Abstract
Introduction
Several congenital abnormalities present late in pregnancy necessitating invasive testing to rule out genetic/infectious causes at late gestation. Not many studies have described the indications/safety of a late gestation amniocentesis.
Methods
All records of amniocentesis performed beyond 24 weeks were reviewed and evaluated for indications, positive yield and complications.
Results
About 187 women had an amniocentesis after 24 weeks for various indications with CNS abnormalities being the commonest. The total yield of positive findings was 14.60% (22/150; excluding 2 VOUS). CNS, multiple system involvement and skeletal system anormalities yielded maximum results. About 32.05% abnormalities could have potentially been detected at the time of a routine anomaly scan. Amongst all the deliveries, 2.1% delivered spontaneously within a week of the procedure and about 5.4% delivered spontaneously within a month of the procedure.
Conclusion
The study emphasises the need for additional accreditation (FMF, ISUOG) of sonographers to ensure the detection of anomalies at the routine 18–20 weeks scan. Inspite of a normal mid-trimester scan, central nervous system and gastrointestinal abnormalities presented more commonly after 24 weeks. The high positive yield in our study highlights the importance of testing even in late pregnancy beyond the legal age of termination. The test could clearly stratify the pregnancies with a poor outcome whilst reassuring the others. The procedure itself did not lead to a neonatal death due to prematurity.
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References
Akolekar R, Beta J, Picciarelli G et al (2015) Procedure-related risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 45(1):16–26
Malinger G, Lerman-Sagie T, Watemberg N et al (2002) A normal second-trimester ultrasound does not exclude intracranial structural pathology. Ultrasound Obstet Gynecol. 20(1):51–56
Yinon Y, Katorza E, Nassie DI et al (2013) Late diagnosis of fetal central nervous system anomalies following a normal second trimester anatomy scan. Prenat Diag. https://doi.org/10.1002/pd.4163
The Medical Termination of Pregnancy (Amendment) Act, 2021. The Gazette of India, No. 8 of 2021
Geffen KT, Ben-Zvi O, Weitzner O et al (2017) The yield and complications of amniocentesis performed after 24 weeks of gestation. Arch Gynecol Obstet 296(1):69–77
Daum H, David AB, Nadjari M et al (2019) The impact of late amniocentesis in the modern genomic technologies era. Ultrasound Obstet Gynecol 53:676–685
O’Donoghue K, Giorgi L, Pontello V et al (2007) Amniocentesis in the third trimester of pregnancy. Prenat Diagn 27:1000–1004
Drummond CL, Molina-Gomes D, Senat MV (2003) Fetal karyotyping after 28 weeks of gestation for late ultrasound findings in a low risk population. Prenat Diagn 23:1068–1072
Bardin R (2018) Eran Hadara,*, lylach haizler-cohen, rinat gabbay-benziv, et al cytogenetic analysis in fetuses with late onset abnormal sonographic findings. J Perinat Med 46(9):975–982
Ficara A, Syngelaki A, Hammami A, Akolekar R, Nicolaides KH (2020) Value of routine ultrasound examination at 35–37 weeks’ gestation in diagnosis of fetal abnormalities. Ultrasound Obstet Gynecol 55(1):75–80
Gagnon S, Fraser W, Fouquette B et al (1992) Nature and frequency of chromosomal abnormalities in pregnancies with abnormal ultrasound findings: an analysis of 117 cases with review of the literature. Prenat Diagn 12:9–18
Borrell A, Grande M (2017) Eva meler joan sabrià; genomic microarray in fetuses with early growth restriction: a multicenter study. Fetal Diagn Ther 42:174–180
O’Donoghue K, Giorgi L (2007) Valentina pontello; amniocentesis in the third trimester of pregnancy. Prenat Diagn 27:1000–1004
Michael C (2002) Gordon, komal narula, richard o’shaughnessy, et al; complications of third-trimester amniocentesis using continuous ultrasound guidance. Obstet Gynecol 99(2):255–259
Hodor JG, Poggi SH, Spong CY (2006) Risk of third-trimester amniocentesis a case-control study. Am J Perinatol 23(3):177–180
Toutain J, Lemaire-Coustel MA, Begorre M et al (2012) Proportion of parents agreeing to delay fetal karyotyping until the third trimester of pregnancy in cases with an indication. Fetal Diagn Ther 31:115–121
Gabbay R, Yogev Y, Melamed N et al (2012) Pregnancy outcome after third trimester amniocentesis: a single center experience. J Matern Fetal Neonatal Med 25(6):666–668
Picone O, Senat M-V, Rosenblatt J, Audibert F, Tachdjian G (2008) Rene frydman; fear of pregnancy loss and fetal karyotyping: a place for third-trimester amniocentesis? Fetal Diagn Ther 23:30–35
Salomon J, Sotiriadis A, Wulff CB, Odibo A, Akolekar R (2019) Risk of miscarriage following amniocentesis or chorionic villus sampling: systematic review of literature and updated meta-analysis. Ultrasound Obstet Gynecol 54(4):442–451
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Dr AK and Dr AS conceived the study plan. Dr A contributed to collating data and writing the manuscript. Dr Anita Kaul helped in editing the manuscript.
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Institutional Ethical Committee, Biomedical Research Committee, Indraprastha Apollo Hospitals, New Delhi approval obtained (Ref IAH-BMR-013/05–20).
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Sharma, A., Kaul, A. Late amniocentesis: better late than never? A single referral centre experience. Arch Gynecol Obstet 308, 463–470 (2023). https://doi.org/10.1007/s00404-022-06662-6
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DOI: https://doi.org/10.1007/s00404-022-06662-6