Problems posed by prenatal diagnosis of abdominal wall malformations

The authors present 6 observations of in utero detected abdominal wall defect : 2 laparoschisis and 4 omphaloceles. In three cases the diagnosis have been done prior week 20, by systematic AFP assay for amniocentesis performed for cytogenetic or metabolic reasons; the pregnancy was terminated. In three other cases, the pregnancy was complicated by hydramnios after week 30; amniocentesis for AFP and echography were performed to detect fetal malformations after associated with hydramnios. The detected abdominal wall anomaly was not alone: two fetus had an abnormal caryotype (trisomy 18), three other presented a polymalformative syndrome, a Beckwith-Wiedemann syndrome was discussed for the last child. The in utero diagnosis of omphalocele or laparoschisis implicates difficulties for genetic counselling, particularly if the diagnosis is done prior week 20. These anomalies can be treated with surgical management, but frequency of associated malformations must be underlined. it is important for genetic counselling to know the family history, the amniotic fluid cells caryotype, and an ultrasound scanning performed to reveal any other malformations.     

Examination of fetuses after induced abortion for fetal abnormality.

OBJECTIVE--To determine the accuracy of midtrimester diagnosis of fetal abnormality by examination and investigation of fetuses after induced abortion. DESIGN--Prospective study over five years of fetuses aborted in the midtrimester because of abnormalities detected by ultrasonography and amniocentesis. Techniques included a full external examination by a clinical geneticist with experience in dysmorphology and other investigations including necropsy. SETTING--Regional genetic centre. PARTICIPANTS--Clinicians working within the North Western region who wished to use the service offered. RESULTS--133 Fetuses were aborted because of abnormalities detected on ultrasonography and 115 because of abnormal findings on amniotic fluid analysis. In a further two cases fetal abnormality was diagnosed by molecular genetic and biochemical techniques. Among the fetuses with abnormal scans the pretermination diagnosis was changed or refined in a way which affected genetic counselling in 53 of 133 cases. Among the 115 fetuses diagnosed as abnormal by amniocentesis the pretermination diagnosis was confirmed in 112 cases and altered in three. CONCLUSION--Fetuses aborted because of abnormalities detected by screening should be examined by suitably experienced clinicians, both for accurate genetic counselling of the families and for quality control of the tests employed.     

Prenatal diagnosis and outcome of pregnancy in 2036 women investigated by amniocentesis

Summary The report presents the indications for prenatal diagnosis, the results from amniocentesis and details of outcome of pregnancy in 2036 women. Aneuploidy was found in 26 fetuses (1.3%) including 16 with trisomy 21 and 9 sex chromosome abnormalities. There were 38 balanced chromosomal rearrangements (1.9%): 23 of these (1.1%) were pericentric inversions of a number 9 chromosome. Only twoof the chromosomal abnormalities were found in other than those mothers referred for maternal age of 35 or over. Concern is expressed at the low referral rate for older mothers in the population served (only 25% of those over 40 years). Failure of amniotic cell culture occurred in 2.8% of cultures. Maternal cell contamination was detected in 23 cultures (1.1%) with four errors in reported fetal sex. Total error estimate was 0.5%. There were 20 in vitro artefacts (1.0%) with no reporting errors. Neural tube defects were identified in 28 fetuses and there were three false-positive and one false-negative results. Data on outcome of pregnancy was available from 1805 pregnancies (96.5%): 1295 were normal (71.7%) and 510 (28.3%) showed some abnormality. Pregnancy was terminated for fetal abnormality in 53 cases (2.9%) and fetal loss occurred in 65 (3.7%). Methods, quality control, safety and service considerations are discussed. It is suggested that amniocentesis should be restricted to centres where the greatest expertise is available. The service should be improved to meet the needs of a greater number of patients. The series is compared with other studies of over 1500 cases.     

Prenatal diagnosis of genetic disease in Canada: report of a collaborative study.

A study of 1223 amniocenteses carried out during 1020 pregnancies in 990 women showed that 2nd-trimester amniocentesis at about 16 weeks'' gestation is a safe, accurate and reliable procedure for the diagnosis of certain classes of genetic disease when it is monitored by ultrasound, performed by a trained obstetrician and carried out in a major health sciences centre. The percentage of fetal losses (4.7%) and neonatal deaths (0.5%) during the study was not greater than in control samples for women 35 years of age and older. The best results were obtained when needles of gauge 20 or 21 were used. The use of needles of gauge 19 or larger and more than two insertions during a single amniocentesis were associated with a significantly greater frequency of fetal loss than a second or even a third amniocentesis during the same pregnancy. For 39 fetuses (3.8%) a diagnosis of a genetic abnormality was made and 23 male fetuses were found to be potentially hemizygous for an X-linked gene. There were 51 therapeutic abortions as a result of the diagnosis. Sixty-six tests (5.4%) gave an inconclusive result and seven (0.6%) gave an erroneous diagnosis; five of the latter (two false-positives and three false-negatives) resulted from the alpha1-fetoprotein test for neural-tube defects and in two cases the sex was incorrectly determined. The frequency of all chromosome abnormalities was 1:20 when the mother''s age was 40 years or more and 1:60 when the mother''s age was between 35 and 39 years. When a mother had previously had a child with a chromosome abnormality the risk of recurrence of such an abnormality was 1:100 when the age of the mother was 35 years or more.     

Determination of bovine fetal sex by PCR using fetal fluid aspirated by transvaginal ultrasound-guided amniocentesis

Fetal sex can be determined by the polymerase chain reaction (PCR) using cells from fetal fluid collected by transvaginal ultrasound-guided amniocentesis. A total of 35 aspirates from 30 cows, 15 Holsteins and 15 Japanese Blacks at 59 to 250 d of pregnancy were used. Five cows were aspirated twice at a 10-d interval. A 5.0 MHz convex array transducer connected to a scanner was inserted into the vagina under caudal epidural anesthesia. The transducer was equipped with a 65-cm long, 21-g needle within the probe carrier. A bovine male-specific primer and a bovine gender-neutral primer were used. Fetal fluid was obtained from all except 2 cows in early pregnancy. Five animals aborted within 1 wk following aspiration. A total of 33 samples, 29 of amniotic fluid and 4 of allantoic fluid, was subjected to PCR analysis. Fetal gender was verified in 31 33 samples (18 females and 13 males). Gender was also determined by gross examination of external genitalia of offspring after calving or abortion. Fetal gender was correctly identified by PCR analysis of aspirated fetal fluid in 16 16 females and in 13 15 males. Transvaginal ultrasound-guided amniocentesis followed by PCR analysis of aspirated cell DNA can be used accurately to determine fetal sex in cows at 70 to 100 d of gestation. The procedure requires considerable skill and is not without some risk to fetal viability.     

Prenatal diagnosis of sex in bovine fetuses by amniocentesis

The sex of 1, 056 bovine fetuses was diagnosed by cytogenetic analysis of amniotic cells collected surgically from cows made pregnant as a result of embryo transfer. The fetuses ranged in gestational age from 7 to 22 wk at the time of amniocentesis. Amniotic cells were cultured for 5 to 30 d to obtain a sufficient number of cells for cytogenetic analysis. The growth rate of 819 samples was examined in detail. On average, amniotic cells from pregnancies that were 7 or 8 wks old required about 13 d to reach a cell concentration sufficient for analysis, whereas those from pregnancies that were 10 wk old or more required only 10 d or less to reach that concentration. Final disposition of 325 pregnancies subjected to amniocentesis was unequivocally confirmed. Of these, the sex of 302 fetuses (93%) was determined with a male: female ratio of 51:49. The gender of 213 of 220 fetuses (96.8%) was correctly dignosed, as verified by examination of either 33 intentionally induced abortuses or of 187 live calves. Thirteen percent (29) of 216 pregnancies that were allowed to proceed to term ended in spontaneous abortion, a rate only about 5% higher than that reported to occur normally in embryo transfer pregnancies. The remaining 53 pregnancies were induced to abort, but it was not possible to recover and verify the sex of those fetuses. The capability to diagnose fetal sex in utero yielded other useful information as well. For example, the sex ratio of 1,056 fetuses during development from 7 to 15+ wk of gestation was found to be the same (51:49) as it was at calving. Finally, amniocentesis to determine prenatal sex provides time to alter the sex ratio of a calf crop. It may ultimately prove valuable as an adjunct to genetic engineering of cattle to identify presumptive transgenic calves in utero.     

Recurrent nonimmune hydrops fetalis: a rare presentation of sialic acid storage disease.

A case of recurrent hydrops fetalis, diagnosed on second trimester's ultrasonography, has led to the diagnosis of sialic acid storage disease. No classic etiology was found after the first accident. The recurrence in subsequent pregnancy raised the possibility of a storage disease that was confirmed by amniocentesis. The diagnosis of Salla's disease was based on high levels of free sialic acid in amniotic fluid and fetal cells culture and by specific histologic features on fetopathologic examination. Diagnosis of inherited diseases is important because it implies a high risk of recurrence which makes mandatory genetic counseling and prenatal care in subsequent pregnancies.     

Ring chromosome 13 in a polymalformed anencephalic.

In the 33rd week of pregnancy an amniocentesis was performed because of low estriol. X-ray indicated the presence of anencephaly and a premature delivery was induced. Necropsy, in addition to anencephaly, showed a wide variety of malformations. The fetal karyotype determined from cultured amniotic fluid cells revealed a ring chromosome 13.     

Prenatal diagnosis of chromosome disorders in Tunisian population

Cytogenetic prenatal diagnosis (PND) is under national health program in most developed countries, while it concerns a small part of population at risk in developing countries. Finance is common reason of absence of PND development, but socio-cultural believes play an important role in Arab Muslim countries. In this paper we report results of 3110 fetal karyotypes carried out in a Tunisian population, by cultured amniocytes analysis. It is the largest report in a Muslim Arab country in our Knowledge. Abnormal karyotypes rate was 4.18% classified in two groups: bad prognosis (3.05%) and good prognosis (1.13%). Common amniocentesis indication was maternal age. The highest predictive value was observed in balanced karyotype and fetal ultrasound findings indications. Maternal serum markers were not commonly used for trisomy 21 screening. Pregnancy termination that is permitted by legal and religious authorities was accepted by 94,74% parents. Information about PND outcomes was given by genetic counselling prior to fetal sampling, pregnancy interruption was discussed with parents at cytogenetic result announcement. The authors conclude that in order to prevent mental and physical handicap related to cytogenetic disorders we have to promote PND by education for population, genetic counselling and fetal ultrasound screening; all three methods available in Tunisia.     

Amniotic Fluid Cells; Prenatal Sex Prediction and Culture

Sex chromatin studies were carried out on small amounts of amniotic fluid obtained by amniocentesis or from intact amniotic sacs removed at hysterotomy. Provided that satisfactory preparations were obtained the accuracy of fetal sexing was 87%. Nevertheless, in the management of a pregnancy in which there is a risk of a serious X-linked recessive disorder, repeat amniocentesis may be necessary to ensure satisfactory specimens.Of 90 samples of fluid cultured, satisfactory growth was obtained in 49; the success rate was not increased by the addition of stimulants to the culture medium. It is suggested that between the 13th and the 16th week of pregnancy is the optimum time for amniocentesis to obtain cells for culture, since sufficient cells are then present in a small volume of fluid and therapeutic abortion would still be possible once the results were available.     

Prenatal fetal karyotyping and maternal serum alpha-fetoprotein screening.

Prenatal karyotyping was undertaken in 569 consecutive amniotic fluid samples where the indication for amniocentesis was two sequential raised maternal serum alpha-fetoprotein concentrations. In 475 successful cultures five chromosome abnormalities were found--four constitutional anomalies (47,XXY; 47,XYY; an inherited inv(8) (p23q11); and a de-novo translocation t(6;7) (p11;p22) and a culture-derived anomaly (trisomy 2) found in amniotic fluid cells but not in the fetus aborted because it had spina bifida. Of the pregnancies complicated by constitutional abnormalities, only the pregnancy in which the de-novo translocation was detected was terminated. No chromosome abnormalities were detected in the 17 pregnancies which miscarried after amniocentesis. These results provide little justification for including fetal karyotyping as an essential part of maternal serum alpha-fetoprotein screening programmes.     

Prenatal diagnosis of hemoglobinopathies: evaluation of techniques for analysing globin-chain synthesis in blood samples obtained by fetoscopy.

Three techniques for analysing hemoglobin synthesis in blood samples obtained by fetoscopy were evaluated. Of the fetuses studied, 12 were not at risk of genetic disorders, 10 were at risk of beta-thalassemia, 2 were at risk of sickle cell anemia and 1 was at risk of both diseases. The conventional method of prenatal diagnosis of hemoglobinopathies, involving the separation of globin chains labelled with a radioactive isotope on carboxymethyl cellulose (CMC) columns, was compared with a method involving globin-chain separation by high-pressure liquid chromatography (HPLC) and with direct analysis of labelled hemoglobin tetramers obtained from cell lysates by chromatography on ion-exchange columns. The last method is technically the simplest and can be used for diagnosing beta-thalassemia and sickle cell anemia. However, it gives spuriously high levels of adult hemoglobin in samples containing nonlabelled adult hemoglobin. HPLC is the fastest method for prenatal diagnosis of beta-thalassemia and may prove as reliable as the CMC method. Of the 13 fetuses at risk for hemoglobinopathies, 1 was predicted to be affected, and the diagnosis was confirmed in the abortus. Of 12 predicted to be unaffected, 1 was aborted spontaneously and was unavailable for confirmatory studies, as were 3 of the infants; however, the diagnosis was confirmed in seven cases and is awaiting confirmation when the infant in 6 months old in one case. Couples at risk of bearing a child with a hemoglobinopathy should be referred for genetic counselling before pregnancy or, at the latest, by the 12th week of gestation so that prenatal diagnosis can be attempted by amniocentesis, safer procedure, with restriction endonuclease analysis of the amniotic fluid cells.     

Effect of chorionic villus sampling and early pregnancy counselling on uptake of prenatal diagnosis.

An early pregnancy counselling clinic was introduced to improve the uptake of prenatal diagnosis and to offer chorionic villus sampling to women aged 38 and over by their expected date of delivery. Ninety eight (62%) unselected older mothers were seen before 11 weeks'' gestation, and 23 (32%) of those with viable pregnancies elected to undergo chorionic villus sampling compared with 38 (52%) electing amniocentesis. A quarter of the patients booking before 11 weeks had a miscarriage. Because of the future potential demand for chorionic villus sampling counselling during pregnancy and referral of eligible patients should occur as early as possible.     

Cytogenetical prenatal diagnosis by amniocentesis during the II and III gestation trimesters in Costa Rica

The identification of fetal abnormal chromosomes in high risk pregnancies allows proper pediatric and obstetric management of the cases as well as genetic counseling. The results of 842 genetic amniocentesis from 1986 to 1999 are reported. All procedures were performed transabdominally and under ultrasound guidance, in hospitals of the social security system and in private facilities. There were two main reasons for referral: abnormal ultrasound assessment (48% of cases) and advanced maternal age (35%). Most procedures (66%) were performed during the second trimester of pregnancy and 34% during the third trimester. Fetal cells were closed cultured and suspension harvested. Median turn around time was 14 days. In 217 amniotic fluid samples no diagnosis could be obtained, mainly due to absence of cell growth in late gestation samples or because of blood contamination. Of 625 fetal karyotypes 55 (9%) were abnormal, due to 33 trisomies (including a Robertsonian translocation trisomy 13), eight cases of monosomy X, three mosaics (including a mosaic trisomy 22), balanced and unbalanced translocations, extra structurally abnormal chromosomes and other defects. Pseudomosaicism was detected in five cases. Taking into account the reason for referral, cases studied as a result of abnormal ultrasound assessment exhibited 17% abnormal karyotypes, in contrast to 2.5% cytogenetic defects in pregnancies of women 35 years or older. Prenatal cytogenetic and sonographic findings correlated with the phenotype of the newborn in 211 cases available for follow-up. Prenatal diagnosis of fetal defects allowed genetic counseling as well as better obstetric management and pediatric care. Normal results of both tests provided reassurance to prospective parents.     

Familial Down's syndrome.

A family is reported in which the same mother conceived two children with trisomy 21. The pregnancy with the second affected child was interrupted after diagnostic amniocentesis. Maternal chromosome analysis was normal. This family and those previously reported suggest that there is an increased recurrence risk of trisomy 21 after the birth of an affected individual, possibly caused by a genetic tendency for non-disjunction. After the birth of a child with Down's syndrome, amniocentesis and chromosome analysis of cultured amniotic fluid cells is indicated in each further pregnancy, irrespective of maternal age.     

Glial origin of rapidly adhering amniotic fluid cells.

Rapidly adhering cells (RA cells) from the amniotic fluid of a pregnancy with fetal anencephaly were investigated by immunofluorescence assay with an antiserum against glial cells. After 24 hours'' cultivation a high proportion of the cells showed positive glial-specific fluorescence, whereas no staining was seen in cells from samples of normal amniotic fluid. At the 24th week the mother was delivered of a stillborn infant with anencephaly. Immunofluorescence staining of RA cells with glial-specific antiserum may be used for the differential diagnosis of fetal abnormalities associated with a high alpha-fetoprotein concentration in amniotic fluid.     

High amniotic fluid alpha-1-fetoprotein in a case of fetal sacrococcygeal teratoma.

Amniocentesis was performed in a pregnancy of 26 weeks because of hydramnios. The amniotic fluid was examined for fetal karyotype and AFP content. The latter was elevated to 300 mug/ml. Fetal death occurred shortly after amniocentesis and a malformed male fetus with a large sacrococcygeal teratoma was stillborn 3 days later.     

Bovine fetal fluid cells in vitro: fate and fetal sex prediction accuracy

The in vitro fate of bovine fetal fluid cells and the efficiency of fetal sex predication from cultures of these cells are studied using aspirates from live animals and pregnant uteri collected from the slaughterhouse. Over 70 percent of bovine amniotic fluid samples aspirated from pregnant uteri at the time of slaughter yielded cultures adequate for chromosome analysis whereas only 10 percent of allantoic fluid samples produced growth of cells satisfactory for chromosome analysis. Fetal sexing accuracy was 100 percent in all samples studied. Seven readily recognizable cell types were noted in cultures of fetal fluid cells obtained at various stages of gestation. In a majority of cases, the in vitro morphology of cells from both fetal cavities was similar to that observed in primary human amniotic fluid cell cultures.     

Bovine fetal fluid cells in vitro: Fate and fetal sex prediction accuracy

Summary The in vitro fate of bovine fetal fluid cells and the efficiency of fetal sex prediction from cultures of these cells are studied using aspirates from live animals and pregnant uteri collected from the slaughterhouse. Over 70% of bovine amniotic fluid samples aspirated from pregnant uteri at the time of slaughter yielded cultures adequate for chromosome analysis, whereas only 10% of allantoic fluid samples produced growth of cells satisfactory for chromosome analysis. Fetal sexing accuracy was 100% in all samples studied. Seven readily recognizable cell types were noted in cultures of fetal fluid cells obtained at various stages of gestation. In a majority of cases, the in vitro morphology of cells from both fetal cavities was similar to that observed in primary human amniotic fluid cell cultures.