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Published on: September 5, 2011
Instruments for chorionic villus sampling for prenatal diagnosis
Carmen Young1, Peter von Dadelszen, Zarko Alfirevic
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Lois Hole Hospital for Women, Edmonton, Canada.
The Cochrane Database of Systematic Reviews
|February 27, 2013
Summary
For transcervical chorionic villus sampling (CVS), forceps may be preferable to cannulae, though evidence is limited. For transabdominal CVS, continuous and discontinuous needle aspiration systems show similar outcomes.
Area of Science:
- Obstetrics and Gynecology
- Prenatal Diagnostics
- Medical Device Technology
Background:
- Chorionic villus sampling (CVS) is crucial for early prenatal diagnosis before 15 weeks.
- Transabdominal and transcervical approaches exist, with instrument choice impacting outcomes.
- Key procedural goals include accurate maneuvering, visualization, and minimizing uterine passes.
Purpose of the Study:
- To compare the efficacy and safety of various instruments and techniques for CVS.
- To evaluate transabdominal versus transcervical routes for obtaining fetal chorionic tissue.
- Primary outcomes: inadequate sample, reinsertion, pain, and miscarriage rates.
Main Methods:
- Systematic review of randomized trials comparing different CVS instruments (forceps, cannula, needle) and techniques.
- Searched Cochrane Pregnancy and Childbirth Group's Trials Register.
- Two independent reviewers assessed trial eligibility and quality.
Main Results:
- Transcervical CVS: Cannulae led to more inadequate samples and pain compared to forceps, with higher costs.
- Specific cannulae (Portex) showed higher rates of inadequate samples, difficult insertion, and pain.
- Transabdominal CVS: Continuous vs. discontinuous needle aspiration showed conflicting results regarding sample adequacy and weight, but similar miscarriage and pain rates.
Conclusions:
- Limited evidence suggests forceps may be better than cannulae for transcervical CVS, but not strong enough to change established practices.
- For transabdominal CVS, continuous and discontinuous negative pressure needle aspiration systems demonstrate no significant differences in clinically important outcomes.
- Further research may be needed to solidify recommendations for specific CVS instruments and techniques.
