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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