Impact of prenatal testing on maternal-fetal bonding: chorionic villus sampling versus amniocentesis

Article Abstract:

More information has been gathered concerning maternal-infant bonding during the latter period of pregnancy (after 20 weeks' gestation) than during the earlier phase. Also, prenatal diagnosis has been shown to affect some of the psychological aspects of pregnancy. To learn more about the effects on maternal-infant bonding of prenatal diagnostic tests, which may involve long waiting periods for a result, a study was performed with 253 women who underwent such tests. Chorionic villus sampling (CVS) removal of a small amount of tissue containing fetal cells from the area of the uterus where the fetus is attached, was performed in 101 cases; 152 women underwent amniocentesis, insertion of a needle into the amniotic sac to remove a small amount of fluid for analysis. CVS is performed during the first trimester of pregnancy, and amniocentesis in the second trimester. The women were evaluated using the Cranley Maternal-Fetal Attachment Scale before and after they had received their test results. For those in the CVS group, testing took place at 10.6 and 15.7 gestational weeks: for the amniocentesis group, it occurred at 16.5 and 21.1 weeks. All patients showed considerable bonding, which increased after normal test results were obtained, regardless of the gestational age at which they were tested. Maternal-fetal attachment began as early as 10 weeks and increased as the pregnancy progressed, once the results were found to be normal. This increase occurred earlier in pregnancy for women who underwent CVS, indicating that this test enhances maternal bonding more than amniocentesis. Viewing the fetus on ultrasonography was also found to influence maternal bonding favorably. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Mother and infant, Mother-infant relations

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Chorionic villus sampling: quality control - a continuous improvement model

Article Abstract:

Continuous quality control at a center providing chorionic villus sampling indicated that many factors influence not only clinical success but also patient comfort with the procedure. Chorionic villus sampling is a method of prenatal diagnosis for genetic diseases. The management of a clinic dedicated to chorionic villus sampling is discussed. Every three months staff members met to review the patients' and the clinicians' experience at the clinic. This was continued until the cases of 1,000 patients had been assessed. These meetings led to revisions in guidelines which included not scheduling patients for the test if they were less than nine weeks pregnant in order to reduce the risk of spontaneous abortion and the introduction of transabdominal sampling in addition to transcervical sampling. As the patient load increased, a slide presentation was introduced to explain and answer common questions about the procedure before patients met with genetic counselors. Rooms were also set aside for grief counseling in the event that an ultrasound revealed fetal death.

Practice

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Early transabdominal chorionic villus sampling in couples at high genetic risk

Article Abstract:

Transabdominal chorionic villus sampling (CVS) before nine weeks into pregnancy appears to be a safe and accurate technique for the prenatal diagnosis of genetic diseases. CVS is an outpatient procedure not requiring anesthesia in which a long needle is used to remove fluid from the womb. Unlike transcervical CVS, transabdominal CVS can be done early in pregnancy, reducing the wait and parents' anxiety. Of 200 pregnant women who underwent early transabdominal CVS, 198 had fetuses at risk for beta-thalassemia, which is a form of anemia, and two had fetuses at risk for Duchenne muscular dystrophy. Sufficient chorionic tissue for diagnosis was obtained on the first try in 91% of the women and in 9% of them on the second try. Minor bleeding occurred in 2.7% of the women, and in all cases needle insertion lasted 10 seconds or less. Of the 144 infants that were carried full term, one was born with abnormal fingers and toes. Whether this birth defect is related to the transabdominal CVS procedure is unknown.

Methods, Diagnosis, Thalassemia, Duchenne muscular dystrophy

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