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Risk of Fetal Loss After Chorionic Villus Sampling in Twin Pregnancy Derived from Propensity Score Matching Analysis

dc.contributor.authorGil, M
dc.contributor.authorRodríguez‐Fernández, M
dc.contributor.authorElger, T
dc.contributor.authorAkolekar, R
dc.contributor.authorSyngelaki, A
dc.contributor.authorDe Paco Matallana, C
dc.contributor.authorMolina, F
dc.contributor.authorGallardo Arocena, M
dc.contributor.authorChaveeva, P
dc.contributor.authorPersico, N
dc.contributor.authorAccurti, V
dc.contributor.authorKagan, K
dc.contributor.authorProdan, N
dc.contributor.authorCruz, J
dc.contributor.authorNicolaides, K
dc.date.accessioned2023-04-14T14:14:18Z
dc.date.available2023-04-14T14:14:18Z
dc.date.issued2022-02
dc.description.abstractObjective: To estimate the risk of fetal loss associated with chorionic villus sampling (CVS) in twin pregnancy, using propensity score analysis. Methods: This was a multicenter cohort study of women with twin pregnancy undergoing ultrasound examination at 11-13 weeks' gestation, performed in eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. The risk of death of at least one fetus was compared between pregnancies that had and those that did not have CVS, after propensity score matching (1:1 ratio). This procedure created two comparable groups by balancing the maternal and pregnancy characteristics that lead to CVS being performed, similar to how randomization operates in a randomized clinical trial. Results: The study population of 8581 twin pregnancies included 445 that had CVS. Death of one or two fetuses at any stage during pregnancy occurred in 11.5% (51/445) of pregnancies in the CVS group and in 6.3% (515/8136) in the non-CVS group (P < 0.001). The propensity score algorithm matched 258 cases that had CVS with 258 non-CVS cases; there was at least one fetal loss in 29 (11.2%) cases in the CVS group and in 35 (13.6%) cases in the matched non-CVS group (odds ratio (OR), 0.81; 95% CI, 0.48-1.35; P = 0.415). However, there was a significant interaction between the risk of fetal loss after CVS and the background risk of fetal loss; when the background risk was higher, the risk of fetal loss after CVS decreased (OR, 0.46; 95% CI, 0.23-0.90), while, in pregnancies with a lower background risk of fetal loss, the risk of fetal loss after CVS increased (OR, 2.45; 95% CI, 0.95-7.13). The effects were statistically significantly different (P-value of the interaction = 0.005). For a pregnancy in which the background risk of fetal loss was about 6% (the same as in our non-CVS population), there was no change in the risk of fetal loss after CVS, but, when the background risk was more than 6%, the posterior risk was paradoxically reduced, and when the background risk was less than 6%, the posterior risk increased exponentially; for example, if the background risk of fetal loss was 2.0%, the relative risk was 2.8 and the posterior risk was 5.6%. Conclusion: In twin pregnancy, after accounting for the risk factors that lead to both CVS and spontaneous fetal loss and confining the analysis to pregnancies at lower prior risk, CVS seems to increase the risk of fetal loss by about 3.5% above the patient's background risk. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationUltrasound Obstet Gynecol . 2022 Feb;59(2):162-168.pt_PT
dc.identifier.doi10.1002/uog.24826pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4499
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherWileypt_PT
dc.subjectMAC MED MAFpt_PT
dc.subjectHumanspt_PT
dc.subjectFemalept_PT
dc.subjectPregnancypt_PT
dc.subjectAmniocentesis / adverse effects*pt_PT
dc.subjectChorionic Villi Sampling / adverse effects*pt_PT
dc.subjectCongenital Abnormalities / diagnosispt_PT
dc.subjectPregnancy Trimester, Firstpt_PT
dc.subjectPregnancy, Twin*pt_PT
dc.subjectPrenatal Diagnosis / adverse effects*pt_PT
dc.subjectPropensity Scorept_PT
dc.subjectUltrasonography, Prenatalpt_PT
dc.titleRisk of Fetal Loss After Chorionic Villus Sampling in Twin Pregnancy Derived from Propensity Score Matching Analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage168pt_PT
oaire.citation.issue2pt_PT
oaire.citation.startPage162pt_PT
oaire.citation.titleUltrasound in Obstetrics & Gynecologypt_PT
oaire.citation.volume59pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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