Beni Adeniji1, John Williams, Ido Solt, Carlos Morales, Artemis Alanakian, Siegfried Rotmensch. 1. Maternal-Fetal Center, Children's Hospital of Central California, Madera, California, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA. benadeniji@gmail.com
Abstract
OBJECTIVES: Real-time 4-dimensional (4D) sonography can visualize the location of a chorionic villus sampling (CVS) catheter simultaneously in 3 dimensions. We determined the utility of 4D versus 2-dimensional (2D) sonographic guidance for transcervical CVS. METHODS: Chorionic villus sampling was performed on 40 patients at 10 to 13 weeks' gestation (20 in each study group). Primary outcomes were as follows: (1) time in seconds needed to complete the procedure; (2) procedure failure, defined as the inability to obtain an adequate sample by a single catheter insertion or a necessity to switch to the alternative imaging modality; and (3) acquisition of a sample of chorionic villi sufficient for cytogenetic analysis. Wilcoxon rank sum and Fisher exact tests were used for categorical and continuous variables, respectively. Figure 1. A, Two-dimensional guidance of the transcervical chorionic villus sampling procedure. Arrows indicate the chorionic villus sampling catheter. B, Multiplanar 3-dimensional guidance of the procedure. RESULTS: The procedure time was significantly longer in the 4D group than the 2D group (161.4 versus 80.4 seconds, respectively; P = .001). The success rate at first introduction of the catheter was higher for 2D guidance (90%) than 4D guidance (70%) but was not statistically significant with the study group sizes. Adequate sample sizes were obtained in all patients. The main limiting factor in 4D guidance was a low frame rate. CONCLUSIONS: Our findings show the feasibility of 4D guidance for transcervical CVS, although at the expense of a prolonged procedure time when compared to 2D sonographic guidance. The value of 4D guidance for less experienced operators remains to be determined.
OBJECTIVES: Real-time 4-dimensional (4D) sonography can visualize the location of a chorionic villus sampling (CVS) catheter simultaneously in 3 dimensions. We determined the utility of 4D versus 2-dimensional (2D) sonographic guidance for transcervical CVS. METHODS: Chorionic villus sampling was performed on 40 patients at 10 to 13 weeks' gestation (20 in each study group). Primary outcomes were as follows: (1) time in seconds needed to complete the procedure; (2) procedure failure, defined as the inability to obtain an adequate sample by a single catheter insertion or a necessity to switch to the alternative imaging modality; and (3) acquisition of a sample of chorionic villi sufficient for cytogenetic analysis. Wilcoxon rank sum and Fisher exact tests were used for categorical and continuous variables, respectively. Figure 1. A, Two-dimensional guidance of the transcervical chorionic villus sampling procedure. Arrows indicate the chorionic villus sampling catheter. B, Multiplanar 3-dimensional guidance of the procedure. RESULTS: The procedure time was significantly longer in the 4D group than the 2D group (161.4 versus 80.4 seconds, respectively; P = .001). The success rate at first introduction of the catheter was higher for 2D guidance (90%) than 4D guidance (70%) but was not statistically significant with the study group sizes. Adequate sample sizes were obtained in all patients. The main limiting factor in 4D guidance was a low frame rate. CONCLUSIONS: Our findings show the feasibility of 4D guidance for transcervical CVS, although at the expense of a prolonged procedure time when compared to 2D sonographic guidance. The value of 4D guidance for less experienced operators remains to be determined.