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作者报导了在1,000名病人所做1,061次穿刺的结果。主要指征:染色体核型占84.3％,其中为探查染色体异常(79.6％)比作性别诊断者(4.7％)占得较多;酶测定诊断代谢性疾病占5,9％,甲胎蛋白测定9.8％,几乎都是为确定神经管闭合不全(98例中占91例)。作者叙述了他们的操作程序:遗传谘询,手术者亲自作产科检查,穿刺当天或前三天做一次质量好的超声显象图,熟练的术者,严密消毒,在妊娠17周同时宫高达12厘米以上时穿刺,排空膀胱,每次操作只限穿刺两次。作者详述了在20例双胎妊娠的穿刺技术:超声显象,在两个羊膜囊其中之一注入有色物质。按上述规程,很少意外:第一次穿刺失败率1.8％,第二次穿刺无一例失败。抽出羊水完全呈血性者1.7％,呈粉红色者3.8％。第一次穿刺培养失败者2.8％,而第二次穿刺培养无失败。最后培养失败的3例是由于没有重新穿刺。再次穿刺有时是当时再做(9.4％),也可以隔一段时间再做(4.8％)。妊娠的演进一部份依指征而定。作者报导的自然流产有17例占1.7％,其中只有6例可能归咎于羊膜腔穿刺(0.6％)。围产儿死亡率1.8％,包括死产1.2％,。出生死亡0.6％。胎儿病率轻微:无一例损伤,早产仅1.6％,不同程度的畸形(2.6％),其中4例先天性髋关节脱臼(0.45％)。母体病率只限于剖腹产数有所上升:占21％,主要由于产妇年龄较大(30％年龄在40岁或40岁以上)。由于严格采取了预防措施,因此与其他报导不同,本组无一例母婴猕因子(Rh)免疫。中止妊娠的百分率为4.6％,作者已经放弃使用高渗盐水羊膜腔内注射引产,而是改用颈管内输入前列腺素。本组无一例误诊(准确率100％)。1974年曾收集了三位不同医院的妇产科医生的经验,并报导了201名病人所作205次穿刺的结果,第一次发表了“早期羊膜腔穿刺”。到1978年11月,只在一个中心就已为1,000名病人作了1,061次穿刺。我们已经积累了足够的经验,并在这方面有所创新,似乎应该及时发表第二篇报导,尤其是美国皇家妇产科学院最近发表了对早期羊膜腔穿刺的安全性表示持保留态度的时候,更应及时发表。
The authors reported the results of 1,061 punctures done in 1,000 patients. The main indications: chromosome karyotype accounted for 84.3%, of which chromosomal abnormalities (79.6%) accounted for more than for gender diagnoses (4.7%) accounted for more; metabolic assay metabolic disease accounted for 5,9%, alpha-fetoprotein assay 9.8%, almost all to determine neural tube insufficiency (98 cases, 91 cases). The authors described their procedures: genetic counseling, the surgeon personally conducted obstetric examination, puncture the day or the first three days to do a good quality ultrasound imaging, skilled surgeon, close disinfection at 17 weeks of gestation at the same time up to the Palace Puncture 12 cm or more, empty the bladder, puncture only twice per operation. The author details the puncture technique in 20 cases of twin pregnancy: sonographic imaging, injecting colored material into one of two amniotic sacs. Accordance with the above rules, few accidents: the first puncture failure rate of 1.8%, the second puncture without failure. Out of amniotic fluid was completely bloody 1.7% pink 3.8%. The first puncture failed to cultivate 2.8%, while the second puncture culture failed. The last three failed cases were due to no re-puncture. Puncturing is sometimes done again at that time (9.4%) and can be done at intervals (4.8%). Part of the evolution of pregnancy depends on the indication. The authors report 17 cases of spontaneous abortion accounted for 1.7%, of which only 6 cases may be attributed to amniocentesis (0.6%). The perinatal mortality rate was 1.8%, including 1.2% of stillbirths. 0.6% of births died. Fetal morbidity was mild with no injury, premature birth was only 1.6%, varying degrees of deformity (2.6%), of which 4 were congenital dislocation of the hip (0.45%). Maternal prevalence was limited to caesarean sections only: 21%, mainly due to older males (30% aged 40 or over). Due to strict precautions, unlike other reports, there was no case of maternal Rhinosin (Rh) immunity in this group. The percentage of pregnancies discontinued was 4.6%. The authors have abandoned the use of hypertonic saline for intra-amniotic injection of abortion but switched to prostaglandin in the neck. No case of misdiagnosis in this group (accuracy rate of 100%). In 1974, the experience of gynecologists in three different hospitals was collected and the results of 205 punctures in 201 patients were reported. For the first time, “early amniocentesis” was published. By November 1978, 1,061 punctures had been made to 1,000 patients in only one center. We have accumulated enough experience and innovation in this regard, it seems that the second report should appear promptly, especially when the Royal College of Obstetricians and Gynecologists recently published a reservation on the safety of early amniocentesis, More timely publication.