How Many Procedures Does it Take? Success of a CVS Training Program for Maternal Fetal Medicine Fellows

Abstract

Objectives

To quantify the learning curve for a training program for Maternal Fetal Medicine (MFM) fellows in obtaining successful transvaginal chorionic villus sampling (CVS) results in women with early pregnancy failure (EPF).

Methods

Retrospective observational cohort study of transvaginal CVS and subsequent manual vacuum aspiration (MVA) performed by MFM fellows. CVS samples were sent for karyotype and products of conception (POC) were sent if CVS sample did not yield a result. Success was defined as karyotype result on CVS specimen.

Results

130 women with EPF up to 9 weeks gestation, underwent transvaginal CVS and MVA from December 2011 to April 2015. CVS samples were successful in 53 (40.8%) cases, POC were analyzed for karyotype in 68 (52.3%) cases and maternal decidua was obtained in 9 (6.9%) cases. Nine MFM fellows performed CVS and MVA procedures. The mean number of procedures per fellow was 14 (5-24). The average success rate of transvaginal CVS sample was 33.3% after the 1st procedure and 50% at the 14^th procedure. One procedure was performed per patient.

Conclusions

Success increased over time from 33.3% to 50.0%. Given the gestational age and failed pregnancy status, this is a reasonable success rate for CVS at time of EPF.

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