Bacteria in the amniotic fluid without inflammation: early colonization vs. contamination.

OBJECTIVES: Intra-amniotic infection, defined by the presence of microorganisms in the amniotic cavity, is often accompanied by intra-amniotic inflammation. Occasionally, laboratories report the growth of bacteria or the presence of microbial nucleic acids in amniotic fluid in the absence of intra-amniotic inflammation. This study was conducted to determine the clinical significance of the presence of bacteria in amniotic fluid samples in the absence of intra-amniotic inflammation. METHODS: A retrospective cross-sectional study included 360 patients with preterm labor and intact membranes who underwent transabdominal amniocentesis for evaluation of the microbial state of the amniotic cavity as well as intra-amniotic inflammation. Cultivation techniques were used to isolate microorganisms, and broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry (PCR/ESI-MS) was utilized to detect the nucleic acids of bacteria, viruses, and fungi. RESULTS: Patients whose amniotic fluid samples evinced microorganisms but did not indicate inflammation had a similar perinatal outcome to those without microorganisms or inflammation [amniocentesis-to-delivery interval (p=0.31), spontaneous preterm birth before 34 weeks (p=0.83), acute placental inflammatory lesions (p=1), and composite neonatal morbidity (p=0.8)]. CONCLUSIONS: The isolation of microorganisms from a sample of amniotic fluid in the absence of intra-amniotic inflammation is indicative of a benign condition, which most likely represents contamination of the specimen during the collection procedure or laboratory processing rather than early colonization or infection.

A survey of current clinical practice of chorionic villus sampling.

OBJECTIVE: The number of invasive procedures (chorionic villus sampling (CVS) or amniocentesis) for fetal testing is decreasing because of the availability of non-invasive prenatal test (NIPT) leading to a centralisation of prenatal diagnostic services to accredited fetal medicine centres. A new survey was conducted 10 years after the previous one to update the current clinical practice among clinicians who regularly perform CVS. METHOD: Consultants from 32 centres in the United Kingdom were invited to take part in an online survey evaluating: The total number of CVS procedures carried out in the unit in a typical week, the preferred route (transabdominal [TA] vs transcervical [TC]), technique (use of local anaesthetic [LA] and needle technique). RESULTS: Response rate was 96.9%; TA was the preferred route (96.8%) in all centres except one. Single-needle technique is used exclusively in half the centres (51.6%). LA is used by most operators (90.3%) before the procedure. Three centres did not routinely use LA for CVS. CONCLUSIONS: Operators across the United Kingdom almost exclusively use the TA route for CVS with single-needle technique in 51.6% of cases. The use of LA prior to CVS is a very common practice in the United Kingdom.

Varicela en la gestación / Varicella infection in pregnancy

No disponible

Three years' experience of using a 29-gauge atraumatic needle for amniocentesis.

AIMS: To quantify the procedure-related complication rate after using modified technique of amniocentesis with a 29-gauge (29-G) pencil-point needle. METHODS: This is a prospective, descriptive study of 316 amniocenteses that were performed by means of atraumatic 29-G pencil-point needle under ultrasound control. RESULTS: A total of 316 amniocenteses were observed through the postprocedural period. The median time needed to retrieve 15 mL of amniotic fluid was 4 min. A total of 19 pregnancies were terminated after genetic testing. No case was regarded as procedure-related fetal loss. No other complications were observed. Seventeen children were born before 37 completed weeks of gestation and five children had a birth weight <2000 g. CONCLUSIONS: Amniocentesis with the 29-G atraumatic pencil-point needle seems to be a safe procedure with extremely low risk of complications and is a good alternative to the traditional 22-G Quincke needle.

Cribado combinado de síndrome de Down en primer trimestre: comparación de resultados de 4 años de aplicación con los 4 años precedentes / First-trimester combined screening for Down syndrome: comparison of the 4-year results with the previous 4 years

Objetivo. Analizar los resultados de 4 años de aplicación del programa de cribado combinado del primer trimestre y su impacto sobre las tasas de detección de síndrome de Down, cobertura poblacional y procedimientos invasivos. Sujetos y métodos. Estudio retrospectivo poblacional de 8 años consecutivos (17.564 gestaciones que contienen 51 síndromes de Down), en 2 periodos: 31 de enero de 2002 a 30 de enero de 2006, sin cribado (8.182 gestaciones y 24 síndromes de Down) y 31 de enero de 2006 a 30 de enero de 2010, con cribado (8.382 gestaciones y 27 síndromes de Down). El cribado se aplicó en 2 fases: bioquímica a la 10 semana y ecografía a la 12 semana. Se comparan los resultados del cribado con los del periodo precedente basado en la edad materna y la medida de la translucencia nucal. Resultados. La cobertura poblacional fue de 93%. La tasa de detección de síndrome de Down por aplicación del cribado combinado ha sido del 89% (91% para feto único) para un 3,5% de falsos positivos y se realizaron 824 procedimientos invasivos (34,3 para 1 diagnóstico). En los 4 años previos a la aplicación del cribado, la tasa de detección era del 71% y se realizaron 1.406 procedimientos invasivos (87,8 para un diagnóstico). Conclusión. El cribado combinado ha mejorado las tasas de detección para síndrome de Down en un 18%, al tiempo que ha permitido reducir en un 41% los procedimientos invasivos (AU)

Objective. To analyze the 4-year results of first-trimester combined screening and its impact on rates of Down syndrome detection, population coverage and invasive procedures. Subjects and methods. We performed a retrospective population-based study over 8 consecutive years (17,564 gestations with 51 cases of Down syndrome) divided in two periods: from January 31, 2002 to January 30, 2006 without combined screening (8,182 gestations and 24 cases of Down syndrome) and from January 31, 2006 to January 30, 2010 with combined screening (8,382 gestations and 27 cases of Down syndrome). Combined screening was applied in two phases: biochemical analysis was performed in the 10th week of pregnancy and ultrasound examination in the 12th week. We compared the results of screening with the previous period based on maternal age and fetal nuchal translucency measurement. Results. Population coverage was 93%. The rate of Down syndrome detection due to the application of combined screening was 89% (91% for a single fetus) with a false-positive rate of 3.5%. There were 824 invasive procedures (34.1 to diagnose one episode). During the 4 years prior to the application of combined screening, the detection rate was 71% with 1,406 invasive procedures (87.8 to diagnose one episode). Conclusion. Combined screening has improved the Down syndrome detection rate by 18% and has reduced the use of invasive procedures by 41% (AU)

Evaluación del analizador Delfia Xpress para el cribado prenatal de aneuploidías / Evaluation of DelfiaXpress Analyzer for aneuploidy prenatal screening

Objetivo. Evaluar la fiabilidad y la practicabilidad del analizador Delfia Xpress en las técnicas del cribado prenatal del primer y segundo trimestre. Material y métodos. El Delfia Xpress (Perkin-Elmer, Wallac) es un analizador de enzimoinmunoensayo que utiliza el europio como marcador fluorescente específico y que permite la determinación de los parámetros que integran el perfil del cribado prenatal del primer y segundo trimestre; la fracción libre de la β-gonadotrofina coriónica humana libre (fβhCG), la proteína A plasmática asociada al embarazo (PAPP-A), la alfafetoproteína (AFP) y el estriol libre (uE3). Además, el analizador incorpora el software Lifecycle v3.0® para el cálculo del riesgo prenatal de las trisomías 21 y 18, con conexión bidireccional con el sistema informático del laboratorio. Se procesaron 3.020 muestras de cribados del primer trimestre y 678 del segundo. Resultados. En cuanto a fiabilidad, el Delfia Xpress mostró una imprecisión intra-interdía en las determinaciones de fβhCG y PAPP-A inferiores al 6%, comprobándose la linealidad y la correlación de sus determinaciones. El análisis de los resultados de 3.020 gestantes del cribado prenatal combinado del primer trimestre muestra una sensibilidad en la detección del síndrome de Down de 78,57% y un valor predictivo positivo (VPP) de 11,58%, con un 2,79% de falsos positivos. Se diagnosticaron 11 portadoras de síndrome de Down y 2 de síndrome de Edwards. Respecto a la practicabilidad, su sencillo manejo y puesta en marcha, y la estabilidad de las calibraciones, junto con el coste equitativo por cribado, hacen que el analizador presente una buena relación calidad/coste. Conclusiones. El completo estudio realizado muestra que el Delfia Xpress es un analizador de elevada fiabilidad técnica y clínica, y los resultados hallados lo validan para procesar la rutina del cribado prenatal en nuestro hospital de referencia (AU)

Objective. To evaluate the Delfia Xpress analyzer reliability and practicability in all the techniques of first and second trimester prenatal screening. Materials and methods. The Delfia Xpress (Perkin-Elmer, Wallac) is a biochemical immunoassay analyzer,that uses the Europium as specific fluorescent labelled marker and allows the determination of the first and second trimester parameters of the prenatal screening profile's: free β-human chorionic gonadotrophin (fβhCG) and pregnancy associated plasma protein-A (PAPP-A), alpha-fetoprotein (AFP), free-estriol (uE3), incorporating the Lifecycle v3.0® software for risk-prenatal calculation on-line with the laboratory compute system. First trimester combined screening test was performed on 3020 pregnant women and 678 on second trimester screening tests. Results. Concerning its reliability, Delfia Xpress analyzer has shown a within and between day imprecision for the fβhCG and PAPP-A determinations below to 6%, proving the linearity and the correlation of its determinations. The analysis of the results of 3020 first trimester combined prenatal screening tests, shows a sensitivity in detecting Down‘s syndrome of 78.57% with a PPV (positive predictive value) of 11.58% with a 2.79% false positive. Eleven patients were diagnosed as carriers of Down‘s syndrome and two with Edwards syndrome. As for the practicability, the start up and operation of the analyzer are simple, and the stability of the calibration along with equitable cost for screening, makes the Delfia Xpress as an analyzer with a good relationships quality/cost. Conclusions. The complete study has shown that Delfia Xpress is an analyzer with a high technical and clinical reliability, validating the instrument for processing the prenatal screening routine of our reference hospital (AU)

Utilidad de la inhibina A en el cribado de síndrome de Down en el segundo trimestre / Inhibin A in second trimester screening of Down's syndrome

Objetivo. Comprobar la eficacia de la incorporación de la inhibina A en el cribado de segundo trimestre del síndrome de Down en términos de tasa de detección y porcentaje de cribados positivos. Métodos. Estudio retrospectivo de 3.380 embarazadas, que se sometieron al cribado de segundo trimestre, clasificadas en 2 grupos en función de la incorporación de la inhibina A (1.921 mujeres) o no (1.459 mujeres).Resultados. La tasa de detección con un punto de corte de 1:250 fue del 90% en el grupo de inhibina A y 84,6% sin inhibina A, pero con un porcentaje de cribados positivos significativamente menor en el primero (11 vs. 15,9%; p < 0,001). Este concepto también se refleja al comparar el likelihood ratio positivo entre ambos grupos (8,47 vs. 5,54; p <0,001). Conclusión. Es aconsejable la incorporación de la inhibina A en el cribado de segundo trimestre, ya que se observa un menor porcentaje de casos positivos, con la consiguiente reducción en el número de amniocentesis a realizar(AU)

Objective. To evaluate the efficacy of inhibin A in second trimester screening of Down's syndrome in terms of detection rate and percentage of positive results. Methods. A retrospective study of 3380 pregnant women who underwent second trimester screening, classified into 2 groups, one which included inhibin A (1921 pregnant women) and one that did not (1459 pregnant women). Results. The detection rate (cut-off: 1:250) was 90% in the group with inhibin A and 84.6% in the other group, but the percentage of positive results was significantly lower in the first group (11% vs. 15.9%, P<.001). The results were similar if we compared the positive likelihood ratio between groups (8.47 vs. 5.54, P<.001). Conclusion. Inhibin A is a useful marker in second trimester screening due to the low percentage of positive cases observed, thereby reducing the number of amniocentesis(AU)

10 años de experiencia en diagnóstico prenatal invasivo en el Instituto Dexeus / Invasive prenatal diagnostic practice: a review of a ten years experience at Dexeus Institut

Objetivos. Describir nuestra experiencia en la realización y resultados de las técnicas invasivas (TI) de diagnóstico prenatal (DP). Métodos. Se trata de un estudio descriptivo retrospectivo de las pacientes sometidas a una TI de DP desde enero de 1999 a diciembre de 2008, incluyendo todos los casos consecutivos de biopsia corial (BC) y amniocentesis (AC) genéticas. Resultados. Hemos analizado un total de 9.340 TI (8.928 AC y 412 BC). La edad gestacional ha sido de 15,9 (rango 10-38) y 11,6 (rango 9-16) semanas, respectivamente. Las principales indicaciones de referencia son la edad materna avanzada y la ansiedad. El porcentaje de cultivos no informativos ha sido de 0,49% para BC y 0,1% para AC. Se han diagnosticado un total de 380 anomalías cromosómicas (4,1%), 269 clínicamente relevantes. El valor predictivo positivo (VPP) para cromosomopatía relevante es del 2,9% (2,14% en la serie de AC y 19,6% en la serie de BC). El mayor VPP se obtiene ante las indicaciones de referencia ecográficas. Se han recogido un total de 88 complicaciones atribuibles a la TI (0,94%), con una tasa de pérdida fetal pos-procedimiento del 0,6%. La tasa de pérdida gestacional es del 0,9% (0,8% en la serie de AC y 4,3% en BC). Cuando analizamos los aspectos relacionados con la tasa de complicaciones y pérdidas fetales pos-procedimiento, únicamente el n.° de fetos, aspecto del LA, la indicación de la TI y la experiencia del operador son factores significativos. Conclusiones. El seguimiento y monitorización de las TI de DP constituye un primer paso en el proceso de control de calidad, recientemente introducido en la práctica médica en el área del diagnóstico prenatal(AU)

Objective. To describe invasive prenatal diagnostic practice in a single-center over a 10-years period. Methods. Included in this study were all consecutive pregnancies with genetic amniocentesis (AC) or chorionic villous sampling (CVS) procedure done during the period January 1999-December 2008. Results. A total of 8928 AC and 412 CVS were performed. Main indications for referral were increased maternal age and anxiety. The mean gestational age in which the procedure was done was 15,9 weeks (range 10-38) in AC and 11,6 weeks (range 9-16) in CVS. In this series, 380 cases of chromosome abnormalities (CA) were detectable by conventional cytogenetic analysis (4,1%), 269 of them considered clinically significant. The positive predictive value (PPV) for significant CA was 2,9%, 2,1% and 19,6% in the overall, AC and CVS group, respectively. The highest PPV were obtained for sonographic referral indications. A total of 88 complications during the 4 weeks’ period after the procedure were register (0,94%). The post procedural loss rate was 0,6% (0,4% after AC and 4,1% after CVS), 0,3% in singles and 1,6% in twin pregnancies AC group. The overall loss rate was 0,9% (0,8% in AC group, 4,3% in CVS group). There was a significant correlation between post procedure complications and number of fetuses, technical aspects (dark amniotic fluid), indications for referral and operator's experience. Conclusions. Monitoring of prenatal diagnostic invasive tests is the first step in the process of quality control, recently introduced into medical practice in the area of prenatal diagnosis(AU)

Inversión pericéntrica del cromosoma 2: presentación de un caso / Pericentric inversion of chromosome 2: case presentation

Fundamento: Las inversiones cromosómicas pueden provocar un fenotipo afectado debido a la interrupción de genes o a la variación en la actividad de estos. Ellas son relativamente comunes, pero por debajo del 1 porciento. Las inversiones pericéntricas consisten en rupturas y reparaciones invertidas del segmento cromosómico, que involucran al centrómero. Presentación de caso: la amniocentesis se le realizó a una paciente de 38 años de edad a las 17, 2 semanas de gestación; la muestra se cultivó y se procesó según las técnicas estandarizadas en nuestro laboratorio. Conclusión: el estudio cromosómico del propósito evidenció una inversión pericéntrica del cromosoma 2: 46, XX, inv (2)(p21::q24). Es la primera vez que se reporta en Cuba este tipo de aberración cromosómica, siendo el padre portador de la misma(AU)

Background: The chromosomic inversions may provoke a phenotype affected due to genes interruption or to a variation of activity in them. They are relatively common but under 1 percent. The pericentric inversions consist of a ruptura and repair invertid in the chromosomic segment which involve the centrometer. Case presentation: The amniocentesis was performed to a 38 year old patient at 17.2 weeks gestation; the sample was cultured and processed according to standard techniques in our laboratory. Conclusion: The chromosomic study of the objective proved a pericentric inversion of the chromosome 2: 46, XX, inv (2)(p21::q24). This is the first time reported in Cuba this type of chromosomic aberration, being the father the carrier(AU)

A 29-gauge atraumatic needle for amniocentesis.

OBJECTIVE: To compare perforation characteristics of standard 22 G (0.7 mm) to 29 G needle (0.34 mm) for amniocentesis. METHODS: Seventeen human chorio-amnion membranes were perforated immediately after cesarean section using 22 G needle for spinal anesthesia and 29 G "pencil-point" needles for amniocentesis under in-vitro conditions. Area of perforation was determined using a microscope and volume of fluid leakage was measured over a period of 5 min. RESULTS: Membrane perforation with the 22 G needle resulted in a mean damaged area of 225,147.4 µm(2), a hole with a mean area of 50,154 µm(2) and amniotic fluid volume passage of 17.5 mL/5 min, whereas the 29 G needle generated a mean damaged area of 114,812.4 µm(2), a hole with an average area of 1382.5 µm(2) and volume passage of 0.28 mL/5 min. These differences were significant. CONCLUSION: The hole formed by membrane perforation with 29 G "pencil-point" needle for amniocentesis is 36 times smaller, and the amniotic fluid loss is 61 times less than that measured with the 22 G standard needle for spinal anesthesia. Significant reduction of complications following amniocentesis is expected with the 29 G needle.

Puncion intraútero guiada por ecografía de un teratoma sacrococcígeo predominantemente quístico asociado a compresión de la vía urinaria / Percutaneous ultrasound-guided needle drainage of a predominantly cystic sacrococcygeal teratoma associated with compression of the urinary tract

El teratoma sacroccocígeo (TSC) es el tumor neonatal más frecuente. Un 15% de estos tumores son de predominio quístico. Aunque el pronóstico de las formas quísticas es mucho más favorable que el de las formas sólidas, se asocian también a un aumento de la morbilidad y mortalidad perinatal debido al gran volumen tumoral que pueden alcanzar aumentando el riesgo de prematuridad y de compresión de vísceras pélvicas. En caso de compresión de la vía urinaria por un TSC de predominio quístico la punción y drenaje ecoguiados percutáneos parecen ser una técnica segura que permite resolver la obstrucción, disminuir el riesgo de prematuridad y de distocia durante el parto. Presentamos un caso clínico en el que realizó punción y drenaje percutáneo guiado por ecografía de un teratoma sacrococcígeo con afectación de la vía urinaria que evolucionó favorablemente (AU)

Sacrococcygeal teratoma (SCT) is the most common tumor in the neonatal period. Approximately 15% of these tumors are predominantly cystic. Although the prognosis of cystic SCT is more favorable than that of solid SCT, cystic forms are also associated with higher perinatal morbidity and mortality due to their potential large size, which can increase the risk of prematurity and compression of pelvic structures. When a cystic SCT compresses the urinary tract, percutaneous ultrasound-guided needle drainage appears to be a safe procedure that allows resolution of the obstruction and minimizes the risk of prematurity and soft tissue dystocia (AU)

Comparison of complications in second trimester amniocentesis performed with 20G, 21G and 22G needles.

AIM: to compare short- and long-term complications of amniocentesis performed with 20G, 21G, and 22G needles. METHODS: this observational study included 793 pregnant women who underwent amniocentesis in the Perinatology Department of Cerrahpasa Medical Faculty, Istanbul University, Turkey. The patients were divided into three groups according to the needle size used for the procedure: 20G (Group 1), 21G (Group 2), and 22G (Group 3). The incidences of early and late complications were compared among groups. RESULTS: fetal loss rates did not differ among groups (Group 1=1.57%, Group 2=1.47%, Group 3=1.61%). Rates of vaginal bleeding (1.57%, 1.10%, and 0.81%, respectively), bloody amniotic fluid (2.32%, 6.23%, and 2.67%, respectively) and amniotic fluid leakage (1.57%, 1.10%, and 1.61%, respectively) were also similar among the three groups. CONCLUSION: short- and long-term complications did not differ among amniocenteses performed with 20G, 21G, and 22G needles.

Agenesia lumbosacra. Expresión del síndrome de regresión caudal / Lumbosacral agenesis. Caudal regression syndrome expresión

La agenesia lumbosacra es una malformación congénita muy infrecuente que forma parte del síndrome de regresión caudal. Presentamos un caso diagnosticado como agenesia lumbosacra en nuestra consulta de diagnóstico prenatal durante el segundo trimestre de gestación. No se presentaron malformaciones asociadas, el cariotipo fetal fue normal y la gestante carecía de antecedentes de interés. La pareja se acogió al derecho de interrupción legal del embarazo (AU)

Lumbosacral agenesis is an uncommon condition which is part of the caudal regression syndrome. We report a case de lumbosacral agenesis detected by ultrasound in the second trimester of gestation. The fetus was not presenting other malformations. The fetal karyotype was normal and the pregnant woman did not have precedents of interest. The parents decide to abort (AU)

Comparison between 20G and 22G needle for second trimester amniocentesis in terms of technical aspects and short-term complications.

OBJECTIVE: To compare short-term complications of amniocentesis using 20G versus 22G needle. METHODS: A total of 200 women referred for mid-trimester amniocentesis were randomized to a 20G (Group I, n = 100) or 22G amniocentesis needle (Group II, n = 100). The primary outcome was intrauterine bleeding at needle insertion. The operator reported technical aspects and patient's reactions immediately after the procedure. Women's perception of discomfort 30 min after the procedure and complications after 2 weeks were recorded. RESULTS: Intrauterine bleeding at needle insertion was similar between groups (4/100 vs 8/100). When only transplacental taps were analyzed, bleeding was significantly lower in Group I (4/20 vs 8/14, p = 0.035). Fluid retrieval was faster in Group I (9.6 vs 26.8 sec, p < 0.001). In all, 65% of women in Group I versus 30% in Group II reported discomfort during the procedure, although discomfort 30 min after the procedure and complications within 2 weeks after the procedure were similar in the two groups. CONCLUSION: Amniocentesis with 20G needle is associated with lower risk of intrauterine bleeding in case of transplacental needle insertion and allows for faster fluid retrieval, as compared with 22G needle. Nevertheless, 20G needle is associated with more immediate discomfort during the procedure.

Situación actual del diagnóstico prenatal no invasivo / Current state of the non-invasive prenatal diagnosis methods

El diagnóstico prenatal se basa en la obtención de tejido fetal, mediante métodos invasivos, para su posterior análisis genético. La amniocentesis y la biopsia corial son las técnicas más utilizadas, cuyo principal inconveniente es que conllevan un riesgo de aborto, entre el 0,5¿1% y el 3,9%, respectivamente. El aislamiento de células fetales en sangre materna permite obtener material genético del feto de forma no invasiva, pero su escasez en sangre materna dificulta su utilización como método diagnóstico. La relativa abundancia del ADN fetal en la circulación materna, junto con la sensibilidad de la técnica utilizada para su cuantificación, convierten la detección de ADN fetal en plasma materno en un método alternativo para el diagnóstico de las enfermedades ligadas al cromosoma X o la determinación del estado RhD. En este artículo se hace una revisión del estado actual de los métodos de diagnóstico prenatal no invasivo(AU)

Prenatal diagnosis is based on genetic analysis of invasively obtained fetal tissue. Amniocentesis and chorial biopsy are the most used techniques, but carry a potential risk of miscarriage, from 0.5¿1% up to 3.9% respectively. Isolation of fetal cells from maternal blood allows a non-invasive obtention of fetal genetic material, but their scarcity difficults an efficient diagnosis method. The relative abundance of fetal DNA in maternal blood, as well as the sensitivity of quantitative PCR based methods, constitute an attractive alternative method for X-linked diseases and RhD status diagnosis. In this paper, a review of the present state of non-invasive prenatal diagnosis methods is described(AU)

Anticipated and perceived pain from midtrimester amniocentesis.

OBJECTIVE: To evaluate the anticipated and perceived pain and determine the factors contributing to pain perception in women undergoing midtrimester amniocentesis. METHODS: A visual analog scale was used to quantify pain in this prospective study of 64 women undergoing amniocentesis in the same clinical setting. The analysis was done using the paired-samples t test, analysis of variance, the Kruskal-Wallis test, the Mann-Whitney U test, and Pearson correlation analysis. RESULTS: The postprocedural pain scores were significantly less than the preprocedural pain scores (P<0.01). Parity, a previous amniocentesis, the indication for amniocentesis, and the previous loss of a child were factors contributing to pain scores. No correlations were found between pain score and maternal age, week of pregnancy at the time of the procedure, parity, or having lost a child. CONCLUSION: The perceived pain was less than the anticipated pain, and the factors contributing to pain should be kept in mind when counseling patients undergoing midtrimester amniocentesis.

Reducing pain with genetic amniocentesis-A randomized trial of subfreezing versus room temperature needles.

OBJECTIVE: To determine whether pain associated with second trimester genetic amniocentesis is decreased by using subfreezing rather than room temperature needles. METHODS: Subjects were randomized to a -14 degrees C or room temperature (20-22 degrees C) 22-gauge spinal needle. Patients, blinded to allocation, recorded anticipated and actual pain before and after the procedure, respectively, using a 0-10 visual analog scale with 0 = no pain and 10 = excruciating pain. RESULTS: Thirty-three subjects were randomized to room temperature and 29 subjects to subfreezing needles. Anticipated pain was similar in room temperature, 5.1 +/- 1.7, and subfreezing groups, 4.9 +/- 2.0, respectively (p = 0.6). Actual pain was also similar in the room temperature, 3.6 +/- 2.0, and subfreezing groups, 2.8 +/- 2.0, respectively (p = 0.14). Similar numbers of subjects in the room temperature and subfreezing groups reported less actual pain (20 vs. 18), greater actual pain (4 vs. 4) or no difference in pain (9 vs. 5) than anticipated (p = 0.6). CONCLUSION: A subfreezing 22-gauge spinal needle does not decrease perceived pain associated with second trimester genetic amniocentesis.