Fetal loss after chorionic villus sampling in twin pregnancy

Abstract

Objective To estimate the chorionic villus sampling (CVS)‐related risk of fetal loss in twin pregnancy after adjustment for chorionicity, nuchal translucency thickness (NT), intertwin discordance in crown–rump length (CRL), maternal demographic characteristics and serum pregnancy‐associated plasma protein‐A (PAPP‐A) and free β‐human chorionic gonadotropin (β‐hCG). Methods This was a multicenter study from eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. Data were obtained prospectively from women with twin pregnancy undergoing routine ultrasound examination at 11–13 weeks' gestation. Multivariable logistic regression analysis with backward stepwise elimination was used to examine whether CVS provided a significant independent contribution to the prediction of risk of fetal loss after adjusting for maternal and pregnancy characteristics, including maternal age, racial origin and weight, method of conception, smoking status, parity, chorionicity, intertwin discordance in CRL, fetal NT ≥ 95th percentile and free β‐hCG and PAPP‐A multiples of the median. Similarly, within the CVS group, multivariable logistic regression analysis was used to investigate the effect of the number of intrauterine needle insertions and size of the needle on the risk of fetal loss. Results The study population of 8581 twin pregnancies undergoing ultrasound examination at 11–13 weeks' gestation included 316 dichorionic and 129 monochorionic twins that had CVS. First, in twin pregnancies undergoing CVS, compared to those not undergoing CVS, there was a 2‐fold increased risk of fetal loss at < 24 weeks' gestation and of loss at any stage in pregnancy. Second, the factors providing a significant independent contribution to the prediction of miscarriage or fetal loss in twin pregnancy were increased maternal weight, black racial origin, monochorionicity, and more so monoamnionicity, large intertwin discordance in CRL and increased fetal NT, and, in the case of fetal loss at any stage, there was also a contribution from assisted conception and low serum PAPP‐A. Third, after adjustment for maternal and pregnancy characteristics, CVS did not provide a significant contribution to the risk of fetal loss. Fourth, in twin pregnancies that had CVS, there was no significant contribution to fetal loss from the number of intrauterine needle insertions or needle size. Conclusion The 2‐fold increased risk of fetal loss following CVS in twin pregnancy can, to a great extent, be explained by maternal and pregnancy characteristics rather than the invasive procedure itself. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Amniocentesis in Twin Pregnancies: Risk Factors of Fetal Loss

“…Our results are similar to those published recently by Elger T et al, who aimed to estimate the chorionic villous sampling (CVS) related risk of fetal loss in twin pregnancies after adjustment for cofounding factors. The authors reported that in twin pregnancies undergoing CVS, there is a trend for an increased risk of fetal loss from CVS after adjustment for maternal and pregnancy characteristics but this does not reach statistical significance [ 23 ].…”

Risk of fetal loss after chorionic villus sampling in twin pregnancy derived from propensity score matching analysis

“…This was a multicenter cohort study of women with twin pregnancy from eight fetal medicine units in the UK, Spain, Italy, Bulgaria and Portugal, in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar 5 . At 11-13 weeks, we recorded maternal demographic characteristics and carried out ultrasound examination for, first, determination of gestational age from the measurement of CRL of the larger twin 13 , second, determination of chorionicity from the number of placentae and the presence or absence of the lambda sign at the intertwin membrane-placental junction 14 , third, exclusion of vanishing twin 15 , fourth, diagnosis of major fetal abnormalities 16 , fifth, assessment of intertwin discordance in CRL (difference between the two fetuses expressed as a percentage of the larger one), because a large discordance is associated with adverse pregnancy outcome 10 , and, sixth, measurement of NT in each fetus for assessment of risk for trisomy and determination of whether the NT in one or both fetuses was ≥ 95 th percentile of our reference range for CRL 17 , because high NT is associated with adverse pregnancy outcome 11 .…”

“…Four small studies reported contradictory results concerning the risk of CVS-related miscarriage, as compared to controls that did not undergo invasive testing [1][2][3][4] . The issue of the CVS-related risk of fetal loss was addressed by a recent multicenter study of 8581 twin pregnancies undergoing ultrasound examination at 11-13 weeks' gestation, including 445 twin pregnancies that had CVS 5 . Multivariable logistic regression analysis with backward stepwise elimination was used to examine whether CVS provided a significant independent contribution to the prediction of the risk of fetal loss after adjusting for maternal and pregnancy characteristics.…”

“…The objective of this study was to investigate the risk of CVS-related fetal loss in twin pregnancy, using propensity score analysis in the same dataset in which we previously examined the risk using multivariable logistic regression analysis 5 .…”

Does chorionic villus sampling protect against fetal loss in twin pregnancy at high background risk of spontaneous miscarriage?

“…In terms of safety, many studies have demonstrated that CVS is a safe prenatal diagnostic procedure in both singleton and twin pregnancies 7,8 . Patients should be reassured that CVS is not associated with a significant increase in the rate of miscarriage.…”