Chorionic villus sampling and marked membrane separation
Poster No.:
B-765
Congress:
ECR 2011
Type:
Scientific Paper
Topic:
Interventional Radiology
Authors:
S. Akhlaghpoor, A. Aziz Ahari; Tehran/IR
Keywords:
Pregnancy, Obstretric imaging, Interventional non-vascular,
Ultrasound, Biopsy, Sampling, Obstetrics, Fetus
DOI:
10.1594/ecr2011/B-765
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Page 1 of 7
Purpose
Amnion and chorion membranes are physiologically separated during the first 12-13
weeks of pregnancy and there is a fluid filled extraembryonic cavity between them. The
biochemical and hormonal features of amniotic and extraembryonic celomic fluids are
different [1-3] representing their compartment-specific bioproduction [4]. At 13-14 weeks,
close juxtaposition of amnion and chorion reduces the celomic cavity in size to a virtual
cavity [1].
Although physiologic fusion of amnion and chorion membranes occurs before 14 weeks'
gestation [5] and after this time, the detection of chorioamniotic separation should be
th
considered abnormal [6], our experience shows even after the 10 gestational week
(the minimum limit of performing CVS), marked chorioamniotic separation is an
uncommon finding. The purpose of this study was to report the rate of marked
th
th
membrane separation in 10 -to-14 week gestational age period and to assess its
effect on the frequency of post CVS fetal loss.
Methods and Materials
41 (5.2%) patients were selected among 782 patients as cases with marked membrane
separation. (i.e. more than 10 mm by our definition) (Fig. 1).
We excluded cases with gestational age of lower than 10 week, large size sub chorionic
hematoma (greater than 50% of gestational sac [7]), history of recurrent abortion, active
gynecological infection and watery discharge.
All procedures were carried out after 10 weeks of gestation with regard to the crownrump length and/or biparietal diameter measured immediately before the procedure.
With a 20-gauge Chiba needle pass attached to a 20-ml syringe under continuous
ultrasound guidance all transabdominal CVS procedures were performed (Fig. 2). The
samples were immediately emptied into a disposable sterile plastic dish and flushed with
normal saline.
Follow up was by telephone and clinical visits until 24 weeks of gestation but for the
patients without marked membrane separation the follow-up was only for two post
procedural weeks.
Page 2 of 7
Those patients who underwent therapeutic abortion or lost a fetus with a major anomaly
(e.g. microcephaly) were excluded from analysis after the abortion. Otherwise, early fetal
loss in first two week post procedural period and late fetal loss from 2 weeks after
th
procedure till 24 gestational week were considered CVS complications.
Table 1. Characteristics and clinical data of selected 41 patients
Characteristic
Value
Number of patients
41
*
76.07 ± 4.54 (10 weeks ± 10.61 days)
Gestational Age (Days)
26.85 ± 4.32
*
Mother Age (years)
*
Membrane Separation (mm)
13.63 ± 2.67 (range, 10-20)
Placenta Location
Anterior
18 (43.9%)
Posterior
19 (46.3%)
Fundal
4 (9.8%)
*
Values are expressed as mean ± standard deviation
Images for this section:
Page 3 of 7
Page 4 of 7
Fig. 1: Two fetuses with marked membrane separation before CVS. A. 11w 3d fetus with
12 mm membrane separation. B. 11w 0d fetus with 13 mm membrane separation
Fig. 2: A 20-gauge Chiba needle, performing CVS from a 11 week and 6 day fetus with
marked chorioamniotic separation
Page 5 of 7
Results
Fourty one (5.2%) of patients undergone CVS had marked membrane separation, i.e.
more than 10 mm by our definition.
In 41 cases with marked membrane separation:
We detected one early fetal loss (2.4%) during first 2 weeks after the procedure. This
was the case with medium size sub chorionic hematoma.
Histological study proved major beta-thalassemia in 13 (31.7 %) cases and hemophilia
in one (2.4 %) case. These cases underwent voluntarily therapeutic abortion. One case
th
had suspected microcephaly and was aborted in 21 gestational week.
No late fetal loss was noted in remaining 26 patients.
For the patients without marked membrane separation
The early fetal loss rate in two weeks after the procedure was 1.48 % (11 out of 741
patients).
Pearson correlation showed no significant difference between two groups of with
and without marked membrane separation (cases and controls) in early fetal loss
occurrence after CVS (P value = 0.37).
Conclusion
th
Even before 14 gestational week (10 to 14 week gestational week), marked separation
of membranes is an uncommon finding.
Page 6 of 7
From loss rates after the CVS in cases and controls groups, we showed that the marked
membrane separation does not have a major impact on early post CVS fetal loss.
References
[1] Lewi L, Hanssens M, Spitz B, Deprest J. Complete chorioamniotic membrane
separation. Case report and review of the literature. Fetal Diagn Ther. 2004 JanFeb;19(1):78-82.
[2] Itskovitz J, Rubattu S, Levron J, Sealey JE. Highest concentrations of prorenin and
human chorionic gonadotropin in gestational sacs during early human pregnancy. J Clin
Endocrinol Metab. 1992 Sep;75(3):906-10.
[3] Wathen NC, Cass PL, Kitau MJ, Chard T. Human chorionic gonadotrophin and
alpha-fetoprotein levels in matched samples of amniotic fluid, extraembryonic coelomic
fluid, and maternal serum in the first trimester of pregnancy. Prenat Diagn. 1991
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[4] Jauniaux E, Gulbis B. Fluid compartments of the embryonic environment. Hum Reprod
Update. 2000 May-Jun;6(3):268-78.
[5] Abboud P, Mansour G, Zejli A, Gondry J. Chorioamniotic separation after 14 weeks'
gestation associated with trisomy 21. Ultrasound Obstet Gynecol. 2003 Jul;22(1):94-5.
[6] Montero JJ, Ortega S, Vazquez C, Martinez T, Loidi B. Delay of chorioamniotic fusion:
relation to chromosomal anomalies. Prenat Diagn. 2000 Jun;20(6):517-8.
[7] Akhlaghpoor S, Tomasian A. Safety of chorionic villus sampling in the presence of
asymptomatic subchorionic hematoma. Fetal Diagn Ther. 2007;22(5):394-400.
Personal Information
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