Risk of fetal loss following amniocentesis or chorionic villus sampling in twin pregnancy: systematic review and meta‐analysis

Abstract

Objective To assess the rate of fetal loss following amniocentesis or chorionic villus sampling (CVS) in twin pregnancy. Methods MEDLINE, EMBASE and Cochrane databases were searched for studies reporting procedure‐related complications following amniocentesis or CVS in twin pregnancy. The primary outcome was the rate of procedure‐related fetal loss. The secondary outcomes were fetal loss occurring before 24 weeks of gestation and fetal loss occurring within 4 weeks after the procedure. Head‐to‐head meta‐analyses were used to compare directly each outcome, between women undergoing amniocentesis and those not undergoing amniocentesis and between women undergoing CVS and those not undergoing CVS, and to compute pooled risk differences (RD) between women exposed and those not exposed to each invasive procedure. Additionally, meta‐analyses of proportions were used to estimate the pooled rates of each of the three outcomes in women undergoing amniocentesis or CVS and in controls. Results Sixteen studies (3419 twin pregnancies undergoing and 2517 not undergoing an invasive procedure) were included. Head‐to‐head meta‐analyses comparing directly twin pregnancies undergoing and those not undergoing amniocentesis showed a higher risk for overall fetal loss in those undergoing amniocentesis (odds ratio (OR), 1.46 (P = 0.04); RD, 0.013 (P = 0.04)), while there was no difference in the risk of either fetal loss before 24 weeks of gestation (OR, 1.59 (P = 0.06); RD, 0.010 (P = 0.11)) or fetal loss within 4 weeks after the procedure (OR, 1.38 (P = 0.3); RD, 0.003 (P = 0.8)). Overall, the pooled rate of fetal loss was 2.4% (95% CI, 1.4–3.6%) in twin pregnancies undergoing amniocentesis compared with 2.4% (95% CI, 0.9–4.6%) in those not undergoing amniocentesis. Head‐to‐head meta‐analyses directly comparing twin pregnancies undergoing and those not undergoing CVS showed no significant difference in either overall fetal loss (OR, 1.61 (P = 0.5); RD, 0.003 (P = 0.8)) or fetal loss before 24 weeks of gestation (OR, 1.61 (P = 0.5); RD, 0.003 (P = 0.8)). Overall, the pooled rate of fetal loss was 2.0% (95% CI, 0.0–6.5%) in twin pregnancies undergoing CVS compared with 1.8% (95% CI, 0.3–4.2%) in those not undergoing CVS. Conclusion The risk of fetal loss following amniocentesis and CVS in twins is lower than reported previously and the rate of fetal loss before 24 weeks of gestation, or within 4 weeks after the procedure, did not differ from the background risk in twin pregnancy not undergoing invasive prenatal testing. These data can guide prenatal counseling for twin pregnancies undergoing invasive procedures. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

Counseling in maternal–fetal medicine: SARS‐CoV‐2 infection in pregnancy

“…There is no consistent data yet indicating that pregnant women affected by SARS-CoV-2 infection undergoing invasive procedures for fetal diagnosis and therapy are at higher risk of vertical transmission or adverse fetal outcomes, compared to the background risk. [32][33] The largest body of evidence of the potential effect of invasive procedure in pregnancies complicated by infectious diseases come from the past experience with human immunodeficiency virus and hepatitis. 34 In such women, especially if under antiviral therapy, the risk of vertical transmission following amniocentesis does not appear to be higher compared to women not undergoing invasive testing, particularly if the viral load is undetectable, although this evidence is limited by the small number of cases reported in the published literature.…”

Ramifications of third trimester amniocentesis in twin pregnancies: a retrospective cohort study

“…It is therefore necessary to explain these risks when planning amniocentesis in twin pregnancies and expedite chromosomal microarray analysis results. Furthermore, mid-trimester amniocentesis remains another plausible option, especially since amniocentesis related fetal loss in twin pregnancies appear to be lower than previously reported (4,13) and the risk of fetal loss before 24 weeks of gestation is comparable to twin pregnancies without amniocentesis (13,23). However, it should be noted that much of the published data is based on nonrandomized cohort studies.…”

Do Males Affect Twinning Events? A Review of Current Findings/Twin Research Reviews: Monozygotic Twins Discordant for Parkinson’s Disease; Fetal Loss in Twin Pregnancies Following Prenatal Diagnosis; Uterine Rupture and Repair in an Early Twin Pregnancy; Twin Study of Affectionate Communication/Human Interest: Conjoined Twins in a Triplet Set; Identical Twin Nurses Deliver Identical Twins; Identical Twins Discordant for COVID-19 Recovery Course; Identical Twins Pass Away from COVID-19; Archeological Finds

“…A collaborative effort by researchers from Italy, England and Russia compared fetal loss in twin pregnancies in which mothers had or had not undergone chorionic villus sampling or amniocentesis (Di Mascio et al, 2020). The meta-analysis included 16 studies in which the prenatal diagnostic procedures had been used in 3419 twin pregnancies and had not been used in 2517 twin pregnancies.…”