title: The transvaginal probe as a uterine manipulator: a new technique to simplify transabdominal chorionic villus sampling in cases with difficult access to the trophoblast.
abstract: OBJECTIVE
  To evaluate the efficacy of using the transvaginal probe to manipulate the uterus and change the position of the trophoblast, and to simplify access to the chorionic villus under difficult conditions.
  
  
  METHODS
  One thousand five hundred and thirty-nine procedures were performed in our centre in 1524 pregnant women from September 2006 to September 2009. In 90 of these, a difficult access to the trophoblast was observed and uterine manipulation under continuous ultrasound guidance with a double needle technique, was applied to obtain the sample. Of these, 86 samples were taken from singleton pregnancies and 4 from two bichorionic twin pregnancies
  
  
  RESULTS
  One thousand five hundred and thirty-nine transabdominal chorionic villus sampling (TA-CVS) procedures were conducted on 1524 pregnant women. As many as 1449 were performed without manipulation with the transvaginal probe and in 90 cases the manipulation was carried out. In 89 cases, access to the trophoblast was difficult and the uterus was manipulated, which enabled an adequate TA-CVS to be performed with a single aspiration. In one case, TA-CVS was not performed due to significant pelvic pain in a patient with a fixed, retroflexed uterus and a previous history of endometriosis.
  
  
  CONCLUSIONS
  Uterine manipulation with the transvaginal probe may be a useful solution in cases where TA-CVS is limited by difficult access to the trophoblast.
authors.affiliation: Prenatal Medicine Unit, Department of Obstetrics and Gynaecology, University of Modena, Modena, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Bertucci
authors.forename: M
authors.initials: M
authors.lastname: Pati
authors.forename: C
authors.initials: C
authors.lastname: Cani
authors.forename: A
authors.initials: A
authors.lastname: Volpe
authors.forename: V
authors.initials: V
authors.lastname: Mazza
mesh_terms: D034861:Abdominal Wall; D000328:Adult; D015193:Chorionic Villi Sampling / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D017699:Pelvic Pain; D011247:Pregnancy; D059285:Pregnancy, Twin; D014327:Trophoblasts; D016216:Ultrasonography, Prenatal; D060725:Uterine Retroversion; D014621:Vagina