Training for transabdominal villous sampling is feasible and safe




Objective


In the near future, the spread of noninvasive prenatal testing will drastically decrease the number of invasive diagnostic procedures currently performed to diagnose aneuploidy. Thus, adequate training will be a challenge with a decreased number of available procedures. The demand for chorionic villous sampling (CVS) has increased as this is the method of choice for DNA analysis and prenatal diagnosis of inborn errors of metabolism. Among the available techniques, transabdominal (TA) CVS offers advantages over the transcervical approach.




Study Design


Training for TA-CVS remains an important clinical need. However, there is not a well-structured training method to achieve proficiency with this procedure. The aim of this study was to determine the frequency of procedure success and the fetal loss after TA-CVS performed by trainees of a senior physician expert with CVS. This was a retrospective cohort study of procedure and pregnancy outcomes of TA-CVS cases performed by individuals trained under our direction from January 1986 through December 2014. Each fellow underwent a 2-week period of training by a single senior physician (G.M.). The program consisted of observation of CVS, followed by the performance of amniocentesis and then mentor experience with TA-CVS. Firstly, fellows assisted several procedures; then performed tutored amniocentesis; finally, fellows started to perform TA-CVS according to the tangential free-hand technique, previously described by Monni et al ( Figure ).




Figure


Needle insertion tangential to probe and perpendicular to placenta

Changes according to A, bladder’s filling grade, and B, vaginal manipulation to allow perpendicular needle insertion in case of complete posterior placenta and retroverted uterus.

Monni. Training in TA-CVS. Am J Obstet Gynecol 2015 .




Study Design


Training for TA-CVS remains an important clinical need. However, there is not a well-structured training method to achieve proficiency with this procedure. The aim of this study was to determine the frequency of procedure success and the fetal loss after TA-CVS performed by trainees of a senior physician expert with CVS. This was a retrospective cohort study of procedure and pregnancy outcomes of TA-CVS cases performed by individuals trained under our direction from January 1986 through December 2014. Each fellow underwent a 2-week period of training by a single senior physician (G.M.). The program consisted of observation of CVS, followed by the performance of amniocentesis and then mentor experience with TA-CVS. Firstly, fellows assisted several procedures; then performed tutored amniocentesis; finally, fellows started to perform TA-CVS according to the tangential free-hand technique, previously described by Monni et al ( Figure ).


May 6, 2017 | Posted by in GYNECOLOGY | Comments Off on Training for transabdominal villous sampling is feasible and safe

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