TY  - BOOK
AU  - Clark-Ganheart, Cecily A
AU  - Driggers, Rita W
AU  - Fries, Melissa H
AU  - Ye, Peggy P
TI  - Use of cell-free DNA in the investigation of intrauterine fetal demise and miscarriage
SN  - 0029-7844
PY  - 2015///
KW  - *Abortion, Missed/bl [Blood]
KW  - *DNA/bl [Blood]
KW  - *Fetal Death
KW  - *Gestational Age
KW  - *Trisomy/di [Diagnosis]
KW  - *Ultrasonography, Prenatal
KW  - Abortion, Missed/us [Ultrasonography]
KW  - Adult
KW  - Female
KW  - Humans
KW  - Karyotyping
KW  - Pregnancy
KW  - Pregnancy Trimester, First/bl [Blood]
KW  - Pregnancy Trimester, Second/bl [Blood]
KW  - Pregnancy Trimester, Third/bl [Blood]
KW  - Prospective Studies
KW  - Trisomy/ge [Genetics]
KW  - Young Adult
KW  - MedStar Washington Hospital Center
KW  - Obstetrics and Gynecology/Maternal-Fetal Medicine
KW  - Clinical Trial
KW  - Journal Article
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01916928; CONCLUSION: Among nonviable pregnancies, cell-free DNA is present in the maternal plasma with fetal fractions greater than 3.7% in more than three fourths of cases after an ultrasonographic gestational age of 8 weeks; LEVEL OF EVIDENCE: III; METHODS: We conducted a prospective cohort study of 50 participants at MedStar Washington Hospital Center, Washington, DC, between June 2013 and January 2014. Included were women with pregnancies complicated by missed abortion or fetal demise. All gestational ages were considered for study participation. Participants with fetal demise were offered the standard workup for fetal death per the American College of Obstetricians and Gynecologists. Maternal blood samples were processed to determine the presence of cell-free DNA, the corresponding fetal fractions, and genetic abnormalities; OBJECTIVE: To estimate whether cell-free DNA is present in nonviable pregnancies and thus can be used in diagnostic evaluation in this setting; RESULTS: Fifty samples from nonviable pregnancies were analyzed. The average clinical gestational age was 16.9 weeks (standard deviation 9.2). The mean maternal body mass index was 30.3 (standard deviation 9.1). Seventy-six percent (38/50) of samples yielded cell-free DNA results, that is, had fetal fractions within the detectable range of 3.7-65%. Among the 38, 76% (29) were classified as euploid, 21% (8) as trisomies, and 3% (1) as microdeletion. A cell-free DNA result was obtained more frequently at ultrasonographic gestational ages of 8 weeks or greater compared with less than 8 weeks (87.9% [n=29/33, 95% confidence interval (CI) 72.7-95.2; and 52.9%, n=9/17, 95% CI 31.0-73.8] of the time, respectively, P=.012). Time from demise was not associated with obtaining a result
UR  - http://dx.doi.org/10.1097/AOG.0000000000000863
ER  -