Risk of amniocentesis in women screened positive for Down syndrome with second trimester maternal serum markers.
In routine obstetrical practice, prior to offering invasive prenatal diagnosis, it is crucial to weigh the risks attendant on amniocentesis against the individual's risk of aneuploidy. We took advantage of a policy of follow-up of patients undergoing Down syndrome maternal serum screening to compare the rates of fetal loss before 24 weeks and of early premature delivery at 24-28 weeks between women who underwent amniocentesis and women who did not. A total of 54 902 patients entered the study, of whom 4039 (7.35%) were lost to follow-up and 387 were excluded because of a severe fetal abnormality. Of the 50 476 remaining patients, 3472 had an amniocentesis whereas 47 004 had not and served as controls. In the amniocentesis group, the fetal loss rate before 24 weeks was 1.12% (95% CI=1.08-1.15) and the 24-28 weeks premature delivery rate was 0.40% (95% CI=0.39-0.41) which was significantly higher than in controls (0.42% with 95% CI 0.41-0.43 and 0.24% with 95% CI 0.23-0.25, respectively). The 0.86% difference in adverse outcome rates between the amniocentesis and control groups may be attributable to amniocentesis and compares favourably with the positive predictive value of maternal serum markers (1.70%) observed in the present study.
Muller
Françoise
F
Service de Biochimie, Hôpital Ambroise Paré, Boulogne, France. francoise.muller@apr.ap-hop-paris.fr
Thibaud
Didier
D
Poloce
Françoise
F
Gelineau
Marie-Christine
MC
Bernard
Marguerite
M
Brochet
Christine
C
Millet
Christine
C
Réal
Jean-Yves
JY
Dommergues
Marc
M
D000293:Adolescent; D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D011247:Pregnancy / Q000097:blood*; D011262:Pregnancy Trimester, Second; D018570:Risk Assessment
D015415:Biomarkers