Smidt-Jensen S, Philip J, Zachary J M, Fowler S E, Nørgaard-Pedersen B
Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Denmark.
Prenat Diagn. 1994 Jan;14(1):35-45. doi: 10.1002/pd.1970140107.
Of 2882 women allocated to either transabdominal CVS (TA) or transcervical CVS (TC) at two large obstetric centres in Denmark, 2707 had blood samples drawn before and 30 min after CVS for maternal serum-alpha-fetoprotein (MSAFP) measurement. 2535 of these women had cytogenetically normal pregnancies and 2091 of them went on to have samples drawn at the 18-20 week follow-up. Post-procedure MSAFP values were correlated to the biopsy method used, with mean MSAFP values significantly higher after TA than TC, 33 and 15 kU/l, respectively (P < 0.001). Following TA procedures, 18 per cent of cases had feto-maternal transfusion higher than 0.1 ml; this occurred in only 5 per cent of TC cases. MSAFP levels were associated with spontaneous fetal loss in the TA group but not in the TC group. TC, however, was followed by more losses than TA. The post-CVS MSAFP value was positively correlated with the amount of villi aspirated. The difference in post-procedure elevation in MSAFP 30 min later (average 18 kU/l higher for TA than for TC) was not reflected in raised levels at the 18-20 week follow-up. Study medians at mid-trimester did not differ from reference group medians established from a group of singleton pregnancies with sonographically determined gestational age who did not experience invasive procedures and delivered normal infants. Our findings suggest that CVS does not compromise mid-trimester MSAFP for screening for neural tube defects (NTDs). Extremely high mid-trimester MSAFP values in the TC group could predict imminent loss.
在丹麦的两个大型产科中心，2882名被分配接受经腹绒毛取样（TA）或经宫颈绒毛取样（TC）的女性中，2707人在绒毛取样前后抽取了血样，用于检测母血清甲胎蛋白（MSAFP）。其中2535名女性的妊娠细胞遗传学正常，其中2091人在18至20周随访时抽取了样本。术后MSAFP值与所采用的活检方法相关，TA术后的平均MSAFP值显著高于TC，分别为33和15 kU/l（P < 0.001）。在TA术后，18%的病例出现胎儿-母体输血超过0.1 ml；而在TC术后，只有5%的病例出现这种情况。TA组中，MSAFP水平与自然流产相关，而TC组则不然。然而，TC术后的流产情况比TA组更多。绒毛取样术后的MSAFP值与吸出的绒毛量呈正相关。术后30分钟MSAFP升高的差异（TA组平均比TC组高18 kU/l）在18至20周随访时并未反映在升高的水平上。孕中期的研究中位数与通过超声确定孕周、未接受侵入性操作且分娩正常婴儿的单胎妊娠组所建立的参考组中位数无差异。我们的研究结果表明，绒毛取样不会影响孕中期MSAFP用于神经管缺陷（NTD）筛查。TC组中极高的孕中期MSAFP值可能预示即将发生流产。
