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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 24

Does chorionic villus sampling increase the risk of preeclampsia or gestational hypertension?


Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran

Date of Submission28-Feb-2016
Date of Acceptance20-Sep-2017
Date of Web Publication12-Feb-2019

Correspondence Address:
Maryam Rabiei
Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2008-7802.252149

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  Abstract 


Background: Chorionic villus sampling (CVS) and amniocentesis are two methods for prenatal diagnosis. The goal of this study was to compare amniocentesis and CVS-related complications in a large sample of Iranian women. Methods: Medical records of 1624 women who underwent amniocentesis or CVS due to medical indications between 2008 and 2016 were reviewed. Data regarding age, gravidity, parity, gestational age, type of procedure, neonatal weight (and percentile), trisomia, abortion, intrauterine growth restriction (IUGR), severe IUGR, preeclampsia, and gestational hypertension were recorded. Results: Finally, 1215 cases were evaluated. Mean maternal age, gravidity, and gestational age were significantly different between two groups. Preeclampsia, gestational hypertension, IUGR, severe IUGR, and intrauterine fetal death were not significantly different between two groups. Trisomy 18 and 21 were common in cases underwent amniocentesis. Conclusions: Women who underwent CVS are not at higher risk for developing hypertensive disorders than women underwent amniocentesis.

Keywords: Amniocentesis, chorionic villus sampling, intrauterine growth restriction, preeclampsia


How to cite this article:
Shirazi M, Rabiei M, Rahimi F, Niroomanesh S, Golshahi F, Yazdi ME. Does chorionic villus sampling increase the risk of preeclampsia or gestational hypertension?. Int J Prev Med 2019;10:24

How to cite this URL:
Shirazi M, Rabiei M, Rahimi F, Niroomanesh S, Golshahi F, Yazdi ME. Does chorionic villus sampling increase the risk of preeclampsia or gestational hypertension?. Int J Prev Med [serial online] 2019 [cited 2019 Sep 17];10:24. Available from: http://www.ijpvmjournal.net/text.asp?2019/10/1/24/252149




  Introduction Top


Chorionic villus sampling (CVS) and amniocentesis are two methods for prenatal diagnosis.[1],[2] CVS is applied in cases with advanced maternal age, first-trimester screening for Down syndrome, and cases who are known as high-risk group due to the United States Preventive Services Task Force and the Society of Obstetricians and Gynecologists Canada.[3] As the interest for first-trimester screening for aneuploidy has been increased, the number of CVS conducted in prenatal clinics has been increased.[1] Although against amniocentesis it is not an invasive method, fetal loss has been reported between 0.5% and 1.5% while this rate is between 0.06% and 1% for amniocentesis.[4],[5],[6]

Caughey et al. compared 9886 CVS and 30,893 amniocentesis procedures and found that loss rates were 3.12% for CVS and 0.83% for amniocentesis.[7]

There are some evidences that placenta damage after CVS is related to increase risk of preeclampsia. Focal placental hemorrhage and inflammation, stimulation of maternal immune system by fetal antigens, and imbalance between angiogenic and antiangiogenic placental products are factors considered as predisposing factors of CVS-related preeclampsia.[8],[9],[10]

On the other hand, miscarriage, infection, club foot, and puncture of the placenta are amniocentesis-related complications.

There are limited studies regarding comparing complications in women underwent CVS or amniocentesis.

The goal of this study was to compare amniocentesis and CVS-related complications in a large sample of Iranian women.


  Methods Top


We conducted this retrospective study in Moheb YAS Hospital (affiliated hospitals of Tehran University of Medical Sciences). Medical records of 1624 women who underwent amniocentesis or CVS due to medical indications between 2008 and 2016 were reviewed.

Inclusion criteria

Patients with CVS conduction between 11 and 13 weeks of gestational age (with 20 gauge needle) or amniocentesis between 15 and 22 weeks with 22 gauge needle were included.

Exclusion criteria

Patients with medical diseases such as diabetes, hypertension, kidney disease, thyroid disease, conduction of procedure twice or more, and entrance of needle in amniocentesis through placenta were excluded from the study. Patients with multiple pregnancies, maternal anomalies in sonography, maternal body mass index >35 kg/m2, and cigarette smoking were also excluded from the study.

Data regarding age, gravidity, parity, gestational age, type of procedure, neonatal weight (and percentile), trisomia, abortion, intrauterine growth restriction (IUGR), severe IUGR (abdominal circumference <5th percentile), preeclampsia, and gestational hypertension were recorded.

We excluded induced abortion cases.

Statistical analyses were performed with SPSS (version 18, SPSS Inc., Chicago, IL, USA).

Results are presented as mean ± standard deviations and frequencies. The Chi-square test with Fisher's exact test was applied for comparing categorical variables and ANOVA test used to compare continuous variables. P < 0.050 was considered statistically significant.


  Results Top


Medical records of 1624 pregnant women who underwent amniocentesis or CVS were reviewed. Mean maternal age, gravidity, and gestational age were significantly different between two groups [Table 1].
Table 1: Demographic characteristics of two groups

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Abortion occurred in 67 cases who had amniocentesis and 12 who had CVS (P = 0.2). Three hundred and twenty-eight cases were lost to follow up. Finally, 1215 cases were evaluated. Nine hundred and ninety-one cases were in amniocentesis group and 224 in CVS group.

Preeclampsia, gestational hypertension, IUGR, severe IUGR, and intrauterine fetal death were not significantly different between two groups [Table 2].
Table 2: Pregnancy complications in two groups

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Thalassemia was the most common finding of CVS while trisomy 18 and 21 were common in cases underwent amniocentesis.


  Discussion Top


The result of this study showed that incidence of preeclampsia, gestational hypertension, and IUGR were not significantly different between amniocentesis and CVS groups.

This finding is against Daskalakis et al.'s findings. They evaluated 3243 women who underwent CVS and 6875 woman who underwent amniocentesis and reported higher rate of gestational hypertension in CVS group than amniocentesis group (3.8% vs. 1.7%).[11]

In another study, Grobman et al. evaluated 501 women who underwent amniocentesis and 152 who had CVS with 653 women who had no test. They found that maternal age <25 years, nulliparity, and having CVS are factors which are associated with preeclampsia.[12]

Adusumalli et al. conducted a study to evaluate the relationship between CVS and pregnancy-related hypertensive disorders. They followed 1540 women who had CVS and 840 controls. Hypertensive disorders were reported in 4.9% of patients and 4.4% of controls.[9]

In a retrospective analysis of Swedish database, there was no increased risk of preeclampsia or gestational hypertension in women who had CVS.[13]

Basaran et al. conducted a systematic review to assess effects of CVS on preeclampsia and pregnancy-related hypertension. They investigated that CVS does not increase the risk of preeclampsia or hypertensive disorders in pregnancy.[14]

In a previous trial, CVS was related to 0.4% greater pregnancy loss before 20th week of gestation and a 0.7% greater rate before 28th week.[15]

We also found that conduction of CVS is not related with increased risk of IUGR which is consistent with Williams et al. and Ferguson et al.'s results that reported no significant difference between neonatal weight of amniocentesis and CVS groups.[16],[17]

Daniilidis et al. reviewed medical record of pregnant women who underwent amniocentesis in their center. They reported Down syndrome in 4% of cases.[2]

Three hundred and eleven women who had amniocentesis were evaluated by Tchirikov et al.[18] Like our results, Down syndrome followed by trisomy 18 was the most abnormal chromosomal anomalies.

Preeclampsia is one of the most leading causes of mortality and morbidity which is the result of impaired placentation.[19] There is a theory which supports that placenta disruption which occurs during CVS procedure will result in abnormal placental function and finally preeclampsia or gestational hypertension.[11]

CVS is a diagnostic test which includes chorionic villi cells from the placenta. The most indications for CVS conduction are advanced maternal age and family history or abnormal screening tests.[4] It usually is performed at 11 and 14 weeks of gestation and provides a valuable source of extravillous trophoblasts.[20]

CVS may damage placentation which causes inflammation and focal hemorrhage. These processes will cause placental perfusion reduction, impaired placental vasculature, and endothelial dysfunction,[8] leading to the development of preeclampsia or gestational hypertension.

However, there are controversies regarding results of different studies due to sample size, inclusion and exclusion criteria, and study design.

Larger, multicentric studies are recommended.


  Conclusions Top


Women who underwent CVS are not at higher risk for developing hypertensive disorders than women underwent amniocentesis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Odibo AO, Singla A, Gray DL, Dicke JM, Oberle B, Crane J, et al. Is chorionic villus sampling associated with hypertensive disorders of pregnancy? Prenat Diagn 2010;30:9-13.  Back to cited text no. 1
    
2.
Daniilidis A, Karydas H, Zournatzi V, Tantanasis T, Giannoulis C, Tzafettas J, et al. Afour-year retrospective study of amniocentesis: One centre experience. Hippokratia 2008;12:113-5.  Back to cited text no. 2
    
3.
Lau KT, Leung YT, Fung YT, Chan LW, Sahota DS, Leung NT, et al. Outcome of 1,355 consecutive transabdominal chorionic villus samplings in 1,351 patients. Chin Med J (Engl) 2005;118:1675-81.  Back to cited text no. 3
    
4.
Choudry A, Masood S, Ahmed S. Feasibility and safety of transabdominal chorionic villus sampling. J Ayub Med Coll Abbottabad 2012;24:38-43.  Back to cited text no. 4
    
5.
Eddleman K, Berkowitz R, Kharbutli Y, Malone F, Vidaver J, Porter TF, et al. Pregnancy loss rates after midtrimester amniocentesis: The FASTER trial. Am J Obstet Gynecol 2003;189:S111.  Back to cited text no. 5
    
6.
Tabor A, Philip J, Bang J, Madsen M, Obel EB, Nørgaard-Pedersen B, et al. Needle size and risk of miscarriage after amniocentesis. Lancet 1988;1:183-4.  Back to cited text no. 6
    
7.
Caughey AB, Hopkins LM, Norton ME. Chorionic villus sampling compared with amniocentesis and the difference in the rate of pregnancy loss. Obstet Gynecol 2006;108:612-6.  Back to cited text no. 7
    
8.
Silver RK, Wilson RD, Philip J, Thom EA, Zachary JM, Mohide P, et al. Late first-trimester placental disruption and subsequent gestational hypertension/preeclampsia. Obstet Gynecol 2005;105:587-92.  Back to cited text no. 8
    
9.
Adusumalli J, Han CS, Beckham S, Bartholomew ML, Williams J 3rd. Chorionic villus sampling and risk for hypertensive disorders of pregnancy. Am J Obstet Gynecol 2007;196:591.e1-7.  Back to cited text no. 9
    
10.
McKeeman GC, Ardill JE, Caldwell CM, Hunter AJ, McClure N. Soluble vascular endothelial growth factor receptor-1 (sFlt-1) is increased throughout gestation in patients who have preeclampsia develop. Am J Obstet Gynecol 2004;191:1240-6.  Back to cited text no. 10
    
11.
Daskalakis G, Papapanagiotou A, Antonakopoulos N, Mesogitis S, Papantoniou N, Loutradis D, et al. Invasive diagnostic procedures and risk of hypertensive disorders in pregnancy. Int J Gynaecol Obstet 2014;125:146-9.  Back to cited text no. 11
    
12.
Grobman WA, Auger M, Shulman LP, Elias S. The association between chorionic villus sampling and preeclampsia. Prenat Diagn 2009;29:800-3.  Back to cited text no. 12
    
13.
Lindgren P, Cederholm M, Haglund B, Axelsson O. Invasive procedures for fetal karyotyping: No cause of subsequent gestational hypertension or pre-eclampsia. BJOG 2010;117:1422-5.  Back to cited text no. 13
    
14.
Basaran A, Basaran M, Topatan B. Chorionic villus sampling and the risk of preeclampsia: A systematic review and meta-analysis. Arch Gynecol Obstet 2011;283:1175-81.  Back to cited text no. 14
    
15.
Group CCC-ACT. Multicentre randomised clinical trial of chorion villus sampling and amniocentesis:First report. Lancet 1989;333:1-6.  Back to cited text no. 15
    
16.
Williams J 3rd, Medearis AL, Bear MB, Kaback MM. Chorionic villus sampling is associated with normal fetal growth. Am J Obstet Gynecol 1987;157:708-12.  Back to cited text no. 16
    
17.
Ferguson JE 2nd, Vick DJ, Hogge JS, Hogge WA. Transcervical chorionic villus sampling and amniocentesis: A comparison of reliability, culture findings, and fetal outcome. Am J Obstet Gynecol 1990;163:926-31.  Back to cited text no. 17
    
18.
Tchirikov M, Arnold C, Oshovskyy V, Heinrich UR, Thäle V. Three years' experience of using a 29-gauge atraumatic needle for amniocentesis. J Perinat Med 2012;40:413-7.  Back to cited text no. 18
    
19.
Lopez-Mendez MA, Martinez-Gaytan V, Cortes-Flores R, Ramos-Gonzalez RM, Ochoa-Torres MA, Garza-Veloz I, et al. Doppler ultrasound evaluation in preeclampsia. BMC Res Notes 2013;6:477.  Back to cited text no. 19
    
20.
Campbell S, Park JH, Rowe J, Seeho SK, Morris JM, Gallery ED, et al. Chorionic villus sampling as a source of trophoblasts. Placenta 2007;28:1118-22.  Back to cited text no. 20
    



 
 
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  [Table 1], [Table 2]



 

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