Daniel A, Ng A, Kuah K B, Reiha S, Malafiej P
Department of Cytogenetics, Western Sydney Genetics Program, Royal Alexandra Hospital for Children, Westmead, NSW, Australia.
Prenat Diagn. 1998 Jan;18(1):21-8.
A prospective pilot study for early amniocentesis was conducted over 4 years including 279 early amniocenteses (EAs at 10-14 weeks' gestation) and 181 mid-trimester amniocenteses (MAs at 15 weeks upwards). The study was performed with EA and MA utilizing the same proceduralists, techniques, and cytogenetics laboratory. Patients were offered either procedure and the cytogenetics laboratory was not prospectively informed of the gestational age of each sampled pregnancy. In the early amniocenteses, less fluid was sampled and there were trends for (i) less cells and clones being available for analysis, less successful cultures, and a slightly longer reporting time; (ii) more multiple insertions (12.9 per cent of specimens vs. 9.9 per cent) and more bloody fluids (5.4 per cent specimens vs. 4.4 per cent); and (iii) a higher rate of pregnancy loss (2.2 per cent of EA vs. 0.6 per cent of MA). The multiple insertion rates for both EA and MA were comparatively high and were related to an increased frequency of blood-stained fluids. For EA specimens, the rates of amniotic fluid leakage, preterm delivery, and pregnancy loss were moderate and not significantly increased over the MA group. This study adds more weight to the view that EA is a reasonably safe procedure and a reliable alternative to chorionic villus biopsy to provide early prenatal cytogenetic diagnosis.
一项关于早期羊膜腔穿刺术的前瞻性试点研究历时4年，包括279例早期羊膜腔穿刺术（妊娠10 - 14周时进行的EA）和181例孕中期羊膜腔穿刺术（妊娠15周及以上时进行的MA）。该研究中，EA和MA由相同的操作人员、采用相同的技术并在同一个细胞遗传学实验室进行。向患者提供这两种手术方式供其选择，且细胞遗传学实验室未提前得知每个采样妊娠的孕周。在早期羊膜腔穿刺术中，抽取的羊水较少，存在以下趋势：（i）可供分析的细胞和克隆较少、培养成功率较低且报告时间略长；（ii）多次穿刺的情况较多（12.9%的标本vs. 9.9%），血性羊水较多（5.4%的标本vs. 4.4%）；（iii）妊娠丢失率较高（EA为2.2%，MA为0.6%）。EA和MA的多次穿刺率都相对较高，且与血性羊水频率增加有关。对于EA标本，羊水渗漏、早产和妊娠丢失的发生率处于中等水平，与MA组相比没有显著增加。这项研究进一步支持了以下观点：EA是一种相当安全的手术方式，是绒毛取样术的可靠替代方法，可用于早期产前细胞遗传学诊断。
