NHS nuchal screeing?

[fifitot]

Is it me or is the nuchal screening that is provided by some NHS areas causing more concern than is needed? I read this section of the board alot as it is/was helpful to me, and I can't believe the number of concerns about nuchal thickness and bloods.

It appears, and I could be wrong, that the NHS is giving out inaccurate messages about the nuchal thickness. From what I have read (and believe me I read alot!) the thickness of the nuchal pad is not that great an indicator and for true accuracy of risk of genetic or other issues, it should be combined with bloods taken at the same time, fed through the software the FMF has put together and the nasal bone sighting or otherwise factored in - to give a true estimate of risk. I have read this method gives up to 90% accuracy and ARC reinforced this when I spoke to them.

So why do the NHS just look at nuchal pad alone, or give info on nasal bone, or don't include bloods etc etc. Seems to me it is just causing confusion and anxiety. If they aren't going to do the full screen then why bother?

Have I got it wrong? Just feel bad for all these very concerned mums to be who may feel pressurised into amnio when it's not necessary. I

[katiecubs]

Hi fifitot - at my NHS hospital they do the combined test (bloods and NT)which is thought to be the most effective screening test at 95%. I'm not sure about other trusts though....

[DuelingFanjo]

My NHS don't do Nuchal Screening. I would go private for it.

[yama]

My NHS do combined testing also. Mind you, they have only just started offering this test so I wasn't offered it for either of my pregnancies.

[Coffeeandchocolate]

I had the combined test as well at my NHS hospital, and it took a few days for the results to come through.

[fifitot]

Good to see they are doing the combined screening then. Just sometimes the impression I was getting was that they were doing the nuchal scan on it's own and thought this was a bit ineffective.

[NumptyMum]

Hi fifi

I think what might be happening is that when the nuchal screening is done, bloods are taken - but it takes a couple of days for blood results to come through and at the time of the nuchal screening, if the sonographer spots a raised nuchal fold they may decide it is better to tell the parents so they are aware the fold is larger than 'average'. However this does then present worries, as most people associate this with meaning there must be problems - and as you say, until the bloods come back that is not known. On the other hand sometimes the fold is OK and the bloods raise the risk - so it's swings and roundabouts. Re the nasal bone, I thought that it wasn't necessarily apparent until later (ie around 13wks) and I think most nuchal fold testing is done earlier - so no nasal bone may not mean there is a problem. I think that's why others on here have had a subsequent scan, once the nuchal result has come back as indicating a possible problem. Also if the nuchal testing is done later ie when nasal bone more obvious, then CVS wouldn't be possible. At least, that's my guess! As it is, my NHS don't do nuchal screening as standard, only if you've had a previous chromosomal problem.

[fifitot]

That explains it I guess - thanks! Just curious really. I had my nuchal done privately and it was the best £150 I've spent in a long while!

[fabhead]

I asked these very questions last week when, due to a hospital cock up, I had a nuchal scan on the same day at both my local hospital and the Fetal Medicine Centre. The NHS (at best, some do none) do the combined scan - nuchal thickness and bloods. But the FMC and Harris Birthright at Kings factor in extra markers into the risk factor - presence or not of nasal bone, heart rate and blood flow in 2 places in the foetus.

As you would expect, the results were different. All markers in both were normal. NHS one was 1:1000 odd (quoted 75% detection rate), FMC one was 1:2000 odd (quoted 95% detection) (am 38). So low risk thankfully at either, but I do wonder if the risks had been higher - there is a big difference between being told 1:30 say vs 1:300. Would the difference have been less marked if there had been any abnormalities I wonder.

I asked both sets of people why all factors not used everywhere. The NHS sonographer said that only the FMC have the software that can take account of the extra factors and they won't distribute it (hmmm, dunno - maybe because is not fully published yet) as they make a lot of money from using it privately at the FMC (true, I'm sure). At the FMC they said that there were various reasons, one being that the presence of nasal bone was not indicative in some races - many asian people apparently don't have one and this is not associated with genetic problems. So this factor cannot be used across the board (do they subtract it from the analysis if the parents are asian?).

He also said that these extra factors were based on their own research which was largely published but they weren't yet up to significant enough numbers of cases for it to be adopted by NICE of DOH or whoever - apparently they require stats in the 100,000's of pregnacies as they have for the nuchla fold measurement but they are only into the 10,000's for the extra, newwer factors. He also said some researchers disagree about their significance.

Interesting stuff - it is very reassuring to get low odds but the problem for many people is the enormous stress caused by low odds - as can be seen here, many of which will be false positives I guess if the detection rate is only around 75%.

[fabhead]

Stress from high risk odd I mean

[fifitot]

Thanks - really interesting.