141: CVS loss and complication rates: operator dependent factors

ObjectiveTo examine whether operator related factors affect procedure related loss and complication rates for CVS.Study DesignBoth transabdominal (TA) and transcervical (TC) CVS were performed according to operator preference at the time of the procedure. TC CVS were performed using fine biopsy forceps and TA CVS were performed using a 20G to 18G single needle technique. Procedure-related losses (PRL) were defined as unintentional losses within 28 days who had a normal CVS result, no identified fetal anomalies and no pre-existing pregnancy complications. A procedure related complication (PRC) was defined as PPROM, intrauterine hematoma post procedure, and/or persistent vaginal bleeding for at least 7 days post procedure. Intentional losses, where a PRC led to the decision for a termination were included as PRL. Cases were reviewed in a blinded fashion by the CVS team members for inclusion as a PRL or PRC. Total complications (Tcmx) were defined as PRL and PRC. Operator factors examined were a) participation of MFM trainee, b) # of procedures performed per annum and c) Operator use of one or both CVS techniques.ResultsOutcomes of 1001 of 1035 (97%) CVS procedures were available for analysis and these were performed by 7 procedurists during this time. The participation of trainees did not correlate with increased PRL/Tcmx rates. Procedurists who performed both TA and TC CVS had lower overall CVS PRL (1.3%, p=0.006) and Tcmx rates (2.6%, p=0.004) than procedurists who performed only TC CVS (PRL =4.4%, Tcmx =7.1%). Procedurists who performed both TC and TA CVS had a trend towards lower PRL (2.1%, p=0.05) and Tcmx (3.5%, p=0.09) rates when performing TC CVS than those who performed only TC CVS. When procedurists did 10 or less CVS per year, the PRL and Tcmx rate were 6.9 and 9.2% respectively which is signifcantly more than when > 10/yr are performed (PRL 1.5%, p<0.01; Tcmx 3.0%, p<0.01).ConclusionCVS appears to be safer when operators perform more procedures per year and when they perform both TA and TC CVS rather than TC alone. ObjectiveTo examine whether operator related factors affect procedure related loss and complication rates for CVS. To examine whether operator related factors affect procedure related loss and complication rates for CVS. Study DesignBoth transabdominal (TA) and transcervical (TC) CVS were performed according to operator preference at the time of the procedure. TC CVS were performed using fine biopsy forceps and TA CVS were performed using a 20G to 18G single needle technique. Procedure-related losses (PRL) were defined as unintentional losses within 28 days who had a normal CVS result, no identified fetal anomalies and no pre-existing pregnancy complications. A procedure related complication (PRC) was defined as PPROM, intrauterine hematoma post procedure, and/or persistent vaginal bleeding for at least 7 days post procedure. Intentional losses, where a PRC led to the decision for a termination were included as PRL. Cases were reviewed in a blinded fashion by the CVS team members for inclusion as a PRL or PRC. Total complications (Tcmx) were defined as PRL and PRC. Operator factors examined were a) participation of MFM trainee, b) # of procedures performed per annum and c) Operator use of one or both CVS techniques. Both transabdominal (TA) and transcervical (TC) CVS were performed according to operator preference at the time of the procedure. TC CVS were performed using fine biopsy forceps and TA CVS were performed using a 20G to 18G single needle technique. Procedure-related losses (PRL) were defined as unintentional losses within 28 days who had a normal CVS result, no identified fetal anomalies and no pre-existing pregnancy complications. A procedure related complication (PRC) was defined as PPROM, intrauterine hematoma post procedure, and/or persistent vaginal bleeding for at least 7 days post procedure. Intentional losses, where a PRC led to the decision for a termination were included as PRL. Cases were reviewed in a blinded fashion by the CVS team members for inclusion as a PRL or PRC. Total complications (Tcmx) were defined as PRL and PRC. Operator factors examined were a) participation of MFM trainee, b) # of procedures performed per annum and c) Operator use of one or both CVS techniques. ResultsOutcomes of 1001 of 1035 (97%) CVS procedures were available for analysis and these were performed by 7 procedurists during this time. The participation of trainees did not correlate with increased PRL/Tcmx rates. Procedurists who performed both TA and TC CVS had lower overall CVS PRL (1.3%, p=0.006) and Tcmx rates (2.6%, p=0.004) than procedurists who performed only TC CVS (PRL =4.4%, Tcmx =7.1%). Procedurists who performed both TC and TA CVS had a trend towards lower PRL (2.1%, p=0.05) and Tcmx (3.5%, p=0.09) rates when performing TC CVS than those who performed only TC CVS. When procedurists did 10 or less CVS per year, the PRL and Tcmx rate were 6.9 and 9.2% respectively which is signifcantly more than when > 10/yr are performed (PRL 1.5%, p<0.01; Tcmx 3.0%, p<0.01). Outcomes of 1001 of 1035 (97%) CVS procedures were available for analysis and these were performed by 7 procedurists during this time. The participation of trainees did not correlate with increased PRL/Tcmx rates. Procedurists who performed both TA and TC CVS had lower overall CVS PRL (1.3%, p=0.006) and Tcmx rates (2.6%, p=0.004) than procedurists who performed only TC CVS (PRL =4.4%, Tcmx =7.1%). Procedurists who performed both TC and TA CVS had a trend towards lower PRL (2.1%, p=0.05) and Tcmx (3.5%, p=0.09) rates when performing TC CVS than those who performed only TC CVS. When procedurists did 10 or less CVS per year, the PRL and Tcmx rate were 6.9 and 9.2% respectively which is signifcantly more than when > 10/yr are performed (PRL 1.5%, p<0.01; Tcmx 3.0%, p<0.01). ConclusionCVS appears to be safer when operators perform more procedures per year and when they perform both TA and TC CVS rather than TC alone. CVS appears to be safer when operators perform more procedures per year and when they perform both TA and TC CVS rather than TC alone.