MKP vs FVP, för och nackdelar???

finns en jättespännande doktorsavhadnling om detta som skrivits av den doktorand i uppsala. håller på att läsa den nu!! fast den är på datorn hemma, sitter på jobbet nu.

om man söker på chorionic villus sampling på google så hittar man den på första sidan.

vad jag har läst hittills så är det mindre risk för senare komplikationer vid cvb än vid fvp.

studien är gjord på ca 80000 mödrar under 1996-2000 eller något sånt (minnet är inte det bästa), och då har de plockat bort alla som kunnat snedvrida undersökningen.

Författaren/doktoranden jobbar tydligen på akademiska sjukhuset i Uppsala.

Var toppen och jag undrade varför man inte gör fler mkp om det är bättre för barnet, men jag vågar inte säga att det är så för jag har ca 15 sidor kvar att läsa - den är på 43 sidor har jag för mig.

Kram från en som skall göra moderkaksprov på måndag, också 39!

hej igen, här är en länk till avhandlingen

www.diva-portal.org/demo/theses/abstract.xsql

man får klicka fram pdf-versionen för full text

här är en kort förklaring:

Amniocentesis (AC) and chorionic villus sampling (CVS) are the principal methods for fetal karyotyping. The aim of this thesis was to evaluate psychological reactions and risks associated with the procedures.

A semi-randomised study was made on 321 women, where AC (147) and CVS (174) at 10-13 weeks? gestation were done trans-abdominally. Spontaneous fetal loss occurred in 6.8% and 1.7% of the women in the AC and CVS groups, respectively. Repeat testing was required more often in the AC (19.0%) than in the CVS (5.2%) group.

A subgroup of 94 women answered a questionnaire prior to the procedure. Anxiety was stated as reason for invasive testing in 38% of the women. Mean scores according to the Hospital Anxiety and Depression Scale for anxiety and depression were low. Likewise, mean scores for the Impact of Event Scale, evaluating the psychological distress evoked by the procedure, were low. Yet, a number of women had higher scores, indicating a risk of clinical anxiety and depression or psychological distress. The women worried most about miscarriage, fetal injury by the procedure and waiting for the result.

Fetal, infant and maternal outcomes were evaluated in a cohort of 71 586 women aged 35 to 49 years old, with single births in Sweden during 1991 to 1996. Altogether, 21 748 were exposed to AC and 1984 to CVS. Women exposed to AC and CVS were compared with non-exposed. Outcomes were extracted from the Swedish Medical Birth Register, the Swedish Hospital Discharge Register, and the Swedish Malformation Register. An increased risk of musculo-skeletal deformities, such as club foot (OR=1.45) and hip dislocation (OR=1.22), and respiratory disturbances such as neonatal pneumonia (OR=1.29), was found for infants born in the AC group. Risk increased with earlier gestation at the procedure. Fewer women in the AC group had a normal delivery and more had a Caesarean section. Complications related to the amniotic cavity and membranes (OR=1.15), hypotonic uterine dysfunction (OR=1.12) and instrumental vaginal deliveries (OR=1.11) were more common in the AC group. No significant differences were found for the CVS group.

CVS is the method of choice for prenatal karyotyping in the first trimester. AC should not be performed before 15 weeks? gestation. Further research to develop methods to better identify women at increased risk of chromosomal abnormal pregnancies and to develop non-invasive tests for prenatal diagnosis is needed. Thereby, the number of women exposed to invasive procedures and the adverse effects caused by these procedures can be minimised

hittade en annan artikel också:

BJOG. 2003 Apr ;110 (4):392-9 12699801 (P,S,G,E,B) Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping.

[My paper] Maria Cederholm, Bengt Haglund, Ove Axelsson
Section of Obstetrics and Gynaecology, Department of Women's and Children's Health, Uppsala University, Sweden.
OBJECTIVE: To investigate whether amniocentesis and chorionic villus sampling increase the risk of bleeding, placental abruption, complications related to amniotic cavity and membranes, abnormal labour, operative deliveries and to investigate the impact of gestational length at the time of the procedure. DESIGN: A population-based cohort study. SETTING: Sweden, 1991-1996. POPULATION: All women, 35 to 49 years old, with single births (N = 71,586). The women were classified as exposed to amniocentesis (N = 21,748) or chorionic villus sampling (N = 1984) or not exposed (N = 47,854). METHODS: Maternal outcomes were collected from the Swedish Medical Birth Register and the Swedish Hospital Discharge Register. With Logistic regression analyses odds ratios were calculated. MAIN OUTCOME MEASURES: Crude and adjusted odds ratios of bleeding, complications related to amniotic cavity and membranes, abnormal labour and operative deliveries. Women exposed to amniocentesis or chorionic villus sampling were compared with women non-exposed. RESULTS: Neither amniocentesis nor chorionic villus sampling was associated with severe pregnancy complications such as placental abruption or placenta praevia. Women in the amniocentesis group had a lower chance of normal delivery (OR = 0.93, 95% CI 0.90-0.97), an increased risk of complications related to amniotic cavity and membranes (OR = 1.15, 95% CI 1.06-1.24) and hypotonic uterine dysfunction (OR = 1.12, 95% CI 1.06-1.18). The risks were higher for amniocentesis before 15 weeks of gestation. Women in the amniocentesis group were more often delivered by forceps or vacuum extractions (OR = 1.11, 95% CI 1.03-1.19) and elective caesarean sections (OR = 1.09, 95% CI 1.02-1.16). For the chorionic villus sampling group, no significant associations were found. CONCLUSIONS: Among women aged 35-49 years, amniocentesis is not associated with important adverse outcomes such as abruption or placenta praevia. Minor associations were found for other maternal complications when amniocentesis was performed before 15 weeks of gestation. Improved methods to identify women with increased risk of chromosomally abnormal pregnancies might minimise the number of women exposed to invasive procedures.