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#Grand Rounds

Fetal loss after amnio or CVS – what is the risk ?

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FINDINGS:

The actual risk of miscarriage following amniocentesis or chorionic villus sampling (CVS) has been controversial. ACOG provides an estimated overall risk of fetal loss due to invasive testing  of 0.1% – 0.3% above the background miscarriage rate. Previous papers that showed an increased rate of miscarriage included fetuses that may have been compromised or had anomalies at the time of invasive testing as the underlying indication.  In this present study, the authors found that

  • The risk of miscarriage and stillbirth were not higher in women who had amniocentesis or CVS after a positive first trimester screening test for fetal Down syndrome

SYNOPSIS:

This study by Wulff et al. involved review of a well-curated national database to answer the question as to whether there was increased risk of miscarriage or stillbirth after a positive first trimester screening test for fetal Down syndrome

KEY POINTS:

  • the authors found no additional risk of miscarriage or stillbirth from amniocentesis or CVS following a positive first trimester screen
  • there is always an underlying risk of miscarriage or stillbirth, though minimal, that is not preventable despite the best efforts of patient and provider
  • invasive prenatal testing in expert hands carries a low risk of fetal loss or miscarriage
  • results are similar to other recent publications (see below)

Learn More – Primary Sources:

Risk of fetal loss associated with invasive testing following combined first-trimester screening for Down syndrome: a national cohort of 147 987 singleton pregnancies

Procedure-related risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review and meta-analysis

Pregnancy loss rates after midtrimester amniocentesis

ACOG Practice Bulletin No. 162: Prenatal Diagnostic Testing for Genetic Disorders

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Related ObG Topics:

Down Syndrome / Trisomy 21: Clinical Findings and Prenatal Considerations
Levels of Evidence – How to Rate the Quality of a Study

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