Factors associated with multiple-pass procedures during chorionic villus sampling: A video analysis

Multiple placental passes during chorionic villus sampling (CVS) increase the risk of fetal loss; however, specific factors that predispose to repeat aspiration have not been delineated. To identify anatomic and technical variables associated with multiple-pass procedures, a detailed review of 205 videotaped CVS procedures (single pass = 163; multiple pass = 42) was performed, blinded to pregnancy outcome. The route of sampling did not influence the need for multiple aspiration attempts (transabdominal—30/ 135; transcervical—12/70), nor was placental location alone discriminatory. However, the combination of a posterior placenta and uterine retroversion was observed more frequently in the multiple-pass cohort (8/42 vs. 9/163; p<0.05). In transabdominal cases, suboptimal needle placement (e.g., perpendicular to the placental long axis) was more common in the initial aspiration of a multiple-pass procedure (21/30 vs. 38/105;p<0.01), while limited penetration of the catheter tip (e.g., just inside the placental edge) characterized a majority of multiple-pass cases in the transcervical subset (7/12 vs. 3/58; p<0.0001). A case-control cohort was constructed to evaluate the impact of these technical variables on sampling efficacy, independent of the influence of uterine position and placental site. In that analysis, suboptimal location and/or orientation of the sampling device remained characteristic of multiple-pass cases. We conclude that further reduction in the frequency of multiple-pass procedures might be achieved by consistent placement of the device tip in the central placental mass. Unlike amniocentesis, where any point of amnion entry will suffice, this technical nuance should be emphasized with CVS to maximize the single-pass success rate.     

Rare non-mosaic trisomies in chorionic villus tissue not confirmed at amniocentesis

This paper reports eight cases of non-mosaic, rare, and typically lethal trisomies diagnosed in chorionic villi and not confirmed by amniocentesis. Four cases were 47,XX, + 16; two cases were 47,XX, +2; one was 47,XX, + 12; and one was 47,XY, +7. There have been no known complications in any of these gestations. These eight cases were found in a series of approximately 12 000 samples processed in our laboratory (0.07 per cent). We conclude that (1) rare non-mosaic trisomy not reflecting the fetal condition is an occasional source of diagnostic ambiguity in chorionic villus sampling; and (2) when encountered, a follow-up amniocentesis should be recommended to the patient to confirm or rule out the abnormality. We propose the term ‘confined placental abnormality’ to describe non-mosaic trisomies and other related abnormalities found only in chorionic tissue.     

Evaluation of British Columbia Ministry of Forests aboriginal rights and title-consultation guidelines — the Ditidaht case study

The British Columbia Ministry of Forests’ “Aboriginal Rights and Title — Consultation Guidelines”, prepared in response to a Supreme Court of Canada decision on aboriginal rights and title, presents an interesting example of how common law influences provincial environmental policy. The policy addresses the British Columbia government’s fiduciary duty to First Nations and requires staff to consult with aboriginals during operational forestry planning. Adequate understanding of the policy is essential for lawful forest management. The Consultation Guidelines have become a key environmental policy in British Columbia.This evaluation will increase understanding of the Consultation Guidelines and aboriginal title for forest practitioners and policy makers. Within the context of a Vancouver Island case study, the policy is analyzed in view of the following criteria: effectiveness, efficiency, equity, and effort. Even though the policy is over 2 years old and the government is actively managing forests in an area under negotiation for treaty, the policy has yet to be implemented. As a result, aboriginal concerns about the long-term environmental and economic sustainability of current forest practices go unheeded. This situation potentially jeopardizes the government’s ability to address its fiduciary responsibilities to aboriginals, as defined in case law and the Canadian Constitution.     

Characteristics of urban ozone level in Hong Kong

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Effect of long-term fertilization on soil nitrate distribution

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Practical environmental monitoring of major construction projects

Independent teams undertook environmental monitoring of particular concentrations of major construction projects forming part of Hong Kong’s U.S. $20 billion airport infrastructure programme located in dense urban areas. The team combination of environmental specialists with experienced civil engineers enabled pragmatic mitigation measures to be developed and accepted by the construction personnel with the result that potentially significant adverse impacts were averted. The authors discuss the mechanism and success of this innovative approach.