Di Mascio D, Khalil A, Rizzo G, Buca D, Liberati M, Martellucci C A, Flacco M E, Manzoli L, D'Antonio F
Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.
Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK.
Ultrasound Obstet Gynecol. 2020 Nov;56(5):647-655. doi: 10.1002/uog.22143. Epub 2020 Oct 13.
To assess the rate of fetal loss following amniocentesis or chorionic villus sampling (CVS) in twin pregnancy.
MEDLINE, EMBASE and Cochrane databases were searched for studies reporting procedure-related complications following amniocentesis or CVS in twin pregnancy. The primary outcome was the rate of procedure-related fetal loss. The secondary outcomes were fetal loss occurring before 24 weeks of gestation and fetal loss occurring within 4 weeks after the procedure. Head-to-head meta-analyses were used to compare directly each outcome, between women undergoing amniocentesis and those not undergoing amniocentesis and between women undergoing CVS and those not undergoing CVS, and to compute pooled risk differences (RD) between women exposed and those not exposed to each invasive procedure. Additionally, meta-analyses of proportions were used to estimate the pooled rates of each of the three outcomes in women undergoing amniocentesis or CVS and in controls.
Sixteen studies (3419 twin pregnancies undergoing and 2517 not undergoing an invasive procedure) were included. Head-to-head meta-analyses comparing directly twin pregnancies undergoing and those not undergoing amniocentesis showed a higher risk for overall fetal loss in those undergoing amniocentesis (odds ratio (OR), 1.46 (P = 0.04); RD, 0.013 (P = 0.04)), while there was no difference in the risk of either fetal loss before 24 weeks of gestation (OR, 1.59 (P = 0.06); RD, 0.010 (P = 0.11)) or fetal loss within 4 weeks after the procedure (OR, 1.38 (P = 0.3); RD, 0.003 (P = 0.8)). Overall, the pooled rate of fetal loss was 2.4% (95% CI, 1.4-3.6%) in twin pregnancies undergoing amniocentesis compared with 2.4% (95% CI, 0.9-4.6%) in those not undergoing amniocentesis. Head-to-head meta-analyses directly comparing twin pregnancies undergoing and those not undergoing CVS showed no significant difference in either overall fetal loss (OR, 1.61 (P = 0.5); RD, 0.003 (P = 0.8)) or fetal loss before 24 weeks of gestation (OR, 1.61 (P = 0.5); RD, 0.003 (P = 0.8)). Overall, the pooled rate of fetal loss was 2.0% (95% CI, 0.0-6.5%) in twin pregnancies undergoing CVS compared with 1.8% (95% CI, 0.3-4.2%) in those not undergoing CVS.
The risk of fetal loss following amniocentesis and CVS in twins is lower than reported previously and the rate of fetal loss before 24 weeks of gestation, or within 4 weeks after the procedure, did not differ from the background risk in twin pregnancy not undergoing invasive prenatal testing. These data can guide prenatal counseling for twin pregnancies undergoing invasive procedures. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
评估双胎妊娠行羊膜腔穿刺术或绒毛取样（CVS）后的胎儿丢失率。
检索MEDLINE、EMBASE和Cochrane数据库，查找报告双胎妊娠行羊膜腔穿刺术或CVS后与操作相关并发症的研究。主要结局是与操作相关的胎儿丢失率。次要结局是妊娠24周前发生的胎儿丢失以及操作后4周内发生的胎儿丢失。采用直接比较的头对头荟萃分析，比较接受羊膜腔穿刺术的女性与未接受羊膜腔穿刺术的女性、接受CVS的女性与未接受CVS的女性的各项结局，并计算暴露于每种侵入性操作的女性与未暴露女性之间的合并风险差异（RD）。此外，采用比例荟萃分析来估计接受羊膜腔穿刺术或CVS的女性以及对照组中三种结局各自的合并发生率。
纳入16项研究（3419例双胎妊娠接受侵入性操作，2517例未接受）。直接比较接受和未接受羊膜腔穿刺术的双胎妊娠的头对头荟萃分析显示，接受羊膜腔穿刺术的女性总体胎儿丢失风险更高（比值比（OR），1.46（P = 0.04）；RD，0.013（P = 0.04）），而妊娠24周前胎儿丢失风险（OR，1.59（P = 0.06）；RD，0.010（P = 0.11））或操作后4周内胎儿丢失风险（OR，1.38（P = 0.3）；RD，0.003（P = 0.8））无差异。总体而言，接受羊膜腔穿刺术的双胎妊娠胎儿丢失合并发生率为2.4%（95%CI，1.4 - 3.6%），未接受羊膜腔穿刺术的为2.4%（95%CI，0.9 - 4.6%）。直接比较接受和未接受CVS的双胎妊娠的头对头荟萃分析显示，总体胎儿丢失（OR，1.61（P = 0.5）；RD，0.003（P = 0.8））或妊娠24周前胎儿丢失（OR，1.61（P = 0.5）；RD，0.003（P = 0.8））均无显著差异。总体而言，接受CVS的双胎妊娠胎儿丢失合并发生率为2.0%（95%CI，0.0 - 6.5%），未接受CVS的为1.8%（95%CI，0.3 - 4.2%）。
双胎妊娠行羊膜腔穿刺术和CVS后的胎儿丢失风险低于先前报道，妊娠24周前或操作后4周内的胎儿丢失率与未进行侵入性产前检查的双胎妊娠的背景风险无差异。这些数据可为接受侵入性操作的双胎妊娠的产前咨询提供指导。©2020国际妇产科超声学会。
