Aims To assess the local compliance for CVS and Amniocentesis, with RCOG Green-top standards1. Additionally, examine the indications for prenatal diagnosis, results and outcomes.
Background 1:20 pregnant women in the UK are offered prenatal diagnosis, amounting to 30,000 procedures annually1. CVS is offered 11–13 weeks, Amniocentesis from 15 weeks1. Type and timing of diagnostic test screening provided. Changes are predicted with adoption of combined first trimester screening for Down’s Syndrome1.
Methods Retrospective case-note audit of 200 consecutive prenatal diagnosis cases, performed by operators in Ormskirk District General Hospital, with 3200 deliveries per annum.
Results 200 procedures (25 CVS, 175 Amniocentesis) performed with continuous ultrasound, by 2 experienced operators, from August 2007 to November 2011. Rate of pregnancy loss following any procedure was 1.7% (3 cases of amniocentesis), and 0.6% loss <14 days of procedure (1 Amniocentesis). All miscarriages were <20 weeks gestation. 5 CVS and 1 Amniocentesis required 2 attempts. Bloodstaining complicated one procedure clinically, and 11 cases were recognised by the lab. 20% CVS and 2.9% of amniocentesis had inadequate sample volumes. Overall culture failure was 1%. 2 women reattended with vaginal discharge, 1 with abdominal pain. There was one liquor leak, and one case of sepsis
Conclusions Introduce continuous audit, with proforma for RCOG standards to be commenced at the procedure. Review results annually, use to inform patients, and develop the prenatal diagnosis service. Continue to train specialist registrars and sonographers, in a supportive environment for competency acquisition.
RCOG. Amniocentesis and Chorionic Villus Sampling (Green-top 8). RCOG. 2010.
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