Significance of the volume of fetomaternal hemorrhage after performing prenatal invasive tests
Dolores SubiráMontserrat UrielChora SerranoSusana CastañónRaquel GonzaloJulia IllánJavier Óscar Garay PlazaA Román
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Background: Fetal erythrocytes cross the placenta during gestation, but invasive prenatal procedures might develop into fetomaternal hemorrhage (FMH). We examine whether flow cytometry immunophenotyping might be useful for measuring the volume of FMH after such procedures. Methods: Fetal erythrocytes (%) were determined in 153 pregnant women after amniocentesis (129) and chorionic villous sampling (24) using a monoclonal antibody against fetal hemoglobin. Fetal erythrocytes were identified for their high expression of fetal hemoglobin (HbF++). Blood samples from two control groups, 53 healthy males and 21 pregnant women not submitted to invasive tests, were used to establish normal values of circulating HbF++ erythrocytes in adults. Results: The highest percentage of HbF++ erythrocytes in the control groups was 0.015%. The rate of HbF++ erythrocytes in samples after invasive tests ranged between <0.01% and 0.15%. Seventy-three women (47%) had ≤0.015% HbF++ erythrocytes, and this rate was higher in 80. Nine women presented >1 ml of FMH (volume of packed cells corresponding to 0.054–0.15% HbF++ erythrocytes), but only two had sonographic evidence of bleeding. Conclusions: Most women in our series had a very low volume of FMH after the invasive tests. Acute bleeding should be thoroughly investigated in women with either more than 1 ml of packed cells or more than 0.05% of HbF++ erythrocytes. Intermediate values between >0.015% and <0.05%, should be carefully considered depending on the week of gestation. Data obtained before 15 weeks might reflect previous cell trafficking between fetus and mother instead of acute hemorrhage. © 2010 International Clinical Cytometry SocietyKeywords:
Amniocentesis
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Abstract We report the first prenatal diagnosis of an affected fetus with Chediak‐Higashi syndrome (CHS). Diagnosis was accomplished via fetal blood sampling at 17 menstrual weeks and was confirmed after birth. Retrospective measurement of the largest acid phosphatase‐positive lysosomes in cultured amniotic fluid cells and chorionic villus cells showed that in CHS these lysosomes are significantly larger than those in normal cells. This method may be used for prenatal diagnosis of CHS by amniocentesis and chorionic villus sampling (CVS).
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Chorionic villus sampling
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Chorionic villus sampling (CVS) has a promising future about early detection of fetal abnormalities. It has the potential to become a major tool in the prenatal diagnosis and therapy of genetic disorders. Villus samples can be analyzed by means of cytogenetic, biochemical or molecular technics. Information available at present indicates fetal loss rate should be in the same proportion than amniocentesis. CVS appears to be a reasonably safe and reliable method of prenatal diagnosis in the first trimester of pregnancy. This procedure is setting as fast as it is possible like an excellent alternative to amniocentesis.
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<i>Objectives:</i> To evaluate the changes in the approaches used for invasive prenatal diagnosis for β-thalassemia and karyotyping at a single center from 1977 to 2004. <i>Methods:</i> For β-thalassemia, in 1977 placentacentesis, in 1982 amniocentesis, in 1983 fetoscopy and cordocentesis, in 1983 trancervical chorionic villi sampling (TC-CVS), in 1984 cardiocentesis, in 1986 transabdominal CVS, and in 2002 preimplantation genetic diagnosis (PGD) were introduced. For karyotyping, in 1977 amniocentesis, in 1983 cordocentesis and cardiocentesis and TC-CVS, in 1986 TA-CVS and in 1991 hepatic vein sampling were introduced. Rates of approaches used were retrospectively considered, for 5 different groups (1977–1981; 1982–1985; 1986–1993; 1994–1999; 2000–2004). <i>Results:</i> 35,127 invasive prenatal diagnoses were considered, and 42 PGD included. For β-thalassemia 6,547 diagnoses were performed and 42 PGD. Since 1986–1993, TA-CVS was the only approach used except for 42 PGD in the 2000–2004 group. For karyotyping 28,538 diagnoses were performed. Amniocentesis and TA-CVS have been the most frequently used in the last years, while cordocentesis and hepatic vein sampling have shown a decline after their introduction. <i>Conclusion:</i> TA-CVS is now the only technique used for β-thalassemia. For karyotype, amniocentesis and TA-CVS are the most frequently used procedures. Obstetrical and laboratory experience, the availability of screening, and other individual factors, have influenced the choice, towards an earlier approach in pregnancy.
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Chorionic villus sampling is under evaluation throughout the world. Amniocentesis with amniotic cell culture is reliable for the diagnosis of certain types of genetic disease in the second trimester, and has been the subject of extensive clinical and laboratory audit. Chorionic villus sampling has the advantage of the early diagnosis (for example, at 10 weeks) of chromosomal abnormalities, a shorter delay with results after the diagnostic procedure, and is, for some couples, a more socially and morally acceptable method of antenatal diagnosis. In current experience, the disadvantages of chorionic villus sampling include an increased fetal loss and an increased diagnostic error rate. Another factor is the early diagnosis of fetuses with chromosomal abnormalities--a proportion of whom would have miscarried spontaneously before being detected at an amniocentesis at 16 weeks. This has implications for an increased rate of therapeutic terminations of pregnancy. Chorionic villus sampling and amniotic cell culture are discussed and comparisons are drawn that concern the clinical advantages and diagnostic issues which are inherent in each method of prenatal diagnosis.
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Recent studies in Canada and the United States have shown that chorionic villus sampling (CVS) is both safe and accurate, with a fetal loss rate likely slightly higher than that of amniocentesis but still at an acceptable level (1%). Although CVS may become the dominant prenatal diagnosis procedure, it is unlikely that it will completely replace amniocentesis. The two procedures are essentially complementary in the provision of prenatal diagnosis in the first and second trimesters.
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Chorionic villus sampling is under evaluation throughout the world. Amniocentesis with amniotic cell culture is reliable for the diagnosis of certain types of genetic disease in the second trimester, and has been the subject of extensive clinical and laboratory audit. Chorionic villus sampling has the advantage of the early diagnosis (for example, at 10 weeks) of chromosomal abnormalities, a shorter delay with results after the diagnostic procedure, and is, for some couples, a more socially and morally acceptable method of antenatal diagnosis. In current experience, the disadvantages of chorionic villus sampling include an increased fetal loss and an increased diagnostic error rate. Another factor is the early diagnosis of fetuses with chromosomal abnormalities — a proportion of whom would have miscarried spontaneously before being detected at an amniocentesis at 16 weeks. This has implications for an increased rate of therapeutic terminations of pregnancy. Chorionic villus sampling and amniotic cell culture are discussed and comparisons are drawn that concern the clinical advantages and diagnostic issues which are inherent in each method of prenatal diagnosis.
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Data were tabulated and compared for cases involving prenatal diagnostic procedures performed in the 8 years between January 1985 and December 1992. Of a total of 2781 pregnancies, 2546 cases (91.5 per cent) were diagnosed by amniocentesis, and 235 (8.5 per cent) by chorionic villus sampling (CVS). These findings reflect the fact that amniocentesis has taken deep root as the prenatal diagnostic procedure widely acknowledged by society, whereas even the existence of CVS has yet to be generally recognized. Analysis of our clinical and laboratory results and complication rates, however, suggests that CVS is a safe and accurate alternative to amniocentesis which should and can be positively presented to all patients who are candidates for prenatal diagnosis.
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