Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India.
Arch Gynecol Obstet. 2023 Aug;308(2):463-470. doi: 10.1007/s00404-022-06662-6. Epub 2022 Aug 8.
Several congenital abnormalities present late in pregnancy necessitating invasive testing to rule out genetic/infectious causes at late gestation. Not many studies have described the indications/safety of a late gestation amniocentesis.
All records of amniocentesis performed beyond 24 weeks were reviewed and evaluated for indications, positive yield and complications.
About 187 women had an amniocentesis after 24 weeks for various indications with CNS abnormalities being the commonest. The total yield of positive findings was 14.60% (22/150; excluding 2 VOUS). CNS, multiple system involvement and skeletal system anormalities yielded maximum results. About 32.05% abnormalities could have potentially been detected at the time of a routine anomaly scan. Amongst all the deliveries, 2.1% delivered spontaneously within a week of the procedure and about 5.4% delivered spontaneously within a month of the procedure.
The study emphasises the need for additional accreditation (FMF, ISUOG) of sonographers to ensure the detection of anomalies at the routine 18-20 weeks scan. Inspite of a normal mid-trimester scan, central nervous system and gastrointestinal abnormalities presented more commonly after 24 weeks. The high positive yield in our study highlights the importance of testing even in late pregnancy beyond the legal age of termination. The test could clearly stratify the pregnancies with a poor outcome whilst reassuring the others. The procedure itself did not lead to a neonatal death due to prematurity.
一些先天性异常在妊娠晚期出现，需要进行有创性检查以排除遗传/感染原因。很少有研究描述过妊娠晚期羊膜穿刺术的适应证/安全性。
回顾了所有在 24 周后进行的羊膜穿刺术记录，并对适应证、阳性结果和并发症进行了评估。
约有 187 名妇女因各种原因在 24 周后进行了羊膜穿刺术，以中枢神经系统异常最为常见。阳性结果的总检出率为 14.60%（22/150；不包括 2 例意义未明的超声软指标）。中枢神经系统、多系统受累和骨骼系统异常的检出率最高。约 32.05%的异常可能在常规异常扫描时就能被发现。在所有分娩中，2.1%在术后一周内自然分娩，约 5.4%在术后一个月内自然分娩。
本研究强调需要对超声医师进行额外的认证（FMF、ISUOG），以确保在 18-20 周的常规扫描中检测到异常。尽管中期扫描正常，但中枢神经系统和胃肠道异常在 24 周后更为常见。本研究的高阳性检出率强调了即使在妊娠晚期（超过终止妊娠的法定年龄）也进行检测的重要性。该检测可以明确区分预后不良的妊娠和预后良好的妊娠，同时也能让其他孕妇安心。该操作本身并未因早产导致新生儿死亡。
