺⁶周进行的早期羊膜腔穿刺术风险似乎与孕中期羊膜腔穿刺术相当，因此可以向父母提供早期羊膜腔穿刺术，作为绒毛取样的替代方法，以便在妊娠早期获得细胞遗传学结果，而不会显著增加母亲和胎儿的风险。基于长期且准确的随访，进一步积累操作者使用该方法的经验以及开展更多研究对于评估该方法的安全性是必要的。
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