Fortuny A, Borrell A, Soler A, Casals E, Costa D, Carrio A, Puerto B, Seres A, Cararach J, Delgado R
Department of Obstetrics and Gynecology, Hospital Clinic, University of Barcelona Medical School, Spain.
Prenat Diagn. 1995 Jun;15(6):541-50. doi: 10.1002/pd.1970150607.
The results of a prospective series of 1580 chorionic villus sampling (CVS) procedures using biopsy forceps are presented. Most of the procedures (1442), including 11 sets of twins, were performed by the transcervical approach (TC-CVS), using a curved-shank thin forceps, and 138 by the transabdominal approach (TA-CVS), using a trocar-guided straight thin forceps. The mean gestational age for TC-CVS was 10.9 weeks, and in 233 cases (16 per cent) the procedure was carried out between the 12th and 14th weeks. The mean gestational age for TA-CVS was 16.7 weeks. The major indication for CVS was advanced maternal age (92.7 per cent in the TC and 91.8 per cent in the TA approach), and indications for abnormal ultrasound findings were more common in the TA approach (4.5 per cent) than in TC-CVS (0.07 per cent). Although sampling was apparently accomplished in all the procedures, in 3.1 per cent of the TC-CVS and 2.2 per cent of TA-CVS procedures, the samples were less than 1 mg after dissection. A cytogenic report was obtained in 96.1 per cent of the TC-CVS and 90.6 per cent of the TA-CVS. Maternal serum alpha-fetoprotein (MSAFP) was measured before and after TC-CVS and the post-CVS MSAFP was positively correlated with the sample weight. Second-trimester amniocentesis following CVS was required in 5.2 per cent (TC-CVS) and 6.5 per cent (TA-CVS), due to the failure to obtain a cytogenetic report or diagnostic confirmation. The follow-up to the 20th week was 100 per cent by ultrasound scan, and 88.6 per cent from the 21st week to 1 week after delivery. Fetal loss rates within 2 weeks of the procedure were 1.7 per cent (TC-CVS) and 0.8 per cent (TA-CVS) and total fetal loss accumulated to 1 week after delivery was 4.6 per cent (TC-CVS) and 5.9 per cent (TA-CVS). Factors found to increase significantly fetal loss in the TC-CVS series were maternal age and the collection of very small samples, but not the number of forceps insertions.
本文介绍了使用活检钳进行的1580例绒毛取样（CVS）前瞻性系列研究结果。大部分操作（1442例），包括11例双胎，采用经宫颈途径（TC-CVS），使用弯柄细钳；138例采用经腹途径（TA-CVS），使用套管针引导的直细钳。TC-CVS的平均孕周为10.9周，233例（16%）在第12至14周进行操作。TA-CVS的平均孕周为16.7周。CVS的主要指征是孕妇年龄较大（TC组为92.7%，TA组为91.8%），超声异常发现的指征在TA组（4.5%）比TC-CVS组（0.07%）更常见。虽然所有操作中取样显然都已完成，但在3.1%的TC-CVS和2.2%的TA-CVS操作中，解剖后样本小于1mg。96.1%的TC-CVS和90.6%的TA-CVS获得了细胞遗传学报告。在TC-CVS前后测量孕妇血清甲胎蛋白（MSAFP），CVS后的MSAFP与样本重量呈正相关。由于未能获得细胞遗传学报告或诊断确认，5.2%（TC-CVS）和6.5%（TA-CVS）的患者在CVS后需要进行孕中期羊膜穿刺术。至第20周的随访通过超声扫描为100%，从第21周至产后1周为88.6%。操作后2周内的胎儿丢失率为1.7%（TC-CVS）和0.8%（TA-CVS），至产后1周累计的总胎儿丢失率为4.6%（TC-CVS）和5.9%（TA-CVS）。在TC-CVS系列中发现显著增加胎儿丢失的因素是孕妇年龄和采集非常小的样本，而不是钳插入次数。
