Worried about nuchal scan

Hotblack Desiato · 11-09-2007 6:57pm #1

On another thread I saw a poster say they had to push to get specific tests etc. which are routine in other countries, and we're a bit worried.

The mrs. had her first 'proper' scan (had early scan at 5 weeks) in the Coombe last week and confirmed that she was 14 weeks 1 day and that all was well, or so they said.

We didn't bring up nuchal scan etc. as we thought it was done a few weeks later (and we were very hassled after being shunted all over the hosp. for hours for a 5 min scan and 2 min blood test) but apparently they are usually done 12-14 weeks and are offered routinely to higher risk mums in the UK - my wife is 36.

Now is everything ok and they're just trying not to worry us, or what.
If so it's counter productive, we're more worried because they've never mentioned DS one way or the other.
Very surprised that nuchal scan was never even mentioned or offered.
At times like this you start to wonder if the religious ethos of the hospital has something to do with it - do they discourage testing in general for the obvious reason?

Can anyone else who's been in the same boat please advise. Thanks.

Edit: not advise obviously, but share your experiences, thanks again. For all we know everything is perfectly ok and we're getting worried over nothing at all.

Nevyn · 11-09-2007 7:09pm

You have to push to have it done, it is not routine.

It will not be mentioned to you even if you are in the higher risk age bracket.
I would suggest talking with your dr and making an appointment to have it done if your wife is in a high enough risk group.

Due to the invasive nature of the test most hospital will not do it with out you pushing and due to that legal situation with abortion over here it is a tricky area that most hospitals won't go into as routine.

Hotblack Desiato · 11-09-2007 7:42pm

Thanks Thaedydal.

Due to the invasive nature of the test most hospital will not do it with out you pushing and due to that legal situation with abortion over here it is a tricky area that most hospitals won't go into as routine.

Obviously yes that is a big issue in this wonderful country :rolleyes: but it's hardly invasive is it? Well, not like amnio is, it's really just an ultrasound isn't it? Couldn't be sure due to the excitement of seeing babs for the first time but I could have sworn the doc was measuring something around the back of the neck area. Didn't think anything of it at the time as we thought it was too early for that and it would be done again later.

I suppose we really should talk to them, but time isn't on our side (in any sense) and the prospect of queueing up for hours to get a non-commital answer followed by "it's too late to do the test now anyway" really does not appeal

Really not impressed so far, in a sense they treat you more like you're a kid yourself, you don't need to be knowing this or talking about that...

ArthurDent · 11-09-2007 8:40pm

ninja900 wrote:

Thanks Thaedydal.

Obviously yes that is a big issue in this wonderful country :rolleyes: but it's hardly invasive is it? Well, not like amnio is, it's really just an ultrasound isn't it? Couldn't be sure due to the excitement of seeing babs for the first time but I could have sworn the doc was measuring something around the back of the neck area. Didn't think anything of it at the time as we thought it was too early for that and it would be done again later.

I suppose we really should talk to them, but time isn't on our side (in any sense) and the prospect of queueing up for hours to get a non-commital answer followed by "it's too late to do the test now anyway" really does not appeal

Really not impressed so far, in a sense they treat you more like you're a kid yourself, you don't need to be knowing this or talking about that...

At this stage it is too late for nuchal fold scan, but if you are worried you can have an AFP test done (maternal blood sample) - needs to be carried out by week 16 and will give you a figure of risk associated with anumber of syndromes. I had it carried out in Coombe last year. Test sent to UK and you get results back yourself. You can also have an amnio - but this IS invasive and carries a miscarriage risk (I ruled it out for this reason). Are there any risk factors that would lead you to be particularly worried about DS (maternal age, other family members with DS?) .

I think everyone worries that their baby will be perfect - its only normal, I hope it doesn't stop you or your wife enjoying the pregnancy.

Best of luck

LegacyUser · 11-09-2007 8:57pm

Can I ask what DS and AFP is please??

My son is now 6 months,but I remember clearly each and every scan...funny thing was that before my wife became pregnant..I knew nothing about pregnancy and babies...but by using the internet and viewing a wide varity of websites,I found myself being capable of understanding charts,alot of the technical language used by the docs and nurses...a fantastic tool.

But during the feotal scans the midwives were always very up front regarding anything they wanted checked or potential issues.

we had a scan at 28 weeks and babs seemed to be very (about 7lbs) big for dates and the nurse told us straight out that we should have a G.T.T done to rule out diabetes...then at roughly 30 weeks the nurse spotted a pool in both of babs kidneys (bi-lateral Hydronephrosis)...she told us straight away what she found and that bi-lateral wasnt a good thing...so had another scan done 2 or 3 weeks later and discovered it was now unilateral...a much better result...but that our baby would need a renal scan about 3 days after birth....which did show up the pool again...but was smaller and was on the line between leaving it be and just monitoring it....they sided with the latter.

Nevyn · 11-09-2007 9:10pm

DS = Downs Syndrome
AFP =Alpha-fetoprotein

What is the AFP test?
The Alpha-fetoprotein test (AFP) is a blood test given to women in their second trimester of pregnancy, usually between weeks 15 and 20. When a woman is pregnant, alpha-fetoprotein is produced by the fetus and mixes with the mother's blood. Alpha-fetoprotein can be detected in a blood sample taken from the arm, according to the Division of Research at Kaiser Permanente, a healthcare system in Northern California.

A high level of AFP can be an indication of a neural tube defect such as spina bifida. However, high levels of AFP can also indicate that the mother is further along in her pregnancy than realized and her due date needs to be recalculated. A high AFP could also mean the mother is carrying twins, according to Kaiser Permanente.

A low level of AFP can be an indication of genetic defects such as a higher risk of Down Syndrome (Trisomy 21) or Trisomy 18, a more severe and less common chromosomal anomaly.

embee · 11-09-2007 10:42pm

The nuchal scan is no more invasive than a regular ultrasound. They just take more detailed measurements of the collection of fluid at the back of the neck. If these measurements give cause for concern, you could then be referred for amniocentesis or CVS, which are more invasive and carry a higher risk (though it should be stated at this point the the chances of miscarraige or introducing uterine infection via amnio or CVS are very small - around 1%). The thickness of the nuchal fold will be compared also to the CRL (crown-rump length) and usually they will give you an idea of how likely Down Syndrome is. Up to 13% of chromosomally "normal" foetuses will have an enlarged nuchal fold. You said you noticed how they were measuring the back of the neck during your wifes scan - they do that for every woman around 12-14 weeks, irrespective of their age and other risk factors. If they haven't said anything to you about it then I wouldn't worry. If they had seem something abnormal they would tell you.

Nuchal scans won't generally be done after 14 weeks as the foetuses lymphatic system will have developed enough to drain away the fluid in the nuchal fold. Amnio can be done later. CVS can be done between 10-14 weeks - earlier than Amnio which is 15-18 weeks.

Hotblack Desiato · 12-09-2007 12:57am

Thanks everyone.

ArthurDent wrote:

Are there any risk factors that would lead you to be particularly worried about DS (maternal age, other family members with DS?)

No, apart from mum is over 35, but then again she's adopted so no knowledge of family history on her side. Afaik though family history is not really a factor in DS?

kaiser1 wrote:

...but that our baby would need a renal scan about 3 days after birth....which did show up the pool again...but was smaller and was on the line between leaving it be and just monitoring it....they sided with the latter.

Hope all is well now kaiser1.

embee wrote:

You said you noticed how they were measuring the back of the neck during your wifes scan - they do that for every woman around 12-14 weeks, irrespective of their age and other risk factors. If they haven't said anything to you about it then I wouldn't worry. If they had seem something abnormal they would tell you.

Thanks for that, some reassurance then!
So a basic nuchal fold measurement is pretty much part of every routine scan at that stage (yes?) and further tests are only done if necessary.
You know how it is, you go in thinking you'll ask them about X, Y and Z but after being shunted over half the hospital and three hours later you can't remember a bit of it!
TBH I thought they should have made a point of telling us about the things they did check and that they were happy that those things were ok. Just because we didn't question them about something doesn't mean it's not on our minds before or afterwards.
Note to self: worry less :rolleyes:

flyz · 12-09-2007 10:17pm

Here in NZ, the Nuchal test is pretty much routine at the 12 week scan.
I got it done and I'm in the low risk age group.

However, the test results are strongly based on statistics and from pregnant women I've spoken to it's not regarded as concrete evidence for DS.
I've heard of cases of women who've had 'high risk' results and ended up with non-DS babies and of 'low-risk' results with DS babies.

The results of the test are stated as chance i.e 1/2543 or 1/153. Anything under 1/250 (i think) is regarded as 'high risk' and you are then given the option for an Amnio test. The Amnio test runs the risk of miscarriage (1/200) so those who decide that they'd have the baby regardless of the results decide not to have the test.

Elen · 13-09-2007 11:04am

I did ask for the Nucal test as well, only to find a big NO straight away. They started telling me about abortion and all that, and all I wanted to know is if it was done.
I do think due to religious beliefs we are not given the same attention and tests as everywhere else in Europe, and this is not right, as the European Community does push for the right attention to pregnant women - this is the only reason why this care is free in Ireland, cos the EU obligues them too.

I think it is pretty bad that we have so very few checks...

CJhaughey · 13-09-2007 4:01pm

Like every other thing in this state, you have to do it yourself.
The Fetal medical centre in Harley St London will do all the tests and it isn't huge money either.
Reading the Above post just further reinforces my belief that keeping religion out of Hospitals and Schools makes sense.

Elen · 13-09-2007 4:14pm

you should be given a choice, specially in this day and age.

Anyone knows of any place in the North even, when they can do this checks for you?

CJhaughey · 13-09-2007 4:59pm

Agreed Elen, it shoul be your choice.
Honestly the Fetal medical centre is fantastic, just go to heathrow, and get the tube in to Harley st, the Ultrasound operators are very skilled as that is more or less what they do day in and day out.
The doctors speak to you like an adult, quite unlike many Drs here.
All in all a remarkably civilised experience which is nice considering how stressful the process is.

aman · 13-09-2007 8:20pm

The private clinic in the Rotunda will do a nuchal scan & bloods for you (called a primark test). I had it done 3 weeks ago - the cost is €250 & the results come through in about an hour.

BostonB · 22-09-2007 1:30am

CJhaughey wrote:

L...
Reading the Above post just further reinforces my belief that keeping religion out of Hospitals and Schools makes sense.

The problem is religion is ingrained in the State not just hospitals and schools.

bea2200 · 25-09-2007 12:53pm

BostonB wrote:

The problem is religion is ingrained in the State not just hospitals and schools.

I was never a religious person but now that Im pregnant, it is driving me crazy, starting with all the obstacles they set to avoid nucal tests! and following with the discrimination of non catholic kids in most of the schools!

I am approximately 15 weeks pregnant:). Only days after i found out i went to spain for holidays (im spanish) and I had my first scan at about 8 weeks and blood test etc. The DR, told me straight away that in a few weeks i had to go back to go the triple screening test, which is the nucal scan. I told her i had to go back to ireland, she said, no problem, Im sure nowadays they do it everywhere. WRONG!!!

I come back and i go to my GP, and after that they give me a date in Bray Health Services for the 20th of September! So, finally last week, i go to Bray clinic, and i got nothing out of it (blood test and urine test yes) but a grumpy indian Dr, more or less telling me that it was too late for a nucal test and that i more or less would better forget about that.... So frustrating!!!

And my first scan in Ireland will be the 31st of OCTOBER! WHy such a big deal with scans? Scans are not dangerous for the baby, so why only one or two during pregnancy? i just dont get it.

I have BUPA health insurance, anyone recommed where to go for a better consultation?

Nevyn · 25-09-2007 1:35pm

Why the health serives why didn't get an appointment with the maternity hopital of your choice ?

I think at there are too few sets of the scan machines tbh, they always seem to be book solid every day.

BostonB · 25-09-2007 4:33pm

Seems to be a lack of resources despite what the official line is. Sometimes it seems like the maternity services are still back in the 50's.

ArthurDent · 25-09-2007 6:35pm

BostonB wrote:

The problem is religion is ingrained in the State not just hospitals and schools.

Agreed - when I was in hospital pregnant on DD last year they asked my religion and i said "Unitarian" and the nurse said - "oh - don't have that on my list - I'll just put you as catholic" :rolleyes: and she was surprised that I wasn't too thrilled with that.

ArthurDent · 25-09-2007 6:37pm

Elen wrote:

you should be given a choice, specially in this day and age.

Anyone knows of any place in the North even, when they can do this checks for you?

I had nuchal fold scan and AFP test carried out in Coombe (bloods were sent to manchester) and was offered an amnio, but didn't have it as the results I had on the other two tests were enough info for me.

Nevyn · 25-09-2007 7:05pm

BostonB wrote:

Seems to be a lack of resources despite what the official line is. Sometimes it seems like the maternity services are still back in the 50's.

I doubt in the 50s they were putting low risk patients up in the Jury's hotel as they did not have enough beds in their wards.

silja · 25-09-2007 9:34pm

bea2200 wrote:

And my first scan in Ireland will be the 31st of OCTOBER! WHy such a big deal with scans? Scans are not dangerous for the baby, so why only one or two during pregnancy? i just dont get it.
I have BUPA health insurance, anyone recommed where to go for a better consultation?

Hi Bea,
I assume you are going public or semi-private? If so, you will likely get only the one scan around 18-22 weeks, ie for you on 31st October, unless there are complications. I agree with the others that it's a question of resources, as the norm used to be 2 scans at least, even 6 years ago... and while you can ask for specific tests, you will likely have to nag them quite a bit to get it done. It will also depend on the ospital... from all I have heard, the (Protestant run) Rotunda is more open to alternative birthing methods and different tests than the (Catholic) Holles Street. We are not Catholic, but decided to go to H Street as their ethos (baby first) suits us.

You have two options really in terms of where to go:
1. Go private. It's what we did as it's our first pregnancy. It's costly at around 4000 euro (though you get much of that back at the end of the tax year). It means you will see the same consultant at every visit, have a visit with that consultant at least every 4 weeks (more often once you are past 28 weeks), and get a u/s at every visit, as well as (generally) the consultant being more receptive to do tests you request.

2. Pay for a private scan. There are several clinics where you can pay for a once-off private scan; in Dublin there is the Charlemont Clinic and also Clane, or you could go all-out for a 3D scan where you get a DVD etc too, though these are more expensive. A private scan will cost anything from 120 to 230, depending on where you go and what kind of scan you get.

BostonB · 25-09-2007 10:33pm

Thaedydal wrote:

I doubt in the 50s they were putting low risk patients up in the Jury's hotel as they did not have enough beds in their wards.

I was talking about the influence of religion, obviously.

Hotblack Desiato · 12-10-2007 4:23am

OK, mrs had some bloods taken in the hospital a couple of weeks ago and sent to the UK for tests (AFP presumably) and we saw the consultant for the results yesterday.
Down's risk is given as 1 in 210, in the UK you'd be offered an amnio at one in 250. He said we could have one if we wanted but it was up to us.
Not sure what we'll do, but we're inclined not to at this stage and just hope for the best. It's not exactly bad odds as they go, for a mid-30s mum.

BostonB · 12-10-2007 8:51am

We did the same. Worked out of so far. I never realized you were playing the odds having a mini me. Till we had one at least.

Kashkai · 15-10-2007 1:57pm

My wife is pregnant on our 4th child - 13 weeks now

. We attended Holles Street last Thursday for the first visit during which the Consultant raised the issue of my wife's age - 40 now and 41 when baby is due. She kept harping on about the "tests" that were available without mentioning anything specific. My wife looked a little confused at the doctor's cryptic messages and so I butted in and said "are you talking about a nuchal fold test and/or amnio". The doctor looked at me and nodded without saying anything. She then said she could do the tests and if the results were positive (I presume she meant down syndrome), then we had the option of "taking vigorous action". My wife looked more than a little worried at this stage so I turned to her and said "what the doctor is trying to tell us is that if our child has down syndrome, then we can think about getting an abortion". This drew an angry look from the doctor so I asked her if I had misrepresented her musings. She said she had not mentioned anything about an abortion so I asked her what she meant by "vigorous action". She said if the tests showed the presence of downs, then we would have to look at our options. My wife and I agreed that if that happened, i.e. the child had downs, then we would love it as much as our other three children.

We then had a mini scan and the doctor tried to check the nuchal fold but the baby was being as "difficult" as its father and was in the wrong position. We'll have to wait for the baby to be born to find out - hopefully everything will be alright.

As a footnote, I'm not religious, I don't believe in a God so I have no baggage where that issue is concerned. However, for me, once conception occured, I became a Dad for the fourth time. I won't get to see my new child until next April but for me, he/she is a living human being and there is no way I could ever consider an abortion/termination or whatever term you'd like to use. To me, it would be murdering my own child. Now I know there are different views on this issue and to each their own and if my views have upset anyone, I apologise. That doctor just peeved me off as she caused unnecessary worry to my wife with her cryptic warnings and yet she didn't have the courage to just come out and say what she was thinking.

Ayla · 15-10-2007 2:07pm

Prosperous Dave wrote: »

...so I butted in and said "are you talking about a nuchal fold test and/or amnio". The doctor looked at me and nodded without saying anything. ... so I turned to her and said "what the doctor is trying to tell us is that if our child has down syndrome, then we can think about getting an abortion. ... so I asked her if I had misrepresented her musings.

Prosperous Dave...first congrats on babe 4!

Then, good on ya for knowing what the heck the doc was actually trying to say and having the gumption to come out and say it. I'm sure your wife feels much better knowing where you stand and that you're strong enough to emotionally support her and your children.

Best of luck with it all

BostonB · 15-10-2007 2:34pm

Prosperous Dave wrote: »

....That doctor just peeved me off as she caused unnecessary worry to my wife with her cryptic warnings and yet she didn't have the courage to just come out and say what she was thinking.

I can't see how courage would come into it since this is not a junior doctor, but a consultant they probably have the same conversation many times a week. More likely they have to tread carefully broaching the subject, considering they are bound by the laws of the state and hospital policy. Be hard not to upset people no matter what you say considering they'd see people of wildly differing beliefs from all walks of life.

Kashkai · 15-10-2007 3:32pm

BostonB wrote: »

I can't see how courage would come into it since this is not a junior doctor, but a consultant they probably have the same conversation many times a week. More likely they have to tread carefully broaching the subject, considering they are bound by the laws of the state and hospital policy. Be hard not to upset people no matter what you say considering they'd see people of wildly differing beliefs from all walks of life.

The way I see it, if you are going to say something, then come out and say it or else don't!!. This Consultant, who looked younger than my wife or I btw, was speaking in code and if it wasn't for the fact that I had done some research on the net with regard to having a baby (and possible dangers) in your forties, then I too would have been as sea with her meanderings.

If it is illegal to mention these tests in this state (don't know tbh) then why was she hinting at them. On the other hand, if its not illegal to mention nuchal fold tests and amnios, then why be so cryptic? Either its against hospital policy or its not. All this doctor managed to do was worry my wife. As for beliefs, like my original post stated, the only belief I have is that I'm going to have another baby in my arms in 6 months time and life doesn't get any better than that.:D:D

Nevyn · 15-10-2007 4:08pm

The tests are not illegal but it is considered a sensative matter and the hospital staff will try to raise the matter with out upseting or offending those present as they will not know of the moral stance of the parents to be and causing stress which can cause complications in a pregnancy and opening themself to a lawsuit.

Congratualtions Dave hope all goes well for your wife and your family.

BostonB · 15-10-2007 4:11pm

AFAIK theres no problem talking about the tests. At least I never experienced any. I'm just making the point that Doctors are bound by certain rules, rules and laws that they themselves may not always agree with. Don't shoot the messenger. Theres somethings they can't talk about. Dammed if they say nothing, dammed if they do. No idea what reaction of prospective parents will be. They can only give you the odds, and their best educated guess. Some people don't want to know the risks some do.

Good luck with jr anyway.

Worried about nuchal scan

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