- Prospective observational study of the use of ultrathin needles for amniocentesis: initial results
Prospective observational study of the use of ultrathin needles for amniocentesis: initial results
HEALTH OF WOMAN.2017.1(117):127–130; doi 10.15574/HW.2017.117.127
Zhuk S. I., Oshowski V. I., Bykova E. G.
National Medical Academy of Postgraduate Education P. L. Shupyk, Kiev
The article presents the experience and initial results of use of the puncture needle of small diameter with karandashami type of sharpening for amniocentesis in the ІІ trimester of pregnancy.
The objective: to determine the effectiveness and safety of use ultrafine needle diameter 29G for amniocentesis in the ІІ trimester of pregnancy.
Patients and methods. There was performed a prospective observational study of 80 cases of singleton 3 cases of multiple pregnancies in which amniocentesis was performed in the period from August 2013 to August 2016 at the bases of the Department of obstetrics, gynecology and fetal medicine NMAPE named after P. L. Shupyk medical center «Uniclinic». The study group included women aged from 21 to 42 years in the term of pregnancy from 16 to 20 weeks. Exclusion criteria were: the presence of vaginal bleeding less than two days before the procedure, body mass index above 35, receiving the preparations containing heparin, or aspirin for 12 hours before the procedure.
All patients received informed consent for the procedure. In addition, each patient before amniocentesis filled a specially designed questionnaire, in which using a numeric rating (1 to 10) was ability to check criteria of general perception of the procedure, in particular the level of excitement about the potential complications and confidence in the correctness of the choice. Group comparison of the perception of the procedure were 100 patients who completed identical questionnaires before the procedure of the amniocentesis needle with a diameter of 20G, which are conducted at clinical sites in the period 2011-2013.
Results. All volumes of amniotic fluid contained a sufficient number of fetal cells to determine the karyotype. In 8 fetus were found pathological changes in the number of chromosomes. Women tolerated the procedure well. No cases of complaints are recorded. Patients noted that the information on noninvasive ultra-thin needle, which was provided during pre-consultation also significantly reduce anxiety before surgery. In one case, diagnosed bradycardia of the fetus, which lasted a few minutes and then spontaneously passed. Within 7 days not recorded any complications.
Conclusion. Given technique is adequate and safe alternative to amniocentesis with the use of large diameter needles and allows not only to reduce trauma to the amniotic membranes but also to decrease the level of excitement in women before the procedure and to facilitate the adoption of decisions about invasive prenatal diagnostics.
Key words: amniocentesis, atraumatic punction needle, safety of invasive prenatal diagnostic.
1. Athanasiadis AP, Pantazis K, Goulis DG, Chatzigeorgiou K, Vaitsi V, Assimakopoulos E et al. 2009. Comparison between 20G and 22G needle for second trimester amniocentesis in terms of technical aspects and short-term complications. Prenat Diagn 29:761–5. https://doi.org/10.1002/pd.2283; PMid:19412914
2. Blessed WB, Lacoste H, Welch RA. 2001. Obstetrician-gynecologists performing genetic amniocentesis may be misleading themselves and their patients. Am J Obstet Gynecol 184:1340–4. https://doi.org/10.1067/mob.2001.115049; PMid:11408850
3. Bombard AT, Powers JF, Carter S, Schwartz A, Nitowsky HM. 1995. Procedure-related fetal losses in transplacental versus nontransplacental genetic amniocentesis. Am J Obstet Gynecol 172:868–72. https://doi.org/10.1016/0002-9378(95)90013-6
4. Bravo RR, Shulman LP, Phillips OP, Grevengood C, Martens PR. 1995. Transplacental needle passage in early amniocentesis and pregnancy loss. Obstet Gynecol 86:437–40. https://doi.org/10.1016/0029-7844(95)00180-Y
5. Devlieger R, Gratacуs E, Ardon H, Vanstraelen S, Deprest J. 2002. Factors influencing the flow rate through a surgical defect in human fetal membranes. Prenat Diagn 22:201–5. https://doi.org/10.1002/pd.284; PMid:11920894
6. Eddleman KA, Malone FD, Sullivan L, Dukes K, Berkowitz RL, Kharbutli Y et al. 2006. Pregnancy loss rates after midtrimester amniocentesis. Obstet Gynecol 108:1067–72. https://doi.org/10.1097/01.AOG.0000240135.13594.07; PMid:17077226
7. Gratacуs E, Devlieger R, Decaluwe H, Wu J, Nicolini U, Deprest JA. 2000. Is the angle of needle insertion influencing the created defect in human fetal membranes? Evaluation of the agreement between specialists’ opinions and ex vivo observations. Am J Obstet Gynecol 182:646–9. https://doi.org/10.1067/mob.2000.103218
8. Li DZ. 2009. Which is preferred: 20G or 22G needle at amniocentesis? Prenat Diagn 29:822. https://doi.org/10.1002/pd.2320; PMid:19630002
9. Mujezinovic F, Alfirevic Z. 2007. Procedure-related complications of amniocentesis and chorionic villous sampling: a systematic review. Obstet Gynecol 110:687–94. https://doi.org/10.1097/01.AOG.0000278820.54029.e3; PMid:17766619
10. Odibo AO, Gray DL, Dicke JM, Stamilio DM, Macones GA, Crane JP. 2008. Revisiting the fetal loss rate after second-trimester genetic amniocentesis: a single center’s 16-year experience. Obstet Gynecol 111:589–95. https://doi.org/10.1097/AOG.0b013e318162eb53; PMid:18310360
11. Scott F, Peters H, Boogert T, Robertson R, Anderson J, McLennan A et al. 2002. The loss rates for invasive prenatal testing in a specialised obstetric ultrasound practice. Aust N Z J Obstet Gynaecol 42:55–8. https://doi.org/10.1111/j.0004-8666.2002.00061.x; PMid:11926642
12. Silver RK, Russell TL, Kambich MP, Leeth EA, MacGregor SN, Sholl JS. 1998. Midtrimester amniocentesis. Influence of operator caseload on sampling efficiency. J Reprod Med 43:191–5. PMid:9564643
13. Steele MW, Breg WR, Jr. 1966. Chromosome analysis of human amniotic-fluid cells. Lancet 1:383–5. https://doi.org/10.1016/S0140-6736(66)91387-0
14. Tabor A, Philip J, Madsen M, Bang J, Obel EB, Norgaard-Pedersen B. 1986. Randomised controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet 1:1287–93. https://doi.org/10.1016/S0140-6736(86)91218-3
15. Tchirikov M, Steetskamp J, Gatopoulos G, Heinrich UR, Brieger J, Heidner K, Koelbl H. 2011. Introduction of a 29 gauge atraumatic needle for amniocentesis. J Perinat Med 39(4):431–5. https://doi.org/10.1515/jpm.2011.039; PMid:21627489
16. The Canadian Early and Mid-trimester Amniocentesis Trial (CEMAT) Group. Randomised trial to assess safety and fetal outcome of early and midtrimester amniocentesis. Lancet. 1998. 351:242–7. https://doi.org/10.1016/S0140-6736(97)12346-7
17. Uludag S, Aydin Y, Ibrahimova F, Madazli R, Sen C. 2010. Comparison of complications in second trimester amniocentesis performed with 20G, 21G and 22G needles. J Perinat Med 38:597–600. https://doi.org/10.1515/jpm.2010.105; PMid:20707629
18. Michael Tchirikov, Carola Arnold, Viktor Oshovskyy. 2012. Ulf-R ü diger Heinrich, Volker Th ä le Three years experience of using a 29-gauge atraumatic needle for amniocentesis. J. Perinat. Med. 40:413–417. https://doi.org/10.1515/jpm-2011-0224; PMid:22752773