The contemporary risk of complication including pregnancy loss of amniocentesis and chorionic villus sampling in a specialised prenatal medicine center – a differentiated analysis

Alexander Scharf, Kai Jahns

The risk of complications including pregnancy loss of amniocentesis and chorionic villus sampling

Einleitung und Fragestellung Both amniocentesis (AC) and chorionic villus sampling (CVS) are reported to show an induced pregnancy loss rate around 1%. Diverse modern large cohort studies however have shown very low rates of pregnancy loss. Still, many medical textbooks and guidelines emphasize the risky nature of the procedures. This study aims to examine whether today this still reflects reality and how a modern concept on this topic should be designed.

Material und Methodik In this single center cohort study, the absolute number of obstetric complications after AC or CVS before 24 months of gestation was determined. To determine the true complication risk directly related to the procedure, the second step was to subject the observed complications to a case-by-case analysis, in which it was determined whether the observed adverse events were random observations (correlations) or causally related to the punctures.

Ergebnisse 1248 files between 2011 and 2020 were were screened. In 427 of these, a complete obstetric follow-up history could be added and were thus suitable for further analysis. In total 101 AC cases, four (3.9%) had a pregnancy loss before the 24th gestational week. In one case (0.99%) an amniotic leak was registered, but the fetus survived until delivery. There were 326 CVS cases in total, of which nine (2.76%) had a pregnancy loss before the 24th gestational week. In the second-stage analysis, all cases reviewed could not be causally attributed to the invasive procedure.

Zusammenfassung A formal statistical analysis regarding complications of AC/CVS is not sufficient to describe puncture-related risks accurately. If these data are subjected to a further differentiation between correlation and causality, it becomes apparent that prenatal punctures in experienced hands are to be regarded as extremely low-risk. From this derives an urgent need for complete revision of the medical dogmas accumulated in this place in the last 40 years.

 

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Publication History

Article published online:
29 August 2023