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Vol. 22, No. 3, 2007
Issue release date: April 2007
Fetal Diagn Ther 2007;22:221–225

Amniocentesis for Twin Pregnancies: Is Alpha-Fetoprotein Useful in Confirming that the Two Sacs Were Sampled?

Delisle M.F. · Brosseuk L. · Wilson R.D.
aChildren’s Hospital and Women’s Health Centre of British Columbia, University of British Columbia, Vancouver, Canada; bChildren’s Hospital of Philadelphia, University of Pensylvania, Philadelphia, Pa., USA

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Objective: To assess if amniotic fluid alpha-fetoprotein (AFAFP) could be useful to determine if both sacs are sampled during an amniocentesis for twin pregnancies. Method: We reviewed all amniocenteses performed on twin pregnancies over a 5-year period. Inclusion criteria were restricted to pregnancies where both karyotypes and AFAFP were available on each fetus. Pregnancies complicated by fetal anomalies were excluded. The following information was obtained: maternal age, gestational age at the procedure, karyotypes, AFAFP values, pregnancy and neonatal outcome. Placental pathology reports were used to confirm chorionicity. Analysis was performed to evaluate the impact of the fetal gender and chorionicity on the AFAFP values. Results: 260 pregnancies were reviewed. Mean maternal age was 36.9 years (33.6, 40.1). Gestational age at the time of the procedure was 16.2 weeks (14.5, 17.9). Complications included 1.8% of misdiagnosis (discrepancy between karyotype and gender). The difference of AFAFP values between the two fetuses was statistically larger in dichorionic pregnancies than in monochorionic gestations. Fetal gender had no influence on the AFAFP. Conclusion: Amniocentesis in twin pregnancies is associated with a 1.8% risk of misdiagnosis. AFAFP can help to assess the chorionicity of a twin pregnancy. When the difference between the two values is <0.2 MoM and the chorionicity was thought to be dichorionic and the two karyotypes are similar, then failure to sample both sacs should be suspected.

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  1. Young PE, Carson KF, Prichard LL, Jones OW: A technique for obtaining precise chromosome and bilirubin studies on amniotic fluid in twin pregnancy. J Reprod Med 1974;4:163–166.
  2. Elias S, Gerbis AB, Simpson JL, Nadler HL, Sabbagha RE, Shkolnik A: Genetic amniocentesis in twin gestation. Am J Obstet Gynecol 1980;138:169–174.
  3. Tabsh K: Genetic amniocentesis in multiple gestation: a new technique to diagnoses monoamniotic twins. Obstet Gynecol 1990;75:296–298.
  4. Bang J, Nielsen H, Philip J: Prenatal karyotyping of twins by ultrasonically guided amniocentesis. Am J Obstet Gynecol 1975;123:695–696.
  5. Jeanty P, Shah D, Roussis P: Single-needle insertion in twin amniocentesis. J Ultrasound Med 1990;9:511–517.
  6. Buscaglia M, Ghisoni L, Bellotti M, Marconi AM, Zamperini P, Stripparo L, Molinari A, Grimoldi MG, Rosella F: Genetic amniocentesis in biamniotic twin pregnancies by single transabdominal insertion of the needle. Prenat Diagn 1995;15:17–19.
  7. Van Vugt JMG, Nieuwint A, van Geijn HP: Single-Needle Insertion: An alternative technique for early second-trimester genetic twin amniocentesis. Fetal Diagn Ther 1995;10:178–181.
  8. Sebire NJ, Noble PL, Odibo A, Malligiamnis P, Nicolaides KH: Single uterine entry for genetic amniocentesis in twin pregnancies. Ultrasound Obstet Gynecol 1996;7:26–31.
  9. Bahado-Singh R, Schmitt R, Hobbins JC: New technique for genetic amniocentesis in twins. Obstet Gynecol 1992;79:304–307.
  10. Palle C, Anderson JW, Tabor A, Lauritsen JG, Bang J, Philip J: Increased risk of abortion after genetic amniocentesis in twin pregnancies. Prenat Diagn 1983;3:83–89.
  11. Librach CL, Doran TA, Benzie RJ, Jones JM: Genetic amniocentesis in seventy twin pregnancies. Am J Obstet Gynecol 1984;148:585–591.
  12. Tabsh KMA, Crandall B, Lebherz TB, Howard J: Genetic amniocentesis in twin pregnancy. Obstet Gynecol 1985;65:843–845.
  13. Pijpers L, Johoda MGJ, Vosters RPL, Niermeijer MF, Sachs ES: Genetic amniocentesis in twin pregnancies. Br J Obstet Gynecol 1988;95:323–326.
  14. Pruggnayer M, Baumann P, Schutte H, Osmers R, Bartels I, Jovanovich V, Rauskolb V: Incidence of abortion after genetic amniocentesis in twin pregnancies. Prenat Diagn 1991;11:637–640.
  15. Anderson RL, Goldberg JD, Golbus MS: Prenatal diagnosis in multiple gestation: 20 years’ experience with amniocentesis. Prenat Diagn 1991;11:263–270.
  16. Kidd SA, Lancaster PAL, Anderson JC Boogert A, Fisher CC, Robertson R, Wass DM: A cohort study of pregnancy outcome after amniocentesis in twin pregnancy. Paediatr Perinat Epidemiol 1997;11:200–213.
  17. Toth-Pal E, Papp C, Beke A, Ban Z, Papp Z: Genetic amniocentesis in multiple pregnancy. Fetal Diagn Ther 2004;19:138–144.
  18. Williamson RA, Varner MW, Grant SS: Reduction in amniocentesis risks using a real-time needle guide procedure. Obstet Gynecol 1985;65:751–755.
  19. Ghidini A, Lynch L, Hicks C, Alvarez M, Lockwood CJ: The risk of second-trimester amniocentesis in twin gestations: a case-control study. Am J Obstet Gynecol 1993;169:1013–1016.
  20. Ko T-M, Tseng L-H, Hwa H-L: Second-trimester genetic amniocentesis in twin pregnancy. Int J Gynecol Obstet 1998;61:285–287.
  21. Yukobowich E, Anteby EY, Cohen SM, Lavy Y, Granat M, Yagel S: Risk of fetal loss in twin pregnancies undergoing second trimester amniocentesis. Obstet Gynecol 2001;98:231–234.
  22. Holbrook RH, Krovoza AM, Schelley S, Ferguson JE: Biamnial elevated alpha-fetoprotein and positive acetycholinesterase in twins, one with anencephaly. Prenat Diagn 1987;7:653–655.
  23. Winsor EJ, Brown BS, Luther ER, Heifetz SA, Welch JP: Deceased co-twin as a cause of false positive amniotic fluid AFP and AchE. Prenat Diagn 1987;7:485–489.
  24. Drugan A, Sokol RJ, Symer FN, Ager JW, Zador IE, Evans MI: Clinical Implications of amniotic alpha-fetoprotein in twin pregnancy. J Reprod Med 1989;34:977–980.
  25. Drugan A, Yaron Y, Murphy J, Ebrahim SA, Kramer RL, Johnson MA, Evans MI: No effect of fetal sex on amniotic fluid alpha-fetoprotein. Fetal Diagn Ther 1997;12:301–303.
  26. Sharony R, Drugan A, Amiel A, Grinshpun-Cohen J, Markov S, Feigin MD: Are amniotic fluid alpha-fetoprotein levels influenced by the gender in twin pairs? Fetal Diagn Ther 2003;18:281–283.
  27. Van der Pol JG, Wolf H, Boer K, Treffers PE, Leschot NJ, Hey HA, Vos A: Jejunal atresia related to the use of methylene blue in genetic amniocentesis in twins. Br J Obstet Gynaecol 1992;99:141–143.
  28. Brandenburg H: The use of synthetic dyes for identification of the amniotic sacs in multiple pregnancies. Prenat Diagn 1997;17:281.

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