Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"

Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018

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Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 289 - 292

The Outcome of Amniocentesis at 14 Weeks of Gestation

Latika Narang, Alexandra Sawyer, Vaishali Garg, Onome Ogueh

PARTI CULARS OF CONTRIBUTORS: 1. MRCOG; Brighton and Sussex University Hospitals NHS trust, 2. MSc; School of Psychology; University of Sussex, 3. MRCOG; Brighton and Sussex University Hospitals NHS Trust, 4. MRCOG; Brighton and Sussex University Hospitals NHS Trust, NAME OF DEPARTME NT(S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRI BUTED: Department of Obstetrics and Gynaecology Princess Royal Hospital, Brighton and Sussex University Hospital NHS Trust.

Correspondence Address :
Dr. Latika Narang; 158,Winkworth Road, Banstead,
Surrey; SM7 2QT
Phone: 07961055723


Objective: To compare the safety and efficacy of amniocentesis at 14 weeks of gestation with amniocentesis at ≥15 weeks and chorionic villous sampling.

Method: This was a retrospective study of the pregnancy outcome of 299 women who underwent invasive prenatal diagnosis by using amniocentesis at 14 weeks of gestation, amniocentesis at ≥15 weeks of gestation and chorionic villous sampling. We compared the pregnancy outcomes and the complications in the 3 groups by using the Pearson’s χ2 test or the Fisher’s exact test.

Results: There was no significant difference between the women who underwent amniocentesis at 14 weeks of gestation and those who underwent amniocentesis at ≥ 15 weeks of gestation or chorionic villous sampling in terms of failed cultures, miscarriage, preterm pre-labour, rupture of membranes, preterm delivery and neonatal respiratory complications (p > 0.05).

Conclusion: Amniocentesis at 14 weeks of gestation is as safe as amniocentesis at ≥ 15 weeks of gestation and chorionic villous sampling.


Amniocentesis, 14 weeks gestation

In the last 20 years, the techniques for the early and accurate diagnosis of foetal disorders have undergone rapid development. The finding of free foetal nucleic acids in the maternal plasma has made it possible to undertake non-invasive prenatal diagnoses (1), (2). However, the techniques for non-invasive prenatal diagnoses are still at the experimental stage, and the only way for making an accurate prenatal diagnosis is by analyzing the foetal cells from the amniotic fluid and the placenta (chorionic villi), or fetal blood. Thus, the principal means by which foetal cells can be obtained for prenatal diagnosis is by amniocentesis, chorionic villous sampling (CVS), and foetal blood sampling. Bevis ushered in the modern era of diagnostic amniocentesis with his report of the technique in 1952 (3), and Liley first demonstrated its utility in the clinical practice in 1961 (4). Amniocentesis is the most commonly performed invasive test for the prenatal diagnosis of genetic disease (5), and it is normally performed between 15 and 18 weeks of gestation. A major disadvantage of the second trimester amniocentesis is that a final result is usually available only after 18 weeks of gestation. This can be very distressing for couples, particularly because it may mean a late termination of pregnancy with the associated increased risks. The alternative earlier options include CVS and early amniocentesis.

Chorionic villus sampling was developed during the 1980s and it is currently the preferred invasive technique in the first trimester of pregnancy. It can be performed from 10 weeks of gestation and it involves the ultrasound guided aspiration of the placental tissue by using either the percutaneous trans-abdominal route, or the trans-vaginal/ trans-cervical approach (6). The choice of this approach depends on the operator’s training and experience. Chorionic villous sampling is technically more difficult and it requires more training and expertise than amniocentesis. It also has the disadvantagesSectionof a significantly higher miscarriage rate than with mid-trimester amniocentesis, an increased risk of placental mosaicism and contamination with maternal tissue. A higher rate of hypertension/pre-eclampsia has been observed in association with CVS (7),(8). Early amniocentesis (9 to 14 weeks of gestation), which was introduced in the late 1980s, is technically the same as the latter procedure. The major concern with early amniocentesis is the increased risk of miscarriage, as well as orthopaedic foot deformities and respiratory disturbances at birth (5),(9),(10). However, most of these studies considered procedures which were performed before 14 weeks of gestation. Therefore, the aim of this study was to compare the pregnancy outcome following amniocentesis at 14 weeks of gestation with the pregnancy outcome following later amniocentesis and CVS.

Material and Methods

This was a retrospective study of women who underwent invasive prenatal diagnostic procedures in a UK District General Hospital in the four year period from February 2003 to January 2007. Three hundred and twenty five women were identified from the computer database, but the medical records were available for only 299 of them, who formed the study group. All the procedures were performed by OO. All these women were offered and they underwent nuchal translucency evaluation (NT) between 11 and 13+6 weeks of gestation. Two of the women were too advanced in pregnancy for the NT and underwent second trimester biochemistry screening, that gave then a Down’s syndrome risk of > 1:250. The indications for the invasive prenatal diagnostic tests were the NT adjusted risk for Down’s syndrome of >1:300, advanced maternal age of >37 years, maternal anxiety and a previous history of a chromosomal or genetic abnormality (Table/Fig 1). The others had the indications of ultrasonic markers of a chromosomal abnormalitya second trimester biochemistry Down’s syndrome screening risk of > 1:250 and exposure to chickenpox. The complications of invasive prenatal testing and pregnancy outcome as was compared between the 3 groups, included failed procedures, failed cultures, amniotic fluid leakage, blood stained liquor, vaginal bleeding, miscarriage within 1 week of the procedure, miscarriage at < 24 weeks of gestation, preterm, pre-labour rupture of the membranes, preterm delivery and neonatal respiratory complications. Statistical analysis was performed by using SPSS, version 15.0. The three groups of women were compared by using the Pearson χ² test or the Fisher’s exact test when the conditions for the former were not met. When a significant difference was found in the tables, the categories which were responsible for the association were determined by the analysis of the standardized residuals. For all the analyses, a p value of equal to 0.05 was used as the limit of the statistical significance.


Of the 299 women that formed the study population, 130 (43%) underwent CVS, 93 (32%) underwent amniocentesis at 15 weeks, and 76 (25%) women underwent amniocentesis at 14 weeks. (Table/Fig 1) lists the demographic and the obstetric characteristics of the study population. The main reason for having an invasive procedure for the whole group was advanced maternal age (43%) and NT risk 1:300 (35%). There was a significant difference between the groups in terms of the indications for prenatal testing χ² (8) = 40.12, p <.001. The inspection of the standardized residuals indicated that women who had their procedure because their NT risk was > 1:300 were overrepresented in the CVS group, and underrepresented in the later amniocentesis group. Women who requested their procedure because of anxiety but had no other290indication for the invasive testing were overrepresented in the amniocentesis at 15 weeks group. However, the groups showed no difference in terms of the maternal age, parity, previous miscarriage and placental localization (p > .05).

The complications of the procedures and the outcome of the pregnancy are presented in (Table/Fig 2). Chromosomal abnormalities were identified in 19 cases (6.4%), 17 by CVS and the other two by amniocentesis at 14 weeks of gestation. No chromosomal abnormality was identified in the group that had amniocentesis at ≥ 15 weeks of gestation. The difference between the groups was significant χ² (2) = 17.67, p <.001. The standardized residuals indicated that women who underwent CVS had more chromosomal abnormalities than were expected, and that the women in the amniocentesis at 15 weeks group had fewer abnormalities than were expected. There were no cases of early miscarriage (within one week of the procedure) in any of the three groups. With regards to the miscarriages up to 24 weeks of gestation, 1 occurred in women who had amniocentesis at ≥ 15 weeks of gestation, two in women who had CVS, and no miscarriages occurred in women who had amniocentesis at 14 weeks of gestation. The difference between the groups was not statistically significant, and the overall pregnancy loss in this study population was 1.03% (3/292). No information was available for 7 women following the procedure.

There was also no significant difference between the three procedures in terms of culture failures, vaginal bleeding, amniotic fluid leakage, PPROM, preterm delivery and early neonatal respiratory complications (p > .05). There was also no significant difference between the two amniocentesis groups in terms of occurrence of blood stained fluid (p > .05). Two failed procedures occurred in the CVS group. There were no cases of IUFD/SB in any of the three diagnostic test groups.


There is limited evidence on the outcome of amniocentesis, specifically at 14 weeks of gestation. Roper et al., (11) in a review of 2924 amniocenteses, reported that the miscarriage rates varied with the gestational age at which the procedure was performed, and that the total miscarriage rate was 1.0 percent after early amniocenteses (11 + 0−14 + 6 weeks), 1.2 per cent after traditional mid-trimester amniocenteses (15 + 0−18 + 6 weeks) and 3.1 per- cent for amniocenteses which were performed after 18 + 6 weeks of gestation (11). The cumulative miscarriage risk increased from 0.03 % at one week after the procedure to a plateau of 1.1%, five weeks after the procedure (11). The preterm delivery and the stillbirth rates following the amniocenteses were similar in the early and traditional mid-trimester amniocenteses, but they were significantly higher when the amniocenteses were performed after 19 weeks of gestation, although the incidence of the talipes equinovarus was higher after early amniocentesis as compared to the traditional mid-trimester amniocenteses (1.4 percent versus 0.2 percent). None of the affected infants required corrective surgery (11).

In a 10 year study of 3769 amniocenteses, Centini and colleagues found that the amniocenteses which were performed at 13 and 14 weeks gestation were comparable to the later amniocenteses in terms of miscarriage, bloodstained amniotic fluid, failed cell cultures, amniotic fluid leakage, the preterm, premature rupture of the membranes (PPROM), preterm delivery and the presence of neonatal talipes equinovarous (5). In the present study, there was no case of early post procedural miscarriage and the overall pregnancy loss rate was 1.03%. Although no pregnancy loss occurred following amniocentesis at 14 weeks of gestation, this was not statistically different from the later amniocentesis and the CVS groups. Blackstone and colleagues conducted a study to determine the rates of the complications which were associated with amniocentesis, based on the gestational age and found that the 12.0−12.9−week group had a complication rate of 1.20% (3/256), the 13.0−13.9−week group had the highest complication rate of 2.68% (8/298, P < 0.01), the 14.0−14.9−week group had the lowest complicate rate of 0.5% (1/183, P < 0.01), and that the 15.0−15.9−week group had a complication rate of 1.20% (2/166) (12). The finding of the lowest incidence of the pregnancy291complications in the 14.0−14.9−week group was also consistent with the findings of this study, that the pregnancy outcome for women who had amniocentesis at 14 weeks of gestation was similar to those of women who had later amniocentesis and CVS. However, our sample size may have been insufficient to demonstrate any differences in the complication rate.

In a long term follow up study, Schaap and colleagues matched 1509 women with a singleton pregnancy, who had transcervical CVS by age and season of conception with 1509 women with singleton pregnancies who had amniocentesis during 1985−1991 for an advanced maternal age of >35 years and they looked at the pregnancy outcome including congenital malformations, neonatal and paediatric morbidity and complications of motor development, speech, hearing and visual function which was obtained by a questionnaire in 1993−1995 and found no difference between the infants after CVS as compared to the infants after amniocentesis (13). There was a significant difference between the groups in terms of the indication for invasive testing. This difference was because proportionately more CVS was performed for an NT risk of >1:300 as a higher risk of the chromosomal abnormality meant that women wanted an earlier test and hence they opted for CVS. Because the higher risk women mostly had CVS, 17 out of the 19 chromosomal abnormalities occurred in the CVS group. The other two occurred in the 14 weeks amniocentesis group.

In conclusion, although the evidence regarding the safety of amniocentesis specifically at 14 weeks of gestation is scanty it appears to be no different from later amniocentesis and CVS. We found no difference in the pregnancy outcome in women who had amniocentesis at 14 weeks of gestation as compared to later amniocentesis or CVS. Thus, amniocentesis at 14 weeks of gestation could be offered to the women as an alternative to later amniocentesis or CVS without a significantly increased risk for both the mother and the baby. Indeed, performing amniocentesis at 14 weeks of gestation will avoid the technical difficulties of CVS and reduce the distress which is associated with waiting for a later amniocentesis and the increased risks of a late termination of pregnancy.


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DOI and Others

ID: JCDR/3453:1925


Date Of Submission: Oct 15, 2011
Date Of Peer Review: Dec 22, 2011
Date Of Acceptance: Jan 17, 2012
Date Of Publishing: Apr 15, 2012

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