title: Procedure-Related Fetal Loss following Chorionic Villus Sampling after First-Trimester Aneuploidy Screening.
abstract: OBJECTIVE
  The aim was to determine the institutional procedure-related fetal loss rate after chorionic villus sampling (CVS) and the factors which may identify pregnancies at increased risk of having a procedure-related loss.
  
  
  METHODS
  Pregnancy outcomes were retrieved of all women having a singleton pregnancy and undergoing a CVS procedure between 2004 and 2013 at a university hospital in Hong Kong. The incidence of procedure-related fetal loss due to unintended miscarriages adjusted for the background loss incidence of miscarriages was determined. Multivariate regression was performed to examine the factors contributing to an unintended fetal loss and miscarriage.
  
  
  RESULTS
  CVS was performed on 1,906 fetuses. The procedure-related fetal loss rate was 0.17% (95% CI -0.2 to 0.7). After multivariate analysis, a decreased plasma protein-A (PAPP-A) multiple of the median (OR 0.27; 95% CI 0.08-0.98, p = 0.046) was significantly associated with miscarriage in women who did not undergo a CVS. Patient-specific prediction of spontaneous abortion in women who did not undergo CVS was not statistically significant (AUC 0.56; 95% CI 0.49-0.6, p = 0.14).
  
  
  CONCLUSIONS
  The CVS-related fetal loss rate adjusted for background loss was 0.17%. Pregnancies with reduced PAPP-A carry an increased risk of miscarriage irrespective of whether they had undergone an invasive procedure.
authors.affiliation: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China.
authors.forename: Yi Man
authors.initials: YM
authors.lastname: Wah
authors.forename: Tak Yeung
authors.initials: TY
authors.lastname: Leung
authors.forename: Yvonne Kwun Yue
authors.initials: YKY
authors.lastname: Cheng
authors.forename: Daljit Singh
authors.initials: DS
authors.lastname: Sahota
mesh_terms: D000022:Abortion, Spontaneous / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics*; D000328:Adult; D000782:Aneuploidy; D015193:Chorionic Villi Sampling / Q000009:adverse effects* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000235:genetics*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Chorionic villus sampling; Fetal loss; First-trimester Down syndrome screening; Miscarriage; Procedure-related risk