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Instruments for chorionic villus sampling for prenatal diagnosis.

Z Alfirevic¹, P von Dadelszen

¹Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool, UK, L69 3BX. zarko@liverpool.ac.uk

The Cochrane Database of Systematic Reviews

|January 22, 2003

Summary

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Small forceps may be better for transcervical chorionic villus sampling (CVS), yielding better sample quality and less pain. However, current evidence does not strongly support changing practice from aspiration cannulae for CVS.

Area of Science:

Perinatal Medicine
Medical Device Technology

Background:

Chorionic villus sampling (CVS) is crucial for prenatal diagnosis before 15 weeks.
Transabdominal and transcervical routes are used for CVS, with instrument choice impacting success.
Instrument maneuverability and ultrasound visibility are key for safe CVS procedures.

Purpose of the Study:

To review the effects of instruments used in transabdominal or transcervical chorionic villus sampling.
To assess technical difficulties, tissue quality/quantity, maternal effects, pregnancy outcomes, and cost-effectiveness.

Main Methods:

Searched the Cochrane Pregnancy and Childbirth Group trials register (up to November 2002).
Included randomized trials comparing forceps, cannula, or needle for CVS.
Assessed eligibility and trial quality with two independent reviewers.

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Main Results:

No trials compared instruments for transabdominal CVS.
Five transcervical CVS trials (472 women) compared forceps and cannulae.
Cannulae resulted in more inadequate samples (RR 4.21), more re-insertions (RR 2.98), and increased pain (RR 1.93) compared to forceps. CVS with cannula was also more expensive ($183.7 difference).

Conclusions:

Limited evidence suggests small forceps may be preferable for transcervical CVS.
Current evidence is insufficient to mandate a change from aspiration cannulae for experienced clinicians.
Further research is needed to definitively establish optimal instrument choice for CVS.