Smidt-Jensen S L, Permin M, Philip J, Lundsteen C, Grüning L K, Zachary J M, Fowler S E
Gynaekologisk obstetrisk afdeling, Rigshospitalet, København.
Ugeskr Laeger. 1993 May 10;155(19):1446-56.
The transabdominal chorionic villus sampling method was compared with the transcervical route and second trimester amniocentesis in a 3-winged randomised trial. Examination of 45 epidemiological variables showed the three procedure groups to be comparable at enrollment. In 3079 women at low genetic risk, we compared transabdominal with transcervical chorionic villus sampling and amniocentesis. The total fetal loss was 10.9%, 6.3% and 6.4% in the transcervical, transabdominal chorionic villus sampling groups and the amniocentesis group, respectively (p < 0.001). The two CVS procedures were compared in 2882 low and high genetic risk women with cytogenetically normal fetuses. Rates of unintended post-procedure loss were 3.7% and 7.7% for transabdominal CVS and transcervical CVS, respectively (p < 0.001), difference in rates 4.0%, 95% C.I. +2.3% to +5.8%. By a priori ultrasound scanning, more transcervical than transabdominal procedures (p < 0.001) were considered to be inaccessible for sampling. Our data indicate that transabdominal allows freer access to the placental site than transcervical sampling and is easier to adapt to than transcervical CVS. Women run comparable risks with transabdominal CVS and amniocentesis. Given the results of our study, transabdominal procedures remain the first choice for prenatal diagnosis and, since in our hands transcervical sampling entails an increased fetal risk, we have abandoned transcervical CVS in our two study centres.
在一项三臂随机试验中，对经腹绒毛取样法与经宫颈途径及孕中期羊膜腔穿刺术进行了比较。对45个流行病学变量的检查表明，三个操作组在入组时具有可比性。在3079名低遗传风险的女性中，我们比较了经腹与经宫颈绒毛取样及羊膜腔穿刺术。经宫颈、经腹绒毛取样组和羊膜腔穿刺术组的总胎儿丢失率分别为10.9%、6.3%和6.4%（p<0.001）。在2882名胎儿细胞遗传学正常的低遗传风险和高遗传风险女性中比较了两种绒毛取样操作。经腹绒毛取样和经宫颈绒毛取样术后意外丢失率分别为3.7%和7.7%（p<0.001），率差为4.0%，95%置信区间为+2.3%至+5.8%。通过产前超声扫描，认为经宫颈操作比经腹操作更难进行取样（p<0.001）。我们的数据表明，与经宫颈取样相比，经腹操作更容易接近胎盘部位，并且比经宫颈绒毛取样更容易操作。经腹绒毛取样和羊膜腔穿刺术使女性面临的风险相当。根据我们的研究结果，经腹操作仍然是产前诊断的首选方法，并且由于在我们的研究中经宫颈取样会增加胎儿风险，我们在两个研究中心已放弃经宫颈绒毛取样。
