Volume 164 Number 1, Pdn 2

636 MATERNAL SERUM SCREENING lTSlNG ALPHA-FETO PROTEIN, BETA-HUMAN CHORIONIC GONADOTROPIN AND UN CONJUGATED ESTRIOL (AFP+) IN THE SECOND TRIMESTER. X Leonard H. Kellner1

637

Robert R. Weiss1, Marsha Neuerl, Jay L. Bock2 (l:Winthrop University Hospital, Mineola, N.Y. 2:University Hospital Stony Brook, New York)

Low levels of maternal serum Alpha-feto protein (AFP) in mid-gestation (16-18 weeks) have been linked with Downs syndrome and other trisomies. Using this approach, screening of an un-selected population, however, will detect only 20% of trisomies. The combination of AFP, Beta-human chorionic gonadotropin (B-hCG) and Unconjuated estriol (uE3), AFP+ has been reported to give a better yield. In an attempt to test this theory, specimens from ten cases of trisomy 21 and three cases of trisomy IS were tested through the combination of the tests named above AFP+. The results are represented as (multiple-of-median, MOM) mean AFP HOM = O.S':>, mean B-hCG MOM = L.71 and mean uE3 MOM = 0.65. The mean modified risk was 1:237. Based on these results, the detection rate of AFP+ was 80%. In three cases of trisomy IS, all three markers were markedly depressed in two of the cases, and in the third case only uE3 was depressed.

COMPLICATIONS AFfER CHORIONIC VILLUS SAMPLING MC Frederiksen, BJ Rosinsky', AO Martinx

, RK Tamura, R SabbaghaX

, MA Eichmannx, S Elias, and JL Simpson, Department of Ob/Gyn, Northwestern University Medical School, Chicago, II

The clinical course of patients encountering a complication after a chorionic villus sampling (CVS) procedure was studied in a series of 1035 patients sampled predominantly transcervically between 1984-1988. The overall pregnancy loss rate was 2.9%, comparing favorably with reported literature values. Complications occurred In 58 patients (5.6%); 30 of these patients expenenced pregnancy loss (52%). Forty-<>ne percent of all complications occurred in the first 24 hours after the procedure, but only 17% of these patients lost the pregnancy. By comparison, when complications occurred more than 28 days after the procedure, 100% of patients lost the pregnancy. Vaginal bleeding was the most common complication (37 of 58 patients or 64%). Patients whose bleeding occurred within a week of the procedure and lasted 1-3 days had a 14% pregnancy loss rate. Patients whose bleeding persisted had a 66% pregnancy loss rate, and patients whose bleeding occurred more than seven days after the procedure had a 91% pregnancy loss rate. Seven patients developed an intrauterine hematoma on ultrasound. None lost the pregnancy. However, 5 of the 7 patients expenenced an episode of heavy vaginal bleeding, afterwhich an ultrasound examination was normal. CVS complications occurred consistently through the series and were not related to operator experience. Prospective CVS patients should be aware that complications do occur irrespective of operator experience, that the most common time for complications to occur is within 24 hours of the procedure, and that experiencing a complication does not always lead to pregnancy loss.

SPO Abstracts 419

638 AN ELEVEN YEAR REVIEW OF CONGENITAL HEART DISEASES AMONG PERINATAL DEATHS IN AN URBAN UNIVERSITY HOSPITAL (UNMH) MS Chatterjee, LB Curet, JF Smith, GJ Gilson, LA Izquierdo, UNM School of Medicine, Albuquerque, New Mexico

639

At UNMH there was a total of 316 (10/1000) stillbirths among 30,597 deliveries in 11 years. Consents for autopsy were obtained in 201 (64%) fetuses. Eighty-two perinatal deaths were found to have congenital cardiac disease. Hypoplastic left heart syndrome was the most common variety of cardiac defect (28%) in this popu­lation. We feel consent for autopsy should always be obtained in un­explained stillbirths. Stereo­microscopic examination of the fetal heart may be necessary in making an accurate diagnosis. Information thus obtained may be of value for future counseling of the patients. with the advent of color flow mapping, an accurate prenatal diagnosis of cardiac malformations is possible. Prevalence of the types of lesions in an index popUlation may help the perinatologist in making an accurate diagnosis.

THE IMPACT OF PRENATAL TESTING ON MATERNAL· FETAL BONDING CHORIONIC VILLUS SAMPLING VERSUS AMNIOCENTESIS

* * * Caccia N ,Johnson JM, Robinson G ,Barna T • University of Toronto, Toronto, Canada.

The process of maternal·fetal attachment, considered vital for normal infant develo~nt, begins during pregnancy and can be affected by a nurber of external factors. In this study, the i"",act of prenatal testing on maternal·fetal bonding was evaluated in 253 women undergoing either fi rst trimester chorionic villus sa"",ling (CVS) (n=101) or second trimester genetic amniocentesis (n=152). The women were evaluated by means of a modification of the Cranley Maternal Fetal Attachment Scale, as well as by questions evaluating their physical and psychological responses to the pregnancy, both before and after resul ts were made known to them (mean gestational ages of 10.6 and 15.7 wks for the CVS group and 16.5 and 21.1 wks for the amniocentesis group). The results showed that 1) maternal-fetal attachment begins as early as 10 weeks gestat i on and increases s i gnit i cant l y as the pregnancy progresses, 2) maternal-fetal attachment increases significantly once the resul ts are known to be normal for both groups (P < 0.001) and 3) this increase occurs about 5 weeks earlier for CVS patients compared with amniocentesis patients (P < 0.001). Thus, with regard to the process of maternal· fetal attachment, fi rst trimester CVS appears to be preferable to second trimester amniocentesis.