Ultrasonography-guided early amniocentesis in singleton pregnancies Frederick W. Hanson, MD, Regina L. Happ, MD, Frances R. Tennant, PhD, Stacy Hune, MS, and Ann G. Peterson, RN, MN Davis, California Between October 1, 1986, and September 30, 1987, 1721 amniocenteses were performed at the University of California, Davis, Medical Center. Of these procedures 527 (30.6%) were early amniocenteses. Medical records were reviewed for maternal age, amniocentesis indication, color of amniotic fluid, gestational age, frequency of needle insertion, complications of amniocentesis and delivery, results of prenatal testing, and pregnancy outcome. Complete follow-up data were available for 517 (98.1 %). There were 10 miscarriages before 28 weeks' gestation (1.9%), one loss after 28 weeks (0.2%), and one stillbirth (0.2%), resulting in a total postproceduralloss rate of 2.3%. Miscarriage within 2 weeks of amniocentesis occurred in four subjects (0.8%). (AM J OSSTET GVNECOL 1990;162:1376-83.)
Key words: Early amniocentesis, discolored amniotic fluid, miscarriage, stillbirth, amniotic fluid leakage
Prenatal diagnosis of chromosomal biochemical and neural tube defects has been widely accepted as a routine procedure in the management of obstetric patients. Amniocentesis has customarily been performed between 16 to 18 weeks' gestation. Patients and physicians, however, have increasingly requested earlier diagnosis for reassurance of the normality of the pregnancy or to allow earlier and safer interruption of pregnancy if indicated by detection of a fetal abnormality. A spectrum of diagnostic procedures is now available to meet these demands and includes chorionic villus sampling (transcervical or transabdominal), earlier amniocentesis, and conventional amniocentesis. In 1987 we published our initial report on earlier amniocentesis. I That report covered an extended time period with increasing operator experience and frequent modification of technique. Continuous uItrasonographic monitoring during amniocentesis was not used for the time period covered by that publication. It is the purpose of this report to reevaluate our experience performing earlier amniocentesis with the use of continuous uItrasonographic guidance.
From the Department of Obstetrics and Gynecology, University of California, Davis, School of Medicine. Presented at the Fifty-sixth Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, Coronado, California, September 17-21, 1989. Reprint requests: Frederick W. Hanson, MD, Department of Obstetrics and Gynecology, School of Medicine, Univenity of California, Davis, 1621 Alhambra Blvd., Alhambra Plaza, Sacramento, CA
95816-7051.
616120284
1376
Methods The prenatal diagnosis program at the University of California, Davis, has been previously described. 2 More than 12,000 amniocentesis procedures have been performed since inception of the program in 1976. During the period covered by this study (October 1, 1986, through September 30, 1987) 1721 amniocentesis procedures were performed. The majority were performed by one of the authors (F. W. H.). Of these procedures 527 were accomplished before week 15 since the last menstrual period, and they are the subject of this report. The data were evaluated for amniocentesis indication; gestational age at the time of amniocentesis (weeks since last menstrual period ± 1 week); color of aP1niotic fluid; pregnancy complications before amniocentesis, delivery complications, amniocentesis complications, and pregnancy outcome. For comparison with previously published studies pregnancy loss data were divided into the following categories: 2 weeks after amniocentesis,
Key words: Early amniocentesis, discolored amniotic fluid, miscarriage, stillbirth, amniotic fluid leakage
Prenatal diagnosis of chromosomal biochemical and neural tube defects has been widely accepted as a routine procedure in the management of obstetric patients. Amniocentesis has customarily been performed between 16 to 18 weeks' gestation. Patients and physicians, however, have increasingly requested earlier diagnosis for reassurance of the normality of the pregnancy or to allow earlier and safer interruption of pregnancy if indicated by detection of a fetal abnormality. A spectrum of diagnostic procedures is now available to meet these demands and includes chorionic villus sampling (transcervical or transabdominal), earlier amniocentesis, and conventional amniocentesis. In 1987 we published our initial report on earlier amniocentesis. I That report covered an extended time period with increasing operator experience and frequent modification of technique. Continuous uItrasonographic monitoring during amniocentesis was not used for the time period covered by that publication. It is the purpose of this report to reevaluate our experience performing earlier amniocentesis with the use of continuous uItrasonographic guidance.
From the Department of Obstetrics and Gynecology, University of California, Davis, School of Medicine. Presented at the Fifty-sixth Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, Coronado, California, September 17-21, 1989. Reprint requests: Frederick W. Hanson, MD, Department of Obstetrics and Gynecology, School of Medicine, Univenity of California, Davis, 1621 Alhambra Blvd., Alhambra Plaza, Sacramento, CA
95816-7051.
616120284
1376
Methods The prenatal diagnosis program at the University of California, Davis, has been previously described. 2 More than 12,000 amniocentesis procedures have been performed since inception of the program in 1976. During the period covered by this study (October 1, 1986, through September 30, 1987) 1721 amniocentesis procedures were performed. The majority were performed by one of the authors (F. W. H.). Of these procedures 527 were accomplished before week 15 since the last menstrual period, and they are the subject of this report. The data were evaluated for amniocentesis indication; gestational age at the time of amniocentesis (weeks since last menstrual period ± 1 week); color of aP1niotic fluid; pregnancy complications before amniocentesis, delivery complications, amniocentesis complications, and pregnancy outcome. For comparison with previously published studies pregnancy loss data were divided into the following categories: 2 weeks after amniocentesis,
