{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:40:26Z","timestamp":1793144426859,"version":"4.5.0"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T00:00:00Z","timestamp":1602547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T00:00:00Z","timestamp":1602547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the rate of fetal loss following amniocentesis or chorionic villus sampling (CVS) in twin pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MEDLINE, EMBASE and Cochrane databases were searched for studies reporting procedure\u2010related complications following amniocentesis or CVS in twin pregnancy. The primary outcome was the rate of procedure\u2010related fetal loss. The secondary outcomes were fetal loss occurring before 24\u2009weeks of gestation and fetal loss occurring within 4\u2009weeks after the procedure. Head\u2010to\u2010head meta\u2010analyses were used to compare directly each outcome, between women undergoing amniocentesis and those not undergoing amniocentesis and between women undergoing CVS and those not undergoing CVS, and to compute pooled risk differences (RD) between women exposed and those not exposed to each invasive procedure. Additionally, meta\u2010analyses of proportions were used to estimate the pooled rates of each of the three outcomes in women undergoing amniocentesis or CVS and in controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixteen studies (3419 twin pregnancies undergoing and 2517 not undergoing an invasive procedure) were included. Head\u2010to\u2010head meta\u2010analyses comparing directly twin pregnancies undergoing and those not undergoing amniocentesis showed a higher risk for overall fetal loss in those undergoing amniocentesis (odds ratio (OR), 1.46 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.04); RD, 0.013 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.04)), while there was no difference in the risk of either fetal loss before 24\u2009weeks of gestation (OR, 1.59 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.06); RD, 0.010 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.11)) or fetal loss within 4\u2009weeks after the procedure (OR, 1.38 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.3); RD, 0.003 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.8)). Overall, the pooled rate of fetal loss was 2.4% (95%\u2009CI, 1.4\u20133.6%) in twin pregnancies undergoing amniocentesis compared with 2.4% (95%\u2009CI, 0.9\u20134.6%) in those not undergoing amniocentesis. Head\u2010to\u2010head meta\u2010analyses directly comparing twin pregnancies undergoing and those not undergoing CVS showed no significant difference in either overall fetal loss (OR, 1.61 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.5); RD, 0.003 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.8)) or fetal loss before 24\u2009weeks of gestation (OR, 1.61 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.5); RD, 0.003 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.8)). Overall, the pooled rate of fetal loss was 2.0% (95%\u2009CI, 0.0\u20136.5%) in twin pregnancies undergoing CVS compared with 1.8% (95%\u2009CI, 0.3\u20134.2%) in those not undergoing CVS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The risk of fetal loss following amniocentesis and CVS in twins is lower than reported previously and the rate of fetal loss before 24\u2009weeks of gestation, or within 4\u2009weeks after the procedure, did not differ from the background risk in twin pregnancy not undergoing invasive prenatal testing. These data can guide prenatal counseling for twin pregnancies undergoing invasive procedures. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.22143","type":"journal-article","created":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T02:24:20Z","timestamp":1594088660000},"page":"647-655","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Risk of fetal loss following amniocentesis or chorionic villus sampling in twin pregnancy: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6560-3393","authenticated-orcid":false,"given":"D.","family":"Di Mascio","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health and Urological Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London UK"},{"name":"Vascular Biology Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5525-4353","authenticated-orcid":false,"given":"G.","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Division of Maternal and Fetal Medicine Ospedale Cristo Re, University of Rome Tor Vergata  Rome Italy"},{"name":"Department of Obstetrics and Gynecology The First I.M. Sechenov Moscow State Medical University  Moscow Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6880-7407","authenticated-orcid":false,"given":"D.","family":"Buca","sequence":"additional","affiliation":[{"name":"Center for Fetal Care and High\u2010Risk Pregnancy, Department of Obstetrics and Gynecology University of Chieti  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Liberati","sequence":"additional","affiliation":[{"name":"Center for Fetal Care and High\u2010Risk Pregnancy, Department of Obstetrics and Gynecology University of Chieti  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. A.","family":"Martellucci","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health University of the Marche Region  Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. E.","family":"Flacco","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences University of Ferrara  Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Manzoli","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences University of Ferrara  Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5178-3354","authenticated-orcid":false,"given":"F.","family":"D'Antonio","sequence":"additional","affiliation":[{"name":"Center for Fetal Care and High\u2010Risk Pregnancy, Department of Obstetrics and Gynecology University of Chieti  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15945"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20353"},{"key":"e_1_2_7_4_1","article-title":"Practice bulletin no. 169: multifetal gestations: twin, triplet, and higher\u2010order multifetal pregnancies","volume":"128","author":"Hayes EJ","year":"2016","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20100"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13613"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20357"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19179"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10152"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5502"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurox.2019.100051"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1797.2010.01380.x"},{"key":"e_1_2_7_13_1","unstructured":"NHS Centre for Reviews and Dissemination. 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