Transvaginal Chorionic Villus Sampling—an Alternative Approach

EDITORIAL COMMENT: We accepted this paper for publication because it seems so sensible to use a transvaginal approach for a posteriorly situated placenta for chorionic villus sampling especially when the uterus is retroverted and the patient is obese. Consultation with the leading practitioners of chorionic villus sampling in Melbourne showed that all were aware of this approach, as mentioned in the literature, although they had not used it. The authors mention that a smaller needle may be appropriate such as the 20 gauge needle usually used for abdominal chorionic villus sampling. One reviewer stressed the importance of not performing this investigation before 10 weeks' gestation because of the recorded association with reduction defects of the limbs in the fetus, presumably due to interruption with vascular supply by trauma to the chorion. Future reports of a larger series of patients is required to reinforce the authors' message that this technique does not carry significant risk of infection. N.B.Summary: Conventional transabdominal approach for chorionic villus sampling (CVS) is difficult in obese women, retroverted uteri and when the placenta is posteriorly placed, while the transcervical method is technically demanding. We investigated the use of an alternative approach‐transvaginal‐in 38 consecutive women undergoing CVS for prenatal diagnosis of haematological conditions. This is an effective method with regard to access and visualization of the placenta, patient tolerance and tissue yield. No major complications were encountered. We recommend that the transvaginal approach be considered for CVS, especially in difficult cases.