Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
Int J Biochem Cell Biol. 2022 Jun;147:106226. doi: 10.1016/j.biocel.2022.106226. Epub 2022 May 14.
The culture failure rate of conventional karyotyping in products of conception evacuated from early pregnancy loss by traditional electrical vacuum aspiration and/or dilation & curettage remains high. We aim to determine whether obtaining products of conception from early pregnancy loss via another evacuation approach, ultrasound-guided manual vacuum aspiration, could decrease the culture failure rate of karyotyping.
For patients with early pregnancy loss, ultrasound-guided manual vacuum aspiration (Case group) and traditional electrical vacuum aspiration and/or dilation & curettage (Control group) were applied as surgical methods for pregnancy loss management respectively. The evacuated products of conception were subjected to cytogenetic karyotyping analysis. The primary outcome was the culture failure rate of karyotyping. Secondary outcomes included the chromosomal abnormality spectrum, maternal cell contamination, and complications from the manual vacuum aspiration procedure.
For the case group, 132 products of conception were genetically analyzed by conventional karyotyping. The culture failure rate was significantly lower than that of the control cohort (2.3% vs 7.4%, p = 0.027). 65.2% of cases were abnormal within the detection scope of karyotyping. The euploid female to male ratio was 0.82 (18:22), suggesting a lower likelihood of maternal cell contamination. The efficacy in achieving complete evacuation was 99.6%. There were no significant complications from the procedure.
Ultrasound-guided manual vacuum aspiration approach significantly decreased the culture failure rate of karyotyping and decreased maternal cell contamination tendency, enabling a high and accurate cytogenetic diagnosis. It is especially crucial when the cytogenetic analysis is required in the early pregnancy loss clinics.
通过传统的电动吸引术和/或扩张刮宫术从早期妊娠流产中吸出的妊娠产物中常规核型分析的培养失败率仍然很高。我们旨在确定通过另一种抽吸方法，即超声引导下的手动真空抽吸，从早期妊娠流产中获得妊娠产物是否可以降低核型分析的培养失败率。
对于早期妊娠流产的患者，分别采用超声引导下的手动真空抽吸（病例组）和传统的电动吸引术和/或扩张刮宫术（对照组）作为妊娠流产管理的手术方法。抽吸的妊娠产物进行细胞遗传学核型分析。主要结局是核型培养失败率。次要结局包括染色体异常谱、母体细胞污染和手动真空抽吸程序的并发症。
对于病例组，132 个妊娠产物通过常规核型分析进行了遗传分析。培养失败率明显低于对照组（2.3%比 7.4%，p=0.027）。在核型检测范围内，65.2%的病例异常。可检测范围内的整倍体女性与男性的比值为 0.82（18:22），提示母体细胞污染的可能性较低。完全排空的效果为 99.6%。该过程无明显并发症。
超声引导下的手动真空抽吸方法显著降低了核型分析的培养失败率，并降低了母体细胞污染的趋势，实现了高而准确的细胞遗传学诊断。在早期妊娠流产临床中需要进行细胞遗传学分析时，这一点尤为重要。
