Wapner R J, Johnson A, Davis G, Urban A, Morgan P, Jackson L
Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Obstet Gynecol. 1993 Jul;82(1):49-56.
To evaluate prospectively the relative risks and accuracy of first-trimester chorionic villus sampling (CVS) and second-trimester amniocentesis in the genetic evaluation of twin gestations.
Between March 1984 and August 1990, patients presenting for prenatal diagnosis of a twin gestation of less than 12 weeks were offered sampling by either first-trimester CVS or amniocentesis at 16-18 weeks' gestation. Selection was based solely on patient preference and was obtained before ultrasound identification of placental position. Women presenting beyond 12 weeks' gestation were sampled by amniocentesis. Clinical and laboratory outcomes were evaluated.
Eighty-one women had amniocentesis (nine of whom also had CVS), and 161 women had CVS. All fetuses in both groups were successfully sampled and karyotyped; 85.3% of the amniocentesis patients and 75.8% of the CVS patients were sampled in two or fewer passes (P = not significant). There were three cases of twin-twin villus contamination following CVS; one of these led to incorrect gender assignment because of erroneous laboratory interpretation. Loss of the entire pregnancy from the time of sampling until the 28th week of gestation followed amniocentesis in 2.9% of the cass and CVS in 3.2%. The total fetal loss rates were 9.3% for amniocentesis and 4.9% for CVS (P = not significant). When pregnancies having mosaic or abnormal karyotype results are excluded, the total amniocentesis loss rate remained 9.3% and the CVS loss rate became 3.9% (P < .05).
In the hands of experienced operators, CVS is at least as safe and effective as amniocentesis for the prenatal diagnosis of twin gestations.
前瞻性评估孕早期绒毛取样（CVS）和孕中期羊膜腔穿刺术在双胎妊娠基因评估中的相对风险和准确性。
在1984年3月至1990年8月期间，为孕周小于12周的双胎妊娠进行产前诊断的患者提供孕早期CVS或孕16 - 18周时的羊膜腔穿刺术取样。选择完全基于患者偏好，且在超声确定胎盘位置之前进行。孕周超过12周的女性通过羊膜腔穿刺术取样。对临床和实验室结果进行评估。
81名女性接受了羊膜腔穿刺术（其中9名也进行了CVS），161名女性进行了CVS。两组所有胎儿均成功取样并进行了核型分析；85.3%的羊膜腔穿刺术患者和75.8%的CVS患者在两次或更少穿刺次数下完成取样（P = 无显著差异）。CVS后有3例双胎绒毛污染病例；其中1例因实验室错误解读导致性别判断错误。羊膜腔穿刺术后从取样时到妊娠28周整个妊娠丢失的发生率为2.9%，CVS为3.2%。羊膜腔穿刺术的总胎儿丢失率为9.3%，CVS为4.9%（P = 无显著差异）。排除染色体嵌合或异常核型结果的妊娠后，羊膜腔穿刺术的总丢失率仍为9.3%，CVS的丢失率变为3.9%（P <.05）。
在经验丰富的操作人员手中，CVS在双胎妊娠产前诊断中至少与羊膜腔穿刺术一样安全有效。
