Amniocentesis precoz y biopsia de vellosidad corial. Pérdidas fetales y anomalías congénitas en un grupo de gestantes brasileñas
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Bernal, L., Consuelo Bernal, M., & Gollop, T. (2018). Amniocentesis precoz y biopsia de vellosidad corial. Pérdidas fetales y anomalías congénitas en un grupo de gestantes brasileñas. NOVA, 16(29), 51-61. https://doi.org/10.22490/24629448.2689
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Autores
Luz Mery Bernal
María Consuelo Bernal
Thomaz Gollop
Resumen
En el Instituto de Medicina Fetal y Genética Humana de São Paulo se ofrecen, a las gestantes que tienen un riesgo aumentado para anomalías cromosómicas, diferentes técnicas, entre ellas, la Biopsia de Vellosidad Corial Transabdominal (BVCTA) y la Amniocentesis Precoz (AP). El objetivo del presente estudio es realizar una comparación de la frecuencia de pérdidas fetales y anomalías congénitas presentadas en cada uno de los procedimientos, ambos realizados por los mismos operadores, en la misma edad gestacional (12-14 6/7 semanas) y bajo un abordaje transabdominal. Fueron analizadas retrospectivamente 432 AP y 418 BVCTA. Todos los procedimientos de colecta fueron monitorizados por ultrasonografía. La frecuencia de pérdidas fetales espontáneas fue del 4,9 % en AP y de 5,3 % en BVCTA, una diferencia no significativa. No se encontraron diferencias significativas entre los dos procedimientos al comparar las frecuencias de pérdidas en cada semana de gestación. Sangrado y pérdida de líquido amniótico fueron más frecuentes en AP que en la BVCTA. Esa diferencia fue significativa en el caso de la pérdida de líquido amniótico. En algunos casos este hallazgo se relacionó con pérdida fetal. La incidencia de prematuridad y bajo peso al nacimiento no difirió significativamente entre los dos procedimientos. La mayor frecuencia de problemas respiratorios registrada en AP no fue significativa en comparación con BVCTA. No se observó diferencia significativa en la incidencia de anomalías músculo-esqueléticas. La amniocentesis después de catorce semanas presenta un bajo riesgo de pérdida fetal o anomalías congénitas. La BVCTA, debe ser realizada alrededor de la semana doce de gestación.
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NOVA por http://www.unicolmayor.edu.co/publicaciones/index.php/nova se distribuye bajo una Licencia Creative Commons Atribución-NoComercial-SinDerivar 4.0 Internacional.
Así mismo, los autores mantienen sus derechos de propiedad intelectual sobre los artículos.
Referencias
1. Tabor A, Madsen M, Obel E, Philip J, Bang J, Noergard-Pe- terson B. Randomised controlled trial of genetic amniocen- tesis in 4606 low-risk women. Lancet.1986; 1: 1287-1293.
2. Reece E. Amniocentese genética precoce e nos trimestres intermediários. Segurança e resultados. Clínicas Obstétricas e Ginecológicas da América do Norte. Diagnostico e Trata- mento Fetal. Vol 1. Rio de Janeiro: Interlivros; 1997.
3. Eddleman K, Malone F, Sullivan L, Dukes K, Berkowitz R, Kharbutli Y, and others. Pregnancy loss rates after mi- dtrimester amniocentesis. Obstet Gynecol. 2006; 108(5): 1067–72.
4. Kong C, Leung T, Leung T, Chan L, Sahota D, Fung T, and others. Risk factors for procedure-related fetal losses after mid-trimester genetic amniocentesis. Prenat Diagn. 2006; 26(10): 925–30.
5. Anuwutnavin S, Chanprapaph P, Ruangvutilert P, Eammatta M, Tontisirin P. Short-term outcomes after second-trimester genetic amniocentesis in Siriraj Hospital. International Jour- nal of Gynecology and Obstetrics. 2014; 124: 222–225. doi: 10.1016/j.ijgo.2013.09.019.
6. Connolly K, Eddleman K. Amniocentesis: A contemporary review. World J Obstet Gynecol. 2016; 5(1): 58-65.
7. Bernal L. Evaluación de la amniocentesis precoz en una ins- titución brasileña de diagnóstico prenatal. NOVA. 2012; 10(17): 12-24.
8. Naccache N, GollopT, Auler-Bittencourt E, Vianna-Mor- gante A, Eigier A. Cytogenetic analysis of first trimester cho- rionic villi sampling. Rev. Brasil. Genet. 1987; 10: 277-287.
9. Gollop T, Pieri P, Naccache N, Auler-Bittencourt E, Eigier A, Hauschild D. Transabdominal Chorionic Villus Sampling: experience with 70 cases. Rev. Brasil. Genet. 1990; 13(3): 591-597.
10. Gollop T, Naccache N, Campos I, Fieri P. Amostra de Vilo Corial: 1.290 casos. Rev. Brasil. Ginecol. Obstet. 1993; 15(2): 84-87.
11. Cederholm M, Axelsson O. A prospective comparati- ve study on transabdominal chorionic villus sampling and amniocentesis performed at 10-13 weeks gestation. Prenat Diagn. 1997; 17(4): 311-317.
12. CEMAT, The Canadian Early and Mid-Trimester Amnio- centesis Trial Group. Randomised trial to asses safety and fetal outcome of early and midtrimester amniocentesis. Lan- cet. 1998; 351:242-247.
13. Al Ibrahim A, Zidan M, Obaidly S, Khenyab N, Al Jenahi N, Al Mansori Z, Bolushi M, and others. Early Amniocentesis: The Resurrection. Qatar Foundation Annual Research Con- ference Proceedings. 2016.
14. Gollop T, Eigier A, Vianna-Morgante A, Naccache, N. Cho- rionic villi sampling for early prenatal genetic diagnosis. Rev. Brasil. Genet.. 1986; 9: 381-385.
15. Nicolaides K, Brizot M, Patel F, Snijders R. Comparison of Chorion Villus Sampling and Early Amniocentesis for karyo- typing in 1492 singlenton preqnancies. Fetal. Diagn. Ther. 1996; 11: 9-15.
16. Chuet J, Goldberg J, Wohlferd M, Golbus M. Comparision of transcervical and transabdominal chorionic villus sam- pling loss rate in nine thousand from a single center. Am. J. Obstet. Gynecol. 1995; 173: 1277-1282.
17. Smidt-Jensen S, Permin M, Phillip J, Lundsteen, C, Zachary, J, Fowler S et al. Randomized comparison of amniocentesis and transabdominal and transcervical chorionis villus sam- pling. Lancet. 1992; 340: 1237-1244.
18. Brambati B, Terzian E, Tognoni G. Randomized clinical trial of transaddominal versus transcervical chorionic villus sam- pling methods. Prenat. Diagn. 1991; 11: 285 293.
19. Fortuny A, Borrell A, Soler A, Casals E, Costa D, Carrio A, and others. Chorionic villus sampling by forceps. Results of 1580 procedures from single centre. Prenat. Diagn. 1995; 15: 541-550.
20. Penso C, Sandstrom M, Garber M, Ladoulis M, Stryker J, Benacerraf, B. Early Amniocentesis: Report of 407 cases with neonatal follow-up. Obstet. Gynecol. 1990; 76: 1032-1036.
21. Sato K, Izuta M, Kojima T, Miyakawa T, Yokoo I, Takahashi K, and others. Early amniocentesis risk and laboratory eva- luation. Acta. Obstet. Gynaecol. Jpn. 1992; 44: 1285-1288.
22. Stripparo L, Buscaglia M, Longatti L, Ghisoni L, Dambrosio F, Guerneri, S, and others. Genetic amniocentesis: 505 ca- ses performed before the sixteenth week of gestation. Prenat. Diagn. 1990; 10: 359-364.
23. Bravo R, Schulman L, Phillips O. Transplacental needle pas- sage in early amniocentesis and pregnancy loss. Obstet. Gy- necol. 1995; 86: 437-440.
24. Johnson J, Wilson R, Winsor E, Singer J, Dansereau J, Ka- lousek, D. The Early Amniocentesis Study: A randomized clinical trial of early amniocentesis versus midtrimester am- niocentesis. Fetal. Diagn. Ther. 1996; 11: 85-93.
25. Elejalde B, de Elejalde M, Acuna J, Thelen D, Trujillo C, Karrmann M. Prospective study of amniocentesis performed between weeks 9 and 16 of gestation: Its feasibility, risks, complications and use in early genetic prenatal diaqnosis. Am. J. Med. Genet.. 1990; 35: 188-196.
26. Brumfield C, Lin S, Conner W, Cosper P, Davis R, Owen J. Pregnancy outcome following genetic amniocentesis at 11-14 versus 16 -19 weeks gestation. Obstet. Gynecol. 1996; 88(1): 114-118.
27. Eiben B, Hammans W, Hansen S, Trawicki W, Osthelder B, Stelzer A, and others. On the complication risk of Early Amniocentesis versus Standard Amniocentesis. Fetal. Diagn. Ther. 1997; 12: 140-144.
28. Daniel A, N, Kuah K, Reiha S, Malafiej P. A study of ear- ly amniocentesis for prenatal cytogenetic diagnosis. Prenat. Diagn. 1998; 18(1): 21-28.
29. Schulman L, Elias S, Simpson, J. Early amniocentesis: Com- plications in initial 150 cases compared to complication in initial 150 cases transabdominal chorionic villus sampling. Am. J. Human. Genet. 1991; 49: 231.
30. Nagel H, Vandenbussche F, Keirse M, Oepkes D, Oosterwijk J, Beverstock G, and others. Amniocentesis before 14 com- pleted weeks as an alternative to transabdominal chorionic villus sampling: A controlled trial with infant follow-up. Pre- nat Diagn. 1998; 18: 465-475.
31. Philip J, Silver R, Wilson R, Thom E, Zachary J, Mohide P, and others. Late First-Trimester Invasive Prenatal Diagnosis: Results of an International Randomized Trial.
Obstetrica and Gynecology. 2004; 103(6): 1164-117
32. Liu D, Jeavons B, Preston C, Pearson D. A prospective study of spontaneous miscarriage in intrasonically normal preg- nancies and relevance to chorionic villus sampling. Pnenat. Diagn. 1987; 7: 223-226.
33. Frates M, Benson C, Doubilet M. Pregnancy outcome after a first trimester sonogram demonstrating fetal cardiac activity. J. Ultrasound. Med. 1993; 12: 383-386.
34. Tharmaratnam S, Sadek S, Steele E, Harper M, Stewart F, Nevin J, and others. Early amniocentesis: Effect of removing a reduced volume of amniotic fluid on pregnancy outcome. Prenat. Diagn. 1998; 18:773-778.
35. Wulff C, Gerds T, Rode L, Ekelund C, Petersen O, Tabor A. Risk of fetal loss associated with invasive testing following combined first-trimester screening for Down syndrome: a national cohort of 147987 singleton pregnancies. Ultra- sound Obstet Gynecol. 2016; 47: 38-44.
36. Sundberg K, Jorgensen F, Bang J. Experience with early am- ncentesis. J Perinat Med. 1995; 23: 149-158.
37. Tharmaratnam S, Sadek S, Steele E, Harper M, Nevin N, Dornan C. Transplacental early amniocentesis and pregnan- cy outcome. British Journal of Obstetrics and Gynaecology. 1998; 105(2): 228-230.
38. Zelig C, Knutzen D, Ennen C, Dolinsky B, Napolitano P. Chorionic Villus Sampling, Early Amniocentesis, and Ter- mination of Pregnancy Without Diagnostic Testing: Compa- rison of Fetal Risk Following Positive Non-invasive Prenatal Testing. J Obstet Gynaecol Can. 2016; 38(5): 441-445
39. Hanson F, Tennant F, Hune S, Brookhyser K. Early amnio- centesis: Outcome, risk, and technical problems at 12.8 wee- ksor less. Am. J. Obstet. Gynecol. 1992; 166: 1707-1711.
40. Sundberg K, Bang J, Smidt-Jensen S, Brocks V, Lundsteen C, Pamer J, and others. Randomised study of risk of fetal loss related to early amniocentesis versus chorionic villus sam- pling. Lancet. 1997; 350: 697-703.
41. Akolekar R, Beta J, Picciarelli G, Ogilvie C, D’Antonio F. Procedure-related risk of miscarriage following amniocente- sis and chorionic villus sampling: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015; 45: 16–26
42. Tara F, Lotfalizadeh M, Moeindarbari S. The effect of diag- nostic amniocentesis and its complications on early spon- taneous abortion. Electronic Physician. 2016; 8(8): 2787- 2792.
43. Ghi T, Sotiriadis A, Calda P, Da Silva Costa F, Raine-Fen- ning N, Alfirevic Z, McGillivray G, on behalf of the Interna- tional Society of Ultrasound in Obstetrics and Gynecology. ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis in obstetrics. Ultrasound Obstet Gynecol. 2016; 48: 256–268.
44. Firth H, Boyd P, Chamberlain P, Mackenzie I, Lindenbaum R, Huson S. Severe limb abnormalities after chorionic villus sampling at 56-66 days gestation. Lancet. 1991; 337: 762- 763.
45. Hoyme H, Jones K, Van Allen M, Saunders B, Benirschke K. Vascular pathogenesis of transverse limb reduction defects. J. Pediatr 1982; 101: 839-843.
46. Wapner, R. Amostragem do Vilo Coriónico. Clínicas Obs- tétricas e Ginecológicas da América do Norte. Diagnóstico e Tratamento Fetal. Reece E.A. Vol 1. Rio de Janeiro: Inter- livros; 1997.
47. Lochmiller C, Johnston D, Scott A,Risman N,Hecht T. Ge- netic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998; 79: 90–96.
48. Bernal Luz Mery, López Greizy. Diagnóstico prénatal: retros- pectiva. Nova. 2014; 12( 21 ): 23-36.
49. Márquez Gómez Marco Antonio, Gómez Díaz Graciela Ma- ría. Accidente ofídico en el departamento de Sucre, Colom- bia. Nova. 2015; 13( 24 ): 39-46.
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51. Corrales Lucia Constanza, Antolinez Romero Diana Mar- cela, Bohórquez Macías Johanna Azucena, Corredor Vargas Aura Marcela. Bacterias anaerobias: procesos que realizan y contribuyen a la sostenibilidad de la vida en el planeta. Nova. 2015; 13( 24 ): 55-81.
52. González Yuri Lilian. Evaluación de la percepción del riesgo ocupacional en trabajadores de una empresa del sector de la construcción en Bogotá D.C. Nova. 2015; 13( 23 ): 93-107.
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2. Reece E. Amniocentese genética precoce e nos trimestres intermediários. Segurança e resultados. Clínicas Obstétricas e Ginecológicas da América do Norte. Diagnostico e Trata- mento Fetal. Vol 1. Rio de Janeiro: Interlivros; 1997.
3. Eddleman K, Malone F, Sullivan L, Dukes K, Berkowitz R, Kharbutli Y, and others. Pregnancy loss rates after mi- dtrimester amniocentesis. Obstet Gynecol. 2006; 108(5): 1067–72.
4. Kong C, Leung T, Leung T, Chan L, Sahota D, Fung T, and others. Risk factors for procedure-related fetal losses after mid-trimester genetic amniocentesis. Prenat Diagn. 2006; 26(10): 925–30.
5. Anuwutnavin S, Chanprapaph P, Ruangvutilert P, Eammatta M, Tontisirin P. Short-term outcomes after second-trimester genetic amniocentesis in Siriraj Hospital. International Jour- nal of Gynecology and Obstetrics. 2014; 124: 222–225. doi: 10.1016/j.ijgo.2013.09.019.
6. Connolly K, Eddleman K. Amniocentesis: A contemporary review. World J Obstet Gynecol. 2016; 5(1): 58-65.
7. Bernal L. Evaluación de la amniocentesis precoz en una ins- titución brasileña de diagnóstico prenatal. NOVA. 2012; 10(17): 12-24.
8. Naccache N, GollopT, Auler-Bittencourt E, Vianna-Mor- gante A, Eigier A. Cytogenetic analysis of first trimester cho- rionic villi sampling. Rev. Brasil. Genet. 1987; 10: 277-287.
9. Gollop T, Pieri P, Naccache N, Auler-Bittencourt E, Eigier A, Hauschild D. Transabdominal Chorionic Villus Sampling: experience with 70 cases. Rev. Brasil. Genet. 1990; 13(3): 591-597.
10. Gollop T, Naccache N, Campos I, Fieri P. Amostra de Vilo Corial: 1.290 casos. Rev. Brasil. Ginecol. Obstet. 1993; 15(2): 84-87.
11. Cederholm M, Axelsson O. A prospective comparati- ve study on transabdominal chorionic villus sampling and amniocentesis performed at 10-13 weeks gestation. Prenat Diagn. 1997; 17(4): 311-317.
12. CEMAT, The Canadian Early and Mid-Trimester Amnio- centesis Trial Group. Randomised trial to asses safety and fetal outcome of early and midtrimester amniocentesis. Lan- cet. 1998; 351:242-247.
13. Al Ibrahim A, Zidan M, Obaidly S, Khenyab N, Al Jenahi N, Al Mansori Z, Bolushi M, and others. Early Amniocentesis: The Resurrection. Qatar Foundation Annual Research Con- ference Proceedings. 2016.
14. Gollop T, Eigier A, Vianna-Morgante A, Naccache, N. Cho- rionic villi sampling for early prenatal genetic diagnosis. Rev. Brasil. Genet.. 1986; 9: 381-385.
15. Nicolaides K, Brizot M, Patel F, Snijders R. Comparison of Chorion Villus Sampling and Early Amniocentesis for karyo- typing in 1492 singlenton preqnancies. Fetal. Diagn. Ther. 1996; 11: 9-15.
16. Chuet J, Goldberg J, Wohlferd M, Golbus M. Comparision of transcervical and transabdominal chorionic villus sam- pling loss rate in nine thousand from a single center. Am. J. Obstet. Gynecol. 1995; 173: 1277-1282.
17. Smidt-Jensen S, Permin M, Phillip J, Lundsteen, C, Zachary, J, Fowler S et al. Randomized comparison of amniocentesis and transabdominal and transcervical chorionis villus sam- pling. Lancet. 1992; 340: 1237-1244.
18. Brambati B, Terzian E, Tognoni G. Randomized clinical trial of transaddominal versus transcervical chorionic villus sam- pling methods. Prenat. Diagn. 1991; 11: 285 293.
19. Fortuny A, Borrell A, Soler A, Casals E, Costa D, Carrio A, and others. Chorionic villus sampling by forceps. Results of 1580 procedures from single centre. Prenat. Diagn. 1995; 15: 541-550.
20. Penso C, Sandstrom M, Garber M, Ladoulis M, Stryker J, Benacerraf, B. Early Amniocentesis: Report of 407 cases with neonatal follow-up. Obstet. Gynecol. 1990; 76: 1032-1036.
21. Sato K, Izuta M, Kojima T, Miyakawa T, Yokoo I, Takahashi K, and others. Early amniocentesis risk and laboratory eva- luation. Acta. Obstet. Gynaecol. Jpn. 1992; 44: 1285-1288.
22. Stripparo L, Buscaglia M, Longatti L, Ghisoni L, Dambrosio F, Guerneri, S, and others. Genetic amniocentesis: 505 ca- ses performed before the sixteenth week of gestation. Prenat. Diagn. 1990; 10: 359-364.
23. Bravo R, Schulman L, Phillips O. Transplacental needle pas- sage in early amniocentesis and pregnancy loss. Obstet. Gy- necol. 1995; 86: 437-440.
24. Johnson J, Wilson R, Winsor E, Singer J, Dansereau J, Ka- lousek, D. The Early Amniocentesis Study: A randomized clinical trial of early amniocentesis versus midtrimester am- niocentesis. Fetal. Diagn. Ther. 1996; 11: 85-93.
25. Elejalde B, de Elejalde M, Acuna J, Thelen D, Trujillo C, Karrmann M. Prospective study of amniocentesis performed between weeks 9 and 16 of gestation: Its feasibility, risks, complications and use in early genetic prenatal diaqnosis. Am. J. Med. Genet.. 1990; 35: 188-196.
26. Brumfield C, Lin S, Conner W, Cosper P, Davis R, Owen J. Pregnancy outcome following genetic amniocentesis at 11-14 versus 16 -19 weeks gestation. Obstet. Gynecol. 1996; 88(1): 114-118.
27. Eiben B, Hammans W, Hansen S, Trawicki W, Osthelder B, Stelzer A, and others. On the complication risk of Early Amniocentesis versus Standard Amniocentesis. Fetal. Diagn. Ther. 1997; 12: 140-144.
28. Daniel A, N, Kuah K, Reiha S, Malafiej P. A study of ear- ly amniocentesis for prenatal cytogenetic diagnosis. Prenat. Diagn. 1998; 18(1): 21-28.
29. Schulman L, Elias S, Simpson, J. Early amniocentesis: Com- plications in initial 150 cases compared to complication in initial 150 cases transabdominal chorionic villus sampling. Am. J. Human. Genet. 1991; 49: 231.
30. Nagel H, Vandenbussche F, Keirse M, Oepkes D, Oosterwijk J, Beverstock G, and others. Amniocentesis before 14 com- pleted weeks as an alternative to transabdominal chorionic villus sampling: A controlled trial with infant follow-up. Pre- nat Diagn. 1998; 18: 465-475.
31. Philip J, Silver R, Wilson R, Thom E, Zachary J, Mohide P, and others. Late First-Trimester Invasive Prenatal Diagnosis: Results of an International Randomized Trial.
Obstetrica and Gynecology. 2004; 103(6): 1164-117
32. Liu D, Jeavons B, Preston C, Pearson D. A prospective study of spontaneous miscarriage in intrasonically normal preg- nancies and relevance to chorionic villus sampling. Pnenat. Diagn. 1987; 7: 223-226.
33. Frates M, Benson C, Doubilet M. Pregnancy outcome after a first trimester sonogram demonstrating fetal cardiac activity. J. Ultrasound. Med. 1993; 12: 383-386.
34. Tharmaratnam S, Sadek S, Steele E, Harper M, Stewart F, Nevin J, and others. Early amniocentesis: Effect of removing a reduced volume of amniotic fluid on pregnancy outcome. Prenat. Diagn. 1998; 18:773-778.
35. Wulff C, Gerds T, Rode L, Ekelund C, Petersen O, Tabor A. Risk of fetal loss associated with invasive testing following combined first-trimester screening for Down syndrome: a national cohort of 147987 singleton pregnancies. Ultra- sound Obstet Gynecol. 2016; 47: 38-44.
36. Sundberg K, Jorgensen F, Bang J. Experience with early am- ncentesis. J Perinat Med. 1995; 23: 149-158.
37. Tharmaratnam S, Sadek S, Steele E, Harper M, Nevin N, Dornan C. Transplacental early amniocentesis and pregnan- cy outcome. British Journal of Obstetrics and Gynaecology. 1998; 105(2): 228-230.
38. Zelig C, Knutzen D, Ennen C, Dolinsky B, Napolitano P. Chorionic Villus Sampling, Early Amniocentesis, and Ter- mination of Pregnancy Without Diagnostic Testing: Compa- rison of Fetal Risk Following Positive Non-invasive Prenatal Testing. J Obstet Gynaecol Can. 2016; 38(5): 441-445
39. Hanson F, Tennant F, Hune S, Brookhyser K. Early amnio- centesis: Outcome, risk, and technical problems at 12.8 wee- ksor less. Am. J. Obstet. Gynecol. 1992; 166: 1707-1711.
40. Sundberg K, Bang J, Smidt-Jensen S, Brocks V, Lundsteen C, Pamer J, and others. Randomised study of risk of fetal loss related to early amniocentesis versus chorionic villus sam- pling. Lancet. 1997; 350: 697-703.
41. Akolekar R, Beta J, Picciarelli G, Ogilvie C, D’Antonio F. Procedure-related risk of miscarriage following amniocente- sis and chorionic villus sampling: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015; 45: 16–26
42. Tara F, Lotfalizadeh M, Moeindarbari S. The effect of diag- nostic amniocentesis and its complications on early spon- taneous abortion. Electronic Physician. 2016; 8(8): 2787- 2792.
43. Ghi T, Sotiriadis A, Calda P, Da Silva Costa F, Raine-Fen- ning N, Alfirevic Z, McGillivray G, on behalf of the Interna- tional Society of Ultrasound in Obstetrics and Gynecology. ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis in obstetrics. Ultrasound Obstet Gynecol. 2016; 48: 256–268.
44. Firth H, Boyd P, Chamberlain P, Mackenzie I, Lindenbaum R, Huson S. Severe limb abnormalities after chorionic villus sampling at 56-66 days gestation. Lancet. 1991; 337: 762- 763.
45. Hoyme H, Jones K, Van Allen M, Saunders B, Benirschke K. Vascular pathogenesis of transverse limb reduction defects. J. Pediatr 1982; 101: 839-843.
46. Wapner, R. Amostragem do Vilo Coriónico. Clínicas Obs- tétricas e Ginecológicas da América do Norte. Diagnóstico e Tratamento Fetal. Reece E.A. Vol 1. Rio de Janeiro: Inter- livros; 1997.
47. Lochmiller C, Johnston D, Scott A,Risman N,Hecht T. Ge- netic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998; 79: 90–96.
48. Bernal Luz Mery, López Greizy. Diagnóstico prénatal: retros- pectiva. Nova. 2014; 12( 21 ): 23-36.
49. Márquez Gómez Marco Antonio, Gómez Díaz Graciela Ma- ría. Accidente ofídico en el departamento de Sucre, Colom- bia. Nova. 2015; 13( 24 ): 39-46.
50. Pinilla B Gladys, Chavarro P Bibiana, Moreno A Natalia, Navarrete O Jeannette, Muñoz M Liliana. Determinación de los genes, 16S ADNr, polA, y TpN47, en la detección de Treponema pallidum subsp. pallidum para el diagnóstico de sífilis congénita. Nova. 2015; 13( 24 ): 17-25.
51. Corrales Lucia Constanza, Antolinez Romero Diana Mar- cela, Bohórquez Macías Johanna Azucena, Corredor Vargas Aura Marcela. Bacterias anaerobias: procesos que realizan y contribuyen a la sostenibilidad de la vida en el planeta. Nova. 2015; 13( 24 ): 55-81.
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