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Purpose: The aim of the study was to evaluate the prenatal diagnosis at a secondary referral hospital., Method: A retrospective study was carried out on 1752 women examined by amniocentesis (AC) (n = 1037) or chorion villus sampling (CVS) (n = 715) at Randers Centralsygehus from 1 April 1987 to 31 December 1996., Results: A cytogenetic diagnosis was made in 99.8% of the AC group and 99.4% of the CVS group. Complications, recorded as either spontaneous abortion, bleeding/threatening abortion, pain/contractions or amniotic fluid leakage, were seen in 1.9%, 3.3%, 2.9%, and 2.3% after AC and 1.8%, 7.3%, 3.4%, and 0% after CVS. There were significantly more re-examinations after CVS when the procedure was carried out by less experienced operators (p < 0.003), whereas experience did not influence the number of re-examinations after AC (p = 0.8)., Conclusion: The frequency of complications during prenatal procedures performed over a period of ten years was comparable with that reported in other studies. It is expedient and safe to perform prenatal examinations at a secondary referral hospital where currently 200 procedures are performed each year.

The transabdominal chorionic villus sampling method was compared with the transcervical route and second trimester amniocentesis in a 3-winged randomised trial. Examination of 45 epidemiological variables showed the three procedure groups to be comparable at enrollment. In 3079 women at low genetic risk, we compared transabdominal with transcervical chorionic villus sampling and amniocentesis. The total fetal loss was 10.9%, 6.3% and 6.4% in the transcervical, transabdominal chorionic villus sampling groups and the amniocentesis group, respectively (p < 0.001). The two CVS procedures were compared in 2882 low and high genetic risk women with cytogenetically normal fetuses. Rates of unintended post-procedure loss were 3.7% and 7.7% for transabdominal CVS and transcervical CVS, respectively (p < 0.001), difference in rates 4.0%, 95% C.I. +2.3% to +5.8%. By a priori ultrasound scanning, more transcervical than transabdominal procedures (p < 0.001) were considered to be inaccessible for sampling. Our data indicate that transabdominal allows freer access to the placental site than transcervical sampling and is easier to adapt to than transcervical CVS. Women run comparable risks with transabdominal CVS and amniocentesis. Given the results of our study, transabdominal procedures remain the first choice for prenatal diagnosis and, since in our hands transcervical sampling entails an increased fetal risk, we have abandoned transcervical CVS in our two study centres.

The results of a retrospective assessment of the first 112 chorion villus biopsies carried out in the Department of Obstetrics and Gynaecology in the Central Hospital in Randers are presented. Karyotype determination was obtained in 98.2% and in 83.9% already by means of direct microscopic examination after incubation for 24 hours. No complications which could be attributed to the biopsies were registered. The present authors consider that the method should be employed more extensively for prenatal cytogenetic diagnosis.

Prenatal diagnosis in the first trimester was established in 318 pregnancies at risk by means of transcervical chorion villus sampling (TC-CVS). Criteria for exclusion were discrepancy between the crown-rump length (CRL) and the expected week of gestation, if there was simultaneously insufficient increase in CRL during a week. With the exception of two cases, (0.6%) the specimens of villi obtained were sufficient for diagnostic purposes (mean: 55 mg (8-200 mg]. Twenty-five patients underwent terminations of pregnancy on account of the abnormal findings and one for social reasons. The fetal loss following CVS was seven (2.4%). No serious maternal complications occurred. Vaginal bleeding presumably on account of perforation of the placenta by the catheter was seen in 8.5% (27) of the cases and does not appear to influence the continuing pregnancy. The cytogenic results were all based on the direct prepartion method and also on culture technique and these were successful in 100%. Two false positive results (0.6%) were found in the direct preparation but normal findings were obtained on culture. No false negative results were found. Late complications i.e. preterm delivery (4.6%), perinatal loss (0.7%) and neonatal death (0.7%) did not exceed the expected values. The mean birthweight was within the normal range. It is concluded that transcervical CVS with the Trophocan catheter seems to be a safe and easy way to obtain prenatal diagnosis and this could be offered on the same terms as amniocentesis.