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Prenatal diagnosis of atypical Tay-Sachs disease by chorionic villi sampling.

We studied a family at risk for atypical TSD in which the index case showed, clinically, a late onset and a gradual psychomotor deterioration and biochemically, a residual hex. A activity in leucocytes. Two prenatal diagnoses of affected fetuses were made in this family. The first one on amniotic cells, the second one on trophoblast biopsy samples. Both of them were confirmed after abortion on cultured cells. Prenatal diagnosis of TSD, even of some atypical forms is possible using trophoblast biopsy, but formal confirmation should be obtained on cultured trophoblasts.

Abortion, Induced

Monitoring of pregnancies at risk for Fanconi's anemia by chorionic villi sampling.

Two pregnancies at risk for Fanconi's anemia have been monitored by a cytogenetic method in the first trimester of gestation. The rate of chromosome breakage was evaluated in spontaneous mitoses from a direct preparation of trophoblasts in one case and from mitoses obtained from standard cultures and from mitoses treated with diepoxybutane in both cases. Cytogenetic studies were carried out also at 16 weeks from amniotic fluid cells in one case, and in fibroblasts sampled from the aborted fetus in the other. In all the experimental conditions the mean frequency of breaks/cell was in the range of controls, suggesting that the fetuses were unaffected by Fanconi's anemia. In one case the results have been confirmed by chromosome analysis at birth.

Adult

Chorionic villi sampling with an echogenic catheter: experiences of the first 500 cases.

Using a newly developed CVS catheter with enhanced echogenicity we performed CVS in 501 consecutive cases. The abortion rate of 4.3% prior to 28 weeks of gestation in this series is within the background rate of controls matched for maternal age. The loss rate was clearly correlated to the number of insertions, time of sampling and sampling success. CVS is safest between 9 and 11 weeks of pregnancy. We recommend to restrict the number of insertions to a maximum of 3. The rate of failed samplings was 4, reflecting a low "aggressiveness in seeking a sample". Complete follow-up of 259 consecutive cases gave no indication of an increased rate of congenital anomalies following CVS in early pregnancy. In our study we also performed cervical swabs, pregnancy hormone testing, maternal serum AFP determination prior to and after CVS as well as maternal AFP screening at 16 weeks of pregnancy together with a detailed sonographic examination. We conclude that CVS can be considered now a safe and reliable diagnostic procedure, but requires further detailed documentation and close follow-up in controlled trials.

Abortion, Spontaneous

Direct-vision sampling of chorionic villi during extra-amniotic instillation of physiologic saline solution: effect on intrauterine pressure and fetal heart activity.

After 150 ml of physiologic saline solution had been infused into the extra-amniotic space before first-trimester vacuum aspiration abortion, intrauterine pressure ranged between 16 and 23 mm Hg, thus not more than during Braxton Hicks contractions. At chorionic villi sampling during continuous saline solution infusion, fetal heart activity (beats per 15 seconds) decreased temporarily from about 36 to about 33.

Amnion

[Sampling of the chorionic villi: transcervical fine-needle and endoscopic aspiration].

In 63 cases chorionic villi sampling has been performed under complete anesthesia just before legal abortion; nine of them were endoscopic transcervical and 54 transcervical by means of a catheter under direct ultrasonic control. 81% offered useful chorionic villi, 17.4% only decidual material. The last 21 aspirations by means of a catheter between the 8th and the 12th week of gestation (p.m.) caused no problem at all. From the first punction on useful chorionic material has been obtained.

Abortion, Legal

[Prenatal cytogenetic diagnosis using chromosomal preparations of the native biopsy samples of chorionic villi, cultured chorionic cells and amniocytes].

Analysis of the results of prenatal cytogenetic diagnosis carried out in the first and second pregnancy trimesters in more than 300 women permitted comparing the efficacies of two methodologic approaches, diagnostic amniocentesis and chorion sampling , with due consideration for the methodologic errors typical of these methods and of the tested biologic material. Up to 5% of the diagnoses are erroneous if the diagnosis is based on chorion sampling data, whereas in amniocentesis the share of diagnostic errors is lower by an order. The authors have given a theoretical rationale for and tried a methodologic approach, involving the employment of the 'direct' chromosomal preparations from villous chorion biopsy specimens and the so-called 'maintained' cell culture technique, that permits obtaining chromosomal preparations of higher quality and, consequently, helps improve the accuracy of chromosomal diagnosis.

Adult

Identification of trophoblast in chorionic villi biopsy samples.

We have investigated a test for rapid discrimination between foetal and maternal origin of chorionic villi biopsy samples. A monoclonal antibody named H315 reacting against a specific antigen present on the surface of foetal trophoblastic cells, plus a double-colour staining technique (FITC + PI), have been used for the identification of foetal cells (H315-positive) and for visualization of nucleate (PI-positive) and anucleate (PI-negative) structures of chorionic villi. This test could be useful in differentiating foetal and maternal cells in chorionic villi biopsy samples currently used for prenatal diagnostic purposes.

Antibodies, Monoclonal

Evaluation of the efficacy of optical genome mapping in prenatal diagnosis: a retrospective cohort study.

BACKGROUND: Optical genome mapping (OGM) is an emerging cytogenetic method for concurrently detecting structural variants (SVs) and copy number variants (CNVs). However, its clinical application in prenatal diagnosis remains underexplored. METHODS: This study retrospectively evaluated the clinical validity of OGM in prenatal diagnosis by comparing with two routine genetic testing methods: karyotyping and chromosomal microarray analysis (CMA). Both positive and negative cases detected by routine genetic methods were enrolled to evaluate the technical concordance of OGM and its capability to improve diagnostic rate in negative cases. The exclusion criteria were balanced centromeric translocations, mosaic cases with cellular fractions&#x2009;<&#x2009;20%, and loss of heterozygosity (LOH)&#x2009;<&#x2009;25&#xa0;Mb. All samples subjected to OGM testing were anonymized and analyzed blindly. The results from OGM were compared with those from routine genetic testing, and statistical analyses were performed to assess technical concordance and diagnostic rate. RESULTS: Of 217 samples (166 positive samples and 51 negative samples for routine genetic testing), all were successfully tested with OGM, including 2 umbilical cord blood samples, 4 chorionic villi samples, and 211 cultured amniotic fluid samples. Of the 207 reportable chromosomal aberrations from 166 positive samples, the blinded concordance between OGM and CMA, karyotyping, and combination of karyotyping plus CMA was 97.81%, 96.36%, and 97.10%, respectively. OGM missed six aberrations initially, including one LOH, two marker chromosomes, and three microdeletions. However, after reanalysis, its concordance improved to 100% with CMA and 99.03% with karyotyping plus CMA. OGM also diagnosed one additional case of a 3-kb deletion in 51 negative samples, improving the diagnostic rate by 1.96%. Moreover, OGM reclassified the pathogenicity of two microdeletions from pathogenic to uncertain significance in 2 positive cases. Furthermore, OGM clarified the diagnosis suspected by routine genetic testing and improved diagnostic accuracy in some cases. CONCLUSION: As far as we know, this is the largest retrospective study on OGM in prenatal diagnosis, and it includes a broad range of sample types. The results showed that OGM exhibits high concordance among the tested methods and increases the diagnostic rate. Thus, OGM has the potential to become a first-line technique for prenatal diagnosis in the future.

Humans

[Value of chorionic biopsy in routine clinical diagnosis].

To test the advantages and risks of chorionic villi sampling, a method still new in prenatal diagnosis, 100 patients were examined. Most of the biopsies were taken in the 8th week of pregnancy. A soft catheter with a flexible mandrin was introduced transcervically to the chorion frondosum guided by ultrasound. The mandrin was then removed and trophoblastic tissue obtained by aspiration. The risk of abortion within 10-14 days after biopsy could be reduced to 4%. In the last series of chorionic villi samplings 92% of these could be evaluated cytogenetically. The use of quinacrine fluorescence technique showed that female mitoses were never found in male tissue. Because of the relatively low risk of abortion and the high diagnostic accuracy achieved in a very short period of time chorionic villi sampling can be considered as an alternative to amniocentesis.

Abortion, Spontaneous

[Transabdominal chorion aspiration in the second pregnancy trimester].

The authors report their experiences with 377 transabdominal chorionic villi samplings performed in the second trimester of pregnancy, between 1987-1989. They used the double needle technique with continuous ultrasound guidance. In every case they could get a sufficient amount of villi from one puncture, and there was no unsuccessful direct chromosome-preparation. The obstetrical complications of the procedure were measured by the analysis of the outcome of the first 300 pregnancies intended to continue: the abortion rate after the transabdominal chorionic villi sampling seems to be lower, than after amniocentesis.

Adult

[Prenatal diagnosis using chorionic biopsy in the 1st trimester of pregnancy].

One hundred-sixteen pregnant women were subjected to chorionic villi sampling at the gestational age of 8-11 weeks. In 12 cases, the transabdominal approach was used, and in the rest of the cases, a flexible catheter was placed transcervically. The most frequent indication was the age of the pregnant women (over 35). Chorionic villi sampling was successfully performed in 97.5% of cases. Fetal loss amounted to 1.9%.

Adult

[Study of the choice between sampling of the chorionic villi and the amniotic fluid in prenatal diagnosis].

We are reporting the results of a 21-month study during which 653 couples were seen in consultation at the prenatal diagnostic center of the University Hospital in Amiens, referred by their physician. 171 patients presented a theoretical term under 11 weeks of amenorrhea, for whom the choice between chorionic villi biopsy or amniotic fluid tap was possible. The different situations and results are compared for each method. The rate of fetal death was 5.4 per cent for chorionic villi biopsy and 1.5 per cent for amniotic fluid tap.

Amniocentesis

The yolk sac in early pregnancy failure.

An attempt was made to visualize the yolk sac in 845 patients scheduled for chorionic villi sampling. The distribution of yolk sac diameters and the interpolating growth curve up to 11 weeks of development were analyzed in 239 pregnant women who were delivered of normal infants. The highest visualizing rate of the yolk sac in normal pregnancies was 97 at 7 weeks of gestation. A total of 130 miscarriages occurred before chorionic villi sampling. In these cases, the diameter of the yolk sac versus crown-rump length tended to be larger than found in normal pregnancies. The visualizing rate of the yolk sac in miscarriages after the embryo had been formed was significantly higher in those women who demonstrated fetal heart activity (82.1%) than in those who did not (54.5%). On the other hand, the yolk sac was observed in 44% of miscarriages without a visible embryo. These findings suggest different types of missed abortion. An abnormal karyotype was observed in 23 of 29 chromosomal analyses performed on aborted specimens. An abnormal karyotype was observed in all eight cases with only a yolk sac-like structure within the gestational sac.

Abortion, Spontaneous

Comparative study of 15 lysosomal enzymes in chorionic villi and cultured amniotic fluid cells. Early prenatal diagnosis in seven pregnancies at risk for lysosomal storage diseases.

A large number of chorionic villi samples obtained from women undergoing elective first trimester termination of pregnancy was analysed by enzyme assays similar to those applied to cultured amniotic cells. The levels of 15 lysosomal enzymes were compared to those observed in tissue cultures of amniotic cells obtained through amniocentesis at 16-18 weeks of pregnancy and the results were discussed in order to assess the usefulness of trophoblast biopsy for first trimester diagnosis of hereditary lysosomal diseases. The data suggest the applicability of this source of fetal cells for prenatal diagnosis of fifteen respective genetically determined enzyme deficiencies with the probable exception of alpha-L-iduronidase deficiency. Enzyme determinations were performed on chorionic villi samples of two pregnancies at risk for Tay-Sachs disease, three pregnancies for GM1 gangliosidosis type 1, one for mucopolysaccharidosis type VI and one for Wolman's disease.

Amniocentesis

Investigations of chorionic villi after chorionic villus sampling (CVS). Correlation of morphological with clinical and laboratory data.

This report documents the first 262 cases of chorionic villus sampling (CVS) performed in parallel with cytogenetic and morphological investigations. Histomorphological examination of these CVS specimens gave suitable results in about 96% (251 cases). Of the latter, 201 samples (80.1%) exhibited villi and 176 (70.1%), maternal tissue. Viability and maturation of the chorionic villi were determined light microscopically even in cases with few villus trees. Smooth avascular villi with poorly defined margins observed under an inverted microscope, less than 10 mitoses after short-term incubation, and reduced growth of cell cultures were significantly correlated with sampling at the chorion laeve by means of histomorphologic criteria. Villi from cases exhibiting cytogenetically proved chromosomal abnormalities were characterized by molar degeneration or stromal fibrosis, or both, in 4 out of 9 cases, including 3 mosaics. In early abortions (within 3 weeks after CVS), an unexpectedly high rate of pathohistological changes within maternal tissue was evident. These results need further confirmation by investigation of a greater number of samples with immunohistochemical and morphometric methods.

Adult

[Research on karyotypic consistency between chorionic villi and fetus].

In the last decade, chorionic villi sampling (CVS) has been widely accepted as a new technique in prenatal diagnosis. An inconsistency in karyotypes between CVS and fetal tissue was found in clinical practice, although the chorionic villi and the fetal tissues were from the same fertilized ovum. Karyotypes from direct chromosomal preparation of chorionic villi and cultured fetal tissues in 52 artificial abortion samples were compared. Results showed two cases with karyotypic inconsistency: (1) 46, XX/46, XY in the chorionic villus direct preparation and 46, XX in the fetal tissue; (2) 46, XY in the direct preparation of chorionic villi and 45,XY, t (15q21q) de novo in the fetal tissue. Our research demonstrates that karyotype from chorionic villus direct preparation does not always reflect the fetal karyotype.

Adult