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Marion S. Verp - One of the best experts on this subject based on the ideXlab platform.
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A Cost-effectiveness Analysis of Amniocentesis and Chorionic Villus Sampling for Prenatal Genetic Testing
Medical care, 1994Co-Authors: Paul S. Heckerling, Marion S. VerpAbstract:Amniocentesis and Chorionic Villus Sampling are tests for the prenatal diagnosis of cytogenetic abnormalities. We calculated the incremental costs per abnormal birth averted, and the incremental costs per quality-adjusted outcome, of amniocentesis and Chorionic Villus Sampling performed for the indication of maternal age. Probabilities were obtained from the literature, and direct medical costs from hospital charges deflated to reflect aggregated contracted care reimbursements. Utilities were used to quality-adjust prenatal testing outcomes. Based on costs per abnormal birth averted, at all maternal ages from 30 to 43 years, amniocentesis was more cost-effective than Chorionic Villus Sampling; at ages 44 and 45, Chorionic Villus Sampling was more cost-effective. However, if the anxiety reduction provided by first-trimester diagnosis was equivalent to a 0.2% risk of an abnormal child, Chorionic Villus Sampling was more cost-effective than amniocentesis at all maternal ages. Based on data from the 1988 United States natality cohort, the current policy of testing women aged 35 and older would cost $103,329 and $111,184 per abnormal birth averted for amniocentesis and Chorionic Villus Sampling, respectively. Testing women aged 30 and older would almost double these costs. For either prenatal test, targeting high risk women for testing, and striving for utilization rates of 50% or higher, appeared to be the most cost-effective policy.
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Amniocentesis or Chorionic Villus Sampling for prenatal genetic testing: A decision analysis
Journal of clinical epidemiology, 1991Co-Authors: Paul S. Heckerling, Marion S. VerpAbstract:We used decision analysis to examine the strategies of amniocentesis, Chorionic Villus Sampling, and no prenatal testing for a pregnant woman who would be 35 years of age at the expected date of delivery. Probabilities were obtained from the obstetric and genetic literature, and utilities from previously published standard reference gambles and from responses of obstetric residents and students recorded on a linear rating scale. The expected utility of amniocentesis exceeded that of Chorionic Villus Sampling by 0.1 utility units, and of no prenatal testing by 0.12 utility units. The decision was insensitive to clinically plausible values for the probabilities of spontaneous abortion after amniocentesis and Chorionic Villus Sampling, the probabilities of abnormal and indeterminate Chorionic Villus Sampling results, the probability of an abnormal amniocentesis result after an indeterminate Chorionic Villus Sampling, the sensitivities and specificities of amniocentesis and Chorionic Villus Sampling, and the probabilities of significant maternal morbidity after first- and second-trimester therapeutic abortion. Chorionic Villus Sampling was preferred to amniocentesis when the utility of a first-trimester therapeutic abortion exceeded that of a second-trimester abortion by 23.2 utility units, or when the anxiety "cost" of awaiting second-trimester amniocentesis results exceeded 0.1 utility unit. We conclude that over a range of assumptions concerning the probabilities involved in the prenatal testing decision, amniocentesis was preferred to Chorionic Villus Sampling. However, for a decision maker for whom a second-trimester therapeutic abortion would be significantly less acceptable than a first-trimester procedure, or for whom the anxiety of awaiting second-trimester chromosomal diagnosis might be an important consideration, Chorionic Villus Sampling could become the procedure of choice.
Paul S. Heckerling - One of the best experts on this subject based on the ideXlab platform.
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A Cost-effectiveness Analysis of Amniocentesis and Chorionic Villus Sampling for Prenatal Genetic Testing
Medical care, 1994Co-Authors: Paul S. Heckerling, Marion S. VerpAbstract:Amniocentesis and Chorionic Villus Sampling are tests for the prenatal diagnosis of cytogenetic abnormalities. We calculated the incremental costs per abnormal birth averted, and the incremental costs per quality-adjusted outcome, of amniocentesis and Chorionic Villus Sampling performed for the indication of maternal age. Probabilities were obtained from the literature, and direct medical costs from hospital charges deflated to reflect aggregated contracted care reimbursements. Utilities were used to quality-adjust prenatal testing outcomes. Based on costs per abnormal birth averted, at all maternal ages from 30 to 43 years, amniocentesis was more cost-effective than Chorionic Villus Sampling; at ages 44 and 45, Chorionic Villus Sampling was more cost-effective. However, if the anxiety reduction provided by first-trimester diagnosis was equivalent to a 0.2% risk of an abnormal child, Chorionic Villus Sampling was more cost-effective than amniocentesis at all maternal ages. Based on data from the 1988 United States natality cohort, the current policy of testing women aged 35 and older would cost $103,329 and $111,184 per abnormal birth averted for amniocentesis and Chorionic Villus Sampling, respectively. Testing women aged 30 and older would almost double these costs. For either prenatal test, targeting high risk women for testing, and striving for utilization rates of 50% or higher, appeared to be the most cost-effective policy.
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Amniocentesis or Chorionic Villus Sampling for prenatal genetic testing: A decision analysis
Journal of clinical epidemiology, 1991Co-Authors: Paul S. Heckerling, Marion S. VerpAbstract:We used decision analysis to examine the strategies of amniocentesis, Chorionic Villus Sampling, and no prenatal testing for a pregnant woman who would be 35 years of age at the expected date of delivery. Probabilities were obtained from the obstetric and genetic literature, and utilities from previously published standard reference gambles and from responses of obstetric residents and students recorded on a linear rating scale. The expected utility of amniocentesis exceeded that of Chorionic Villus Sampling by 0.1 utility units, and of no prenatal testing by 0.12 utility units. The decision was insensitive to clinically plausible values for the probabilities of spontaneous abortion after amniocentesis and Chorionic Villus Sampling, the probabilities of abnormal and indeterminate Chorionic Villus Sampling results, the probability of an abnormal amniocentesis result after an indeterminate Chorionic Villus Sampling, the sensitivities and specificities of amniocentesis and Chorionic Villus Sampling, and the probabilities of significant maternal morbidity after first- and second-trimester therapeutic abortion. Chorionic Villus Sampling was preferred to amniocentesis when the utility of a first-trimester therapeutic abortion exceeded that of a second-trimester abortion by 23.2 utility units, or when the anxiety "cost" of awaiting second-trimester amniocentesis results exceeded 0.1 utility unit. We conclude that over a range of assumptions concerning the probabilities involved in the prenatal testing decision, amniocentesis was preferred to Chorionic Villus Sampling. However, for a decision maker for whom a second-trimester therapeutic abortion would be significantly less acceptable than a first-trimester procedure, or for whom the anxiety of awaiting second-trimester chromosomal diagnosis might be an important consideration, Chorionic Villus Sampling could become the procedure of choice.
Mitchell S. Golbus - One of the best experts on this subject based on the ideXlab platform.
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Comparison of transcervical and transabdominal Chorionic Villus Sampling loss rates in nine thousand cases from a single center
American journal of obstetrics and gynecology, 1995Co-Authors: Jane T. Chueh, James D. Goldberg, Monica M. Wohlferd, Mitchell S. GolbusAbstract:Abstract OBJECTIVES: Our purposes were (1) to compare the safety of transabdominal and transcervical Chorionic Villus Sampling with the use of a consistent technique at one center and (2) to determine whether the training of fellows can be accomplished without an increase in the loss rate. STUDY DESIGN: We performed a retrospective comparison of transabdominal and transcervical Chorionic Villus Sampling loss rates from procedures performed by three principal operators between 1984 and 1992. The type of procedure was chosen by the operator at the time of the procedure on the basis of placental location. RESULTS: Procedures 1 through 2573 were performed solely by transcervical Chorionic Villus Sampling and had an overall fetal loss rate 5.12%. With the addition of transabdominal Chorionic Villus Sampling the overall fetal loss rate dropped to 3.07% p p = 0.035), and the difference widened steadily after that. During the same time period seven fellows performed 716 procedures for a fetal loss rate among fellows of 2.72%. CONCLUSIONS: (1) Under optimal circumstances (one center, large numbers, few operators, consistent technique, operator choice of best approach), transabdominal Chorionic Villus Sampling may be inherently safer than transcervical Chorionic Villus Sampling. (2) The addition of transabdominal Chorionic Villus Sampling decreases overall Chorionic Villus Sampling loss rates. (3) Although the number of procedures performed by fellows is small, it appears that with close supervision by experienced operators successfull training of fellows can be accomplished without adverse effects on loss rates.
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A Randomized Comparison of Transcervical and Transabdominal Chorionic-Villus Sampling
The New England journal of medicine, 1992Co-Authors: Laird G. Jackson, David H Ledbetter, Joe Leigh Simpson, Mitchell S. Golbus, Julia Zachary, Sarah E. Fowler, Robert J. Desnick, Maurice J. Mahoney, Eugene Pergament, Susan H. BlackAbstract:Abstract Background. Chorionic-Villus Sampling is done in early pregnancy to obtain fetal cells for the prenatal diagnosis of genetic and chromosomal defects. Transcervical Chorionic-Villus Sampling has been shown to be safe and effective in national trials. Recently, an alternative transabdominal technique has been suggested as potentially easier and safer. Methods. From April 1987 through September 1989, we prospectively compared transcervical and transabdominal Chorionic-Villus Sampling in 3999 women with singleton pregnancies in whom the risk of a genetically abnormal fetus was increased. Women between 7 and 12 weeks of gestation underwent ultrasonographic evaluation of placental and uterine position. Those with active vaginal infections, active bleeding, or cervical polyps were excluded. If the obstetrician thought either Sampling procedure was acceptable, the woman was asked to consent to random assignment to one of the two procedures. Both groups were followed to determine the outcome of pregnancy ...
Ronald J. Wapner - One of the best experts on this subject based on the ideXlab platform.
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Revisiting the challenges of training Maternal Fetal Medicine fellows in Chorionic Villus Sampling.
American journal of obstetrics and gynecology, 2016Co-Authors: Barrie Suskin, Anthony M. Sciscione, Nickolas Teigen, Thomas C. Jenkins, Ronald J. Wapner, Anthony R. Gregg, Susan J. Gross, Komal BajajAbstract:Background More than a decade ago, researchers described a survey of Maternal Fetal Medicine fellows that showed that Chorionic Villus Sampling training was limited for Maternal Fetal Medicine fellows in the United States. Prenatal screening and diagnosis have rapidly evolved since then and include the introduction of noninvasive aneuploidy screening that uses cell-free fetal DNA. Yet, Chorionic Villus Sampling remains the only method available for first-trimester genetic diagnosis. Objective This study evaluated the Chorionic Villus Sampling training of Maternal Fetal Medicine fellows with respect to availability, competency standards, and education methods. Study Design In November 2015, an electronic survey was sent to Maternal Fetal Medicine fellows and fellowship directors of accredited Maternal Fetal Medicine fellowship programs in the United States. Results Fifty-eight percent of fellows (179/310) and 46% of program directors (35/76) responded. Ninety-five percent of Maternal Fetal Medicine fellows think that invasive diagnostic testing is essential to their training; 100% of fellows have amniocentesis training; and 65% have Chorionic Villus Sampling training. The median number of Chorionic Villus Sampling procedures that are expected during a fellowship in those who trained was 10. Eighty-eight percent of fellows and 89% of program directors state that Chorionic Villus Sampling training could be better; 89% of fellows and 97% of directors would like access to simulated models. Barriers to training included lack of patients (71%) and lack of proficient attending supervisors (43%). Conclusion Since the last survey, >10 years ago, Chorionic Villus Sampling training has declined further. A decrease in the number of procedures that are performed is the leading barrier to this training.
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First trimester prenatal diagnosis: Chorionic Villus Sampling
Seminars in perinatology, 1999Co-Authors: Thomas M. Jenkins, Ronald J. WapnerAbstract:Chorionic Villus smapling has been used successfully for first trimester diagnosis of genetic disorders for over 14 years. When performed between 10 and 14 weeks' gestation, it is both safe and effective in the diagnosis of fetal chromosomal, biochemical, and molecular disorders, with risks comparable to those of second trimester amniocentesis. Cytogenetic results have been confirmed to be reliable and accurate. Although confined placental mosaicism occurs in approximately 1% of cases requiring interpretation, and occasionally additional invasive testing, its finding adds additional information about perinatal outcome and can alert the practitioner to fetal genetic disorders. Earlier concerns about procedure-induced limb defects have been reduced with the accumulation of additional data, showing minimal to no risk when Chorionic Villus Sampling is performed after 70 days of gestation. In experienced hands, it may be the procedure of choice for Sampling multiple gestations. Secondary to the advantage of safe, early diagnosis, Chorionic Villus Sampling appears to be the optimal choice for first trimester testing.
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Ultrasonographically guided intrauterine contraceptive device removal before Chorionic Villus Sampling.
American journal of obstetrics and gynecology, 1995Co-Authors: Angela C. Ranzini, Ronald J. Wapner, George DavisAbstract:Abstract OBJECTIVE: Management of a retained intrauterine contraceptive device with no visible string during early pregnancy presents a dilemma. Because these devices are frequently used by multiparous women, it is not unusual that many women with retained devices are also of advanced maternal age. We describe our experience with ultrasonographically guided first-trimester retrieval of an intrauterine contraceptive device in conjunction with Chorionic Villus Sampling. STUDY DESIGN: Patients with a first-trimester pregnancy and a retained intrauterine contraceptive device where no string was visible were offered ultrasonographically guided retrieval of the device. If the patient had genetic risks and desired prenatal diagnosis, Chorionic Villus Sampling was offered at the same office visit. RESULTS: Six patients underwent intrauterine contraceptive device retrieval, under continuous ultrasonographic guidance, by use of an intrauterine contraceptive device hook. All patients had a posterior or fundal device. One patient had two in situ: a Lippes Loop (Ortho Pharmaceutical Corp., Raritan, N.J.) removed by its string and a Cu-7 (G.D. Searle & Co., Chicago) removed under ultrasonographic guidance. The remaining five patients had a Cu-7. Four of six patientss had Chorionic Villus Sampling performed immediately after the intrauterine contraceptive device removal and one patient had Chorionic Villus Sampling 3 weeks later. There were two losses in our series: one after a lengthy procedure and one before documented viability. All infants were structurally normal and born at term. CONCLUSION: First-trimester ultrasonographically guided retrieval of a retained intrauterine contraceptive device may be safely performed in conjunction with Chorionic Villus Sampling.
Laird G. Jackson - One of the best experts on this subject based on the ideXlab platform.
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Chorionic Villus Sampling safety report of world health organization euro meeting in association with the seventh international conference on early prenatal diagnosis of genetic diseases tel aviv israel may 21 1994
American Journal of Obstetrics and Gynecology, 1996Co-Authors: Anver Kuliev, Joe Leigh Simpson, Laird G. Jackson, Norman Ginsberg, Yury Verlinsky, Ursula Froster, B Brambati, Steen Smidtjensen, Haim ZakutAbstract:Accumulated experience of 138,996 cases of Chorionic Villus Sampling shows that Chorionic Villus Sampling is a safe procedure with an associated fetal loss rate comparable to that of amniocentesis. The Chorionic Villus Sampling registry shows that Chorionic Villus Sampling is currently performed primarily between 9 and 12 weeks' gestation and carried no increased risk of limb reduction defects: the overall incidence of limb reduction defects after Chorionic Villus Sampling is 5.2 to 5.7 per 10,000, compared with 4.8 to 5.97 per 10,000 in the general population. Analysis of the pattern distribution of limb defects after Chorionic Villus Sampling revealed no difference from the pattern in the general population. This applies specifically to transverse limb defects. Together with the overall incidence of limb reduction defects, these data provide no evidence for any risk for congenital malformation determined by Chorionic Villus Sampling. Because Chorionic Villus Sampling is currently performed generally after 8 completed weeks of pregnancy, few data are available for analysis of complications related to earlier procedures. Avoiding early Chorionic Villus Sampling also excludes Sampling in cases of early fetal death, which can be diagnosed reliably by ultrasonography at 9 weeks of pregnancy.
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A Randomized Comparison of Transcervical and Transabdominal Chorionic-Villus Sampling
The New England journal of medicine, 1992Co-Authors: Laird G. Jackson, David H Ledbetter, Joe Leigh Simpson, Mitchell S. Golbus, Julia Zachary, Sarah E. Fowler, Robert J. Desnick, Maurice J. Mahoney, Eugene Pergament, Susan H. BlackAbstract:Abstract Background. Chorionic-Villus Sampling is done in early pregnancy to obtain fetal cells for the prenatal diagnosis of genetic and chromosomal defects. Transcervical Chorionic-Villus Sampling has been shown to be safe and effective in national trials. Recently, an alternative transabdominal technique has been suggested as potentially easier and safer. Methods. From April 1987 through September 1989, we prospectively compared transcervical and transabdominal Chorionic-Villus Sampling in 3999 women with singleton pregnancies in whom the risk of a genetically abnormal fetus was increased. Women between 7 and 12 weeks of gestation underwent ultrasonographic evaluation of placental and uterine position. Those with active vaginal infections, active bleeding, or cervical polyps were excluded. If the obstetrician thought either Sampling procedure was acceptable, the woman was asked to consent to random assignment to one of the two procedures. Both groups were followed to determine the outcome of pregnancy ...