Chorionic villus sampling increases the alpha-fetoprotein level but not the number of fetal erythrocytes in maternal blood

Abstract

NOT THE NUMBER OF FETAL ERYTHROCYTES IN MATERNAL BLOOD DENISE PELIKAN, SICCO SCHERJON, WILMA MESKER, GODELIEVE GROOT SWINGS, HANS TANKE, HUMPHREY KANHAI, Leiden University, Obstetrics, Leiden, Netherlands, Netherlands, Leiden University, Molecular Cell Biology, Leiden, Netherlands, Netherlands OBJECTIVE: To investigate the relation between alpha-fetoprotein (AFP) levels and the number of fetal erythrocytes in maternal blood before and after chorionic villus sampling (CVS). STUDY DESIGN: Blood samples of 53 women between 11 and 13 gestational weeks undergoing CVS, were collected 15 minutes before and after CVS. All pregnancies were cytogenetically normal. A biopsy forceps (n = 47) and a canula (n = 3) were used for transcervical CVS. An aspiration needle (n = 3) was used for transabdominal sampling. The AFP measurements were performed in a single run using the Chemiluminescent Microparticle Immunoassay. Supervised automated microscopy of Kleihauer-Betke stained slides was applied to quantify fetal erythrocytes. Per sample G 2.0x106 cells were evaluated. RESULTS: AFP measurements before and after CVS were obtained in 48 patients, whereas paired slides were complete in 50 patients. The mean AFP level before CVS was 13.9 mg/L (range 6.4-36.4, median 11.7, SD 7.3, SEM 1.1, 95% CI 11.8-16.0) and after CVS 37.2 mg/L (range 8.2-241.7, median 18.4, SD 46.4, SEM 6.7, 95% CI 23.7-50.7), indicating a significant increase of the AFP level in maternal plasma after CVS (Wilcoxon signed ranks test, P ! .0001). The mean number of fetal erythrocytes before CVS was 1.5 (range 0–24, median 0, SD 3.8, SEM 0.5, 95% CI 0.4–2.6) and after CVS 2.0 (range 0 – 23, median 1.0, SD 4.4, SEM 0.6, 95% CI 0.7–3.2). There was no significant increase in the fetal erythrocyte count before versus after CVS (Wilcoxon signed ranks test, P = .327). Consequently, the correlation between the fetal erythrocyte difference before and after CVS and the AFP level difference was not significant (r = 0.13, P = .39). CONCLUSION: Although an increase was found in AFP levels after CVS, no increase in fetal erythrocytes could be detected. This suggests that the CVS procedure results in a leakage of proteins due to placental tissue damage, rather than increased trafficking of fetal cells through the placental barrier. 229 RANDOMIZED COMPARISON OF SUBCUTANEOUS TISSUE REAPPROXIMATION ALONE AND IN COMBINATION WITH SUBCUTANEOUS DRAIN IN OBESE WOMEN UNDERGOING CESAREAN DELIVERY PATRICK RAMSEY, ANNA WHITE, DEBRA GUINN, GEORGE LU, LINDA FONSECA, ASHLEY CASE, DWIGHT ROUSE, University of Alabama at Birmingham, Obstetrics/Gynecology, Birmingham, Alabama, Northwest Perinatal Center and Women’s Healthcare Associates, Obstetrics/Gynecology, Portland, Oregon, Obstetrix Medical Group of Kansas & Missouri, Kansas City, Missouri, University of Texas Health Science Center at Houston, Obstetrics, Gynecology and Reproductive Sciences, Houston, Texas OBJECTIVE: To compare the efficacy of subcutaneous (SQ) suture reapproximation alone to suture plus SQ drain for the prevention of wound complications in obese women undergoing cesarean delivery. STUDY DESIGN: We conducted a prospective multicenter randomized trial of obese women undergoing cesarean delivery. Women preoperatively consented and only those with R4 cm of SQ thickness documented at fascial closure were randomized to either SQ suture closure alone (N = 148) or suture plus SQ drain (N = 132). Women receiving the drain had it placed to bulb suction and was removed at 72 hrs or earlier if output !30 mL/24 hour. The primary study outcome was a composite wound complication rate (defined by any of the following noted at the wound assessment: wound dehiscence, seroma, hematoma, or abscess). RESULTS: From 04/01-07/04 a total of 280 women were enrolled. Ninety-four percent of women (264/280) had a follow-up wound assessment. Both groups were similar with respect to age, parity, weight, cesarean indication, diabetes, steroid/antibiotic use, chorioamnionitis, and SQ thickness. The overall composite wound complication rate was 16.9% (24/142) in the suture group and 23.0% (28/122) in the suture + drain group (RR 1.4: 95% CI 0.8-2.2, P = .22). Individual wound complication rates are shown in the Table. CONCLUSION: The additional use of a SQ drain to a standard SQ suture reapproximation technique is not effective for the prevention of wound complications in obese women undergoing cesarean delivery.