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Grand Rounds

Does Single or Double Needle Insertion in Twin Amniocentesis Influence Complication Risk?

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BACKGROUND AND PURPOSE:

  • Krispin et al. (Eur J Obstet Gynecol Reprod Biol X, 2019) assessed complications rates for twin pregnancies undergoing amniocentesis, comparing single vs double needle insertion

METHODS:

  • Retrospective cohort study
  • Participants
    • Twin gestations undergoing amniocentesis
  • Interventions
    • Uterine entry with passage through the inter-twin membrane
    • Two different entries into the two amniotic sacs
  • Data analysis
    • Primary outcomes were compared for women that underwent single needle insertion versus double needle insertion
    • Multivariate analysis to adjust for confounders
  • Primary outcome: Composite complications outcome occurring within 4 weeks post procedure
    • Late abortion | Chorioamnionitis | PPROM | Hospitalization
  • Secondary outcomes
    • Gestational week at delivery
    • Labor characteristics

RESULTS:

  • 212 women
    • Single insertion group: 34.4%  
    • Double insertion group: 65.6%
    • No difference in baseline characteristics between groups
  • Primary outcome: No difference in adverse neonatal outcome between the two groups (p=0.587)
    • Single insertion: 13.7%
    • Double insertion group: 16.5%  
  • No change in outcome following adjustment for potential confounders (p=0.871)
    • OR = 1.085 (95% CI, 0.4 to 2.9)
  • Single case of abortion was a monochorionic twin gestation with double entry (0.5%)
  • Labor characteristics were similar between the groups

CONCLUSION:

  • The authors acknowledge that while the study met its initial power calculations, their amniocentesis complication rate was lower than anticipated
    • Therefore, lack of difference could be attributed to insufficient sample size  
  • The authors conclude that

Both techniques are optional and medically acceptable. Choice should be left to the operator considering their skills and real-time ultrasound findings.

Learn More – Primary Sources:

Single or double needle insertion in twin’s amniocentesis: Does the technique influence the risk of complications?

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Related ObG Topics:

Should Amniocentesis or Chorionic Villus Sampling Be Offered to All Pregnant Women?
Do Amniocentesis or CVS Really Lead to Increased Risk of Miscarriage? 
Fetal loss after amnio or CVS – what is the risk ?

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