and pain are increased in pregnancies complicated by myoma uteri. Amniocentesis is a frequently used invasive procedure in prenatal diagnosis, for which the ...
15th World Congress on Ultrasound in Obstetrics and Gynecology Results: Excellent visualization of the external fetal anatomy was obtained in 83% of cases (5/6) with the duration of procedures ranging 15 to 40 minutes. A diagnosis of Meckel-Gruber syndrome was made at 13 + 1 weeks of gestation by visualizing postaxial polydactyly and an occipital encephalocele. Subsequently the pregnancy was terminated. Three full-term infants were delivered with no gross limb or facial abnormalities. Amniotic fluid leakage after the procedure occurred in 2 cases resulting in termination of pregnancy. Conclusion: Our experiences confirm the efficacy of embryofetoscopy for early diagnosis in the first trimester of pregnancy. Procedure-related risks are to be established by multicenter studies.
P09.03 Evaluation of the complications of amniocentesis in pregnant women with uterine myomas S. Buyukkurt, A. Yuksel, R. Has, I. Kalelioglu, H. Delier Sezer Department of Obstetrics and Gynecology, Istanbul University Faculty of Medicine, Turkey Uterine leiomyomas are the most frequent tumors of the female pelvis and the incidence of uterine myomas in pregnancy is 1–4%. The risks of abortion, preterm delivery, premature rupture of membranes, placental abruption, dystocia, malpresentation, postpartum bleeding and pain are increased in pregnancies complicated by myoma uteri. Amniocentesis is a frequently used invasive procedure in prenatal diagnosis, for which the most common indication is advanced maternal age and the abortion rate of amniocentesis is approximately 1%. There is only one retrospective study on the pregnancy outcomes of patients with fibroids who underwent genetic amniocentesis. In our prospective cohort study, we evaluated the effects of amniocentesis on the outcomes of pregnancies with fibroids. There were 39 pregnant women with fibroids who underwent amniocentesis in the study group (group 1) while 43 pregnant women with myoma uteri who did not undergo amniocentesis constituted the control group (group 2). Maternal age, gravidity, parity, history of abortion and uterine surgery were similar in both groups, and all women were in the second trimester. Fibroids were evaluated according to their relations to the myometrium, the uterus and the placenta. Their dimensions were measured and their volumes were calculated. All amniocentesis were performed by two experienced operators. The pregnancies were evaluated for abortion rate, gestational age at delivery, preterm delivery, premature rupture of membranes, route of delivery, postpartum complications and birth weight. There were no significant differences in terms of pregnancy outcome. In conclusion, amniocentesis does not worsen the pregnancy outcome in patients with uterine myomas.
P09.04 Amniocentesis – no longer ‘‘a shot in the dark’’ P. Tripathi, H. Batool, K. Surampudi, C. Willocks, D. McLellan Wishaw General Hospital, Hairmyres Hospital, Monklands Hospital, UK Objective: The main aim of this audit was to determine direct procedural loss rate after second trimester amniocentesis at our hospital in view of RCOG recommendations that loss rates following amniocentesis should be no greater than 1% and that perinatal departments should audit and utilise local figures for preprocedural counselling. Method: A previous 5-year retrospective audit of amniocentesis 1994–1998 had confirmed a high procedural loss rate of 4.2%. 237 amniocentesis were performed with 10 direct losses: 5 within 7 days; 1 at 9 days; and 4 between 20–33 days. A large number of operators and lack of departmental training and supervision were
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Poster abstracts identified as culprits. With checks in place, a further audit loop was completed for the year 2002. This revealed a significant reduction in procedure related losses to 0.5% confirming the effectiveness of departmental policy change. Results:
No of patients Case note retrieval Direct procedural losses Procedural loss rate Stillbirths Trisomy 21 other anomalies Termination of pregnancy Livebirths
1994–98
2002
239 237 10 4.2% 1 4 5 7 219
186 186 1* 0.5% 3 2 5 2 181
*Gross fetal hydrops indication for amniocentesis. Miscarriage 1 day post procedure. No cause identified.
There were 9 anomalies identified in the first audit and 7 in the second. The first phase identified five Down’s syndrome, two Edward’s syndrome, and one each of Klinefelter’s and Turner’s. The second phase identified two Down’s syndrome and one Klinefelter’s syndrome. Conclusion: This audit cycle identified the need for the introduction of departmental guidelines on amniocentesis to ensure delivery of a service meeting national quality standards. The reaudit has confirmed the effectiveness of those policy changes and can be utilised to reassure women receiving preprocedural counselling. Continuous revalidation with a rolling programme of audit must be maintained to ensure that those quality standards are maintained.
P09.05 A randomized single blinded trial of subfreezing versus room temperature needles to reduce pain with amniocentesis J. Wax, M. G. Pinette, M. Carpenter, R. Chard, J. Blackstone, A. Cartin Maine Medical Center, USA Objective: To determine whether pain associated with second trimester genetic amniocentesis is decreased by using subfreezing rather than room temperature needles. Methods: Subjects were randomized by sealed opaque envelope, in blocks of 10 by physician to a minus 14◦ C or room temperature (20–22◦ C) 22 gauge spinal needle. Patients, blinded to allocation, recorded anticipated and actual pain before and after the procedure, respectively, using a 10 cm visual analog scale (VAS) with 0 = no pain and 10 = excruciating pain. No local anesthetic was used. Twenty-nine subjects in each arm would provide 80% power at the 0.05 level to detect a 1.4 cm VAS difference in pain between study groups. Parametric continuous variables were analyzed using the 2-tailed Student t-test and dichotomous variables were evaluated by the Chi-square test. Results: Thirty-three subjects were randomized to room temperature and 29 subjects to subfreezing needles. The two study groups were similar with respect to demographics and procedural details. Anticipated pain was similar in room temperature, 5.1 (95% CI 4.5–5.7) ± 1.7, and subfreezing groups, 4.9 (95% CI 4.1–5.6) ± 2.0, respectively (p = 0.6). Actual pain was also similar in the room temperature, 3.6 (95% CI 2.9–4.3) ± 2.0, and subfreezing groups, 2.8 (95% CI 2.0–3.6) ± 2.0, respectively (p = 0.14). The change from anticipated to actual pain was 1.6 (95% CI 0.8–2.3) ± 2.1 and 2.0 (95% CI 0.9–3.0) ± 2.7 in the room temperature and subfreezing groups, respectively (p = 0.5). Similar numbers of subjects in the room temperature and subfreezing groups reported less actual pain (20 vs. 18), greater actual pain (4 vs. 4) or no difference in pain (9 vs. 5) than anticipated (p = 0.6). No procedural complications occurred.
Ultrasound in Obstetrics & Gynecology 2005; 26: 376–471
