University Clinic of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, University Medical Center Halle (Saale), Martin- Luther- University Halle-Wittenberg, Halle, Germany.
Institute of Anatomy, Leipzig-University, Leipzig, Germany.
J Perinat Med. 2022 Sep 8;51(3):379-386. doi: 10.1515/jpm-2022-0229. Print 2023 Mar 28.
Chorioamniotic separation (CAS) at the time of standard amniocentesis (AC) is a risk factor for postprocedural complications and should be avoided. The aim of this study was to quantify procedure-related risks after AC with a 29G-needle in cases of CAS, and evaluation of perinatal outcome in CAS after 15 weeks' gestation (GW).
Retrospective analysis of genetic AC with a pencil-point 29G needle after 15 completed GW in pregnancies, in which the fetal membranes were not yet fused. Included into the study were women aged 16-44 years with at least 15 completed GWs referred for second trimester AC to identify fetal chromosomal aberrations.
437 ACs were made in total with the 29G-needle. The median maternal age was 30 (16-44) years. 145 cases showed CAS where the distance between chorion and amnion was 0.10-10.02 mm at AC. 38 pregnancies were terminated, 37 of which had a genetic disorder. The risk of aneuploidy increases by a factor of 2 (95% CI 1.4-2.8) for every 1 mm of CAS enlargement. No procedure-related complications were found up to two weeks after the AC.
CAS seems to be massively underreported. Early diagnosis in case of CAS is something to strive for as CAS could be an indicator of genetic abnormalities - a "soft marker". With the atraumatic 29G needle, the risk of complications after AC in CAS seems to be very low.
在标准羊膜穿刺术（AC）时发生的羊膜绒毛膜分离（CAS）是术后并发症的危险因素，应予以避免。本研究的目的是量化在 CAS 情况下使用 29G 针进行 AC 相关的风险，并评估 15 周妊娠（GW）后 CAS 的围产结局。
回顾性分析了在 GW 完成至少 15 周的妊娠中，使用笔尖式 29G 针进行的遗传 AC，此时胎膜尚未融合。本研究纳入了年龄在 16-44 岁之间的女性，她们因中期妊娠 AC 来识别胎儿染色体异常。
总共进行了 437 次使用 29G 针的 AC。产妇的中位年龄为 30 岁（16-44 岁）。145 例出现 CAS，AC 时绒毛膜和羊膜之间的距离为 0.10-10.02mm。38 例妊娠终止，其中 37 例存在遗传异常。CAS 每扩大 1mm，非整倍体的风险增加 2 倍（95%CI 1.4-2.8）。AC 后两周内未发现与操作相关的并发症。
CAS 似乎被严重低估了。在 CAS 的情况下，早期诊断是值得努力的，因为 CAS 可能是遗传异常的“软标记”。使用无创伤性的 29G 针，在 CAS 中进行 AC 后的并发症风险似乎非常低。
