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Risk of 2nd trimester amniocentesisFrom: Allen Worrall (jworrall@alaska.net)Fri May 18 19:32:21 2001
When talking to patients, what risk of 2nd trimester amniocentesis do you mention? I think the usual is 1/200 to 1/300, although it is not clear to me if that is the risk of fetal loss, or just the risk of "something" happening. Amniocentesis was just coming into practice when I stopped doing OB, about 26 years ago, so I have little personal experience, but I have provided the ultrasound quidance for many. I have come to wonder, however, if the risk mentioned above really is valid today. Is it possible that the above risk is from the pre-ultrasound experience? My observations of my colleagues' practices and techniques suggests that the risk of 2nd trimester amniocentesis is much lower than 1/200 to 1/300. Is it true that age 35 to offer amniocentesis to detect Down came about because that was the point at which the risk of the amniocentesis equaled the risk of having a baby with Down? If so, and if we determined that the risk of amniocentesis today is much lower than we think, what impact should this have on the way we counsel patients in this area? I recently heard from a patient (not in my community) who had an increased nuchal translucency (I do not remember what it was), a 2nd trimester triple screen risk of Down of 1/76, and opted not to have a 2nd trimester amniocentesis, because she was afraid of the amniocentesis. The outcome of this pregnancy is not yet known. At the AIUM meeting 2 months ago I heard an anecdotal story of a resident, or maybe it was the wife of a resident, who died of sepsis from an amniocentesis! So are we correct to continue to counsel that the risk of something bad happening from amniocentesis is 1/200 to 1/300? Are there any who have kept track of how many amniocenteses they have done, and how many problems there have been? I recently talked with a young doctor who said he has done probably 1000 and is unaware of any problems. Are there other doctors whose personal experience would lead them to think 1/200 to 1/300 is too high?
-- Joseph A Worrall MD RDMS Fairbanks, Alaska
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