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Not having a 20week scan? What can be done for child at that stage?

(36 Posts)
GingerJulep Sat 09-Feb-13 10:22:21

OK, so this seems to be mostly about choices after tests... if it isn't the right places for choices about tests please let me know!

I'm considering not having the 20week scan for the following reasons
1) I personally wouldn't abort (except in case of likely maternal death) after 20weeks
2) I will (anyway) be giving birth within minimal transferring distance of Great Ormond Street which seems to be the alternative suggested outcome in case of most abnormalities that could be found.
3) There is only a /tiny/ chance of them finding anything that can be fixed in utero (some types of diaphragmatic hernia only as far as I can make out from reading up/talking to the screening dept.)
4) Long term effects of scans are unknown (not been done for a generation yet) and there is some evidence that they can alter the handedness of babies, i.e. mess with their brains. Nothing wrong with being a leftie, but definitely not happy about changing the brain of an unborn child for limited potential benefit.

So, what would help me decide for the scan? Some more information on number 3 I think. If there was anything that could/should be done pre-birth it would alter the balance.

Does anyone know of any stats or even anecdotal evidence on this? My MW has never come across anything being done in utero although I do have one friend who had surgery on her/the baby.

Thank you for getting to the bottom of this!

MikeLitoris Sat 09-Feb-13 10:27:07

I would say it is about being prepared for any eventuality.

If they find that your baby has a specific illness they can have specialist doctors ready to help without waiting around.

MikeLitoris Sat 09-Feb-13 10:28:37

Sorry posted to quickly.

Even if they cant help in utero they can be prepared to do anything needed after the birth.

SamSmalaidh Sat 09-Feb-13 10:34:38

I know of people who have found out about heart/kidney problems during the scan which needed immediate attention post-birth, so they had to give birth in a particular hospital and have a specialist team standing by.

Also isn't it a good idea to know the position of the placenta?

babyiwantabump Sat 09-Feb-13 10:38:04

If you only had to have one scan in pregnancy this is the one I would choose . It picks up any abnormalities that may need special treatment at delivery . And more importantly position of the placenta .

But I do agree with you on the little known effects of scans and the issues it may have on the brain ( how do we know that it is not that that causes the amount of children whom seem to have some kind of behavioural issues nowadays days )

So I would be cautious in that respect .

StupidFlanders Sat 09-Feb-13 10:40:07

If your earlier scan was ok then it's likely to be fine but you could also find some serious conditions that will require immediate intervention to prevent suffering. That's what happened with my fourth. I can't imagine why anyone would take that chance.

BeaWheesht Sat 09-Feb-13 10:45:22

I think some conditions would need treatment immediately with paeds on hand.

Also if you have a low lying placenta you NEED to know.

discobeaver Sat 09-Feb-13 10:56:38

I think they can also check growth, and if the baby is not growing properly maybe book you fir further checks and possible early delivery/intervention if the womb environment isn't optimum?
Though I don't think there is much they can actually do at 20 weeks, just prepare for future situations?

noblegiraffe Sat 09-Feb-13 10:58:08

My friend had a kidney problem picked up at the 20 week scan. The baby was monitored after birth and put on antibiotics to prevent urinary infections. The issue was cured by a simple op aged 1. If it hadn't been picked up at scan their baby would have suffered painful urinary infections and much more invasive interventions until the same diagnosis would have been reached and the first year of his life would have been awful and full of pain. For me that alone would be a good enough reason to have the 20 week scan even without the other stuff they can find out.

scaevola Sat 09-Feb-13 10:58:34

The left-handedness study was inconclusive, and never repeated because it was ruled unethical as scanning mid-pregnancy had such huge and overwhelming benefits. Given that scanning in 1st world is nigh on universal, and there is no increase in left-handers in the population, it does suggest that the Swedish study is not sufficiently accurate.

If they discover conditions incompatible with life at do not show up at 12ish weeks (eg certain kidney problems), then you might want to know about this in advance. Also, if there are some types of heart problems, your baby's survivability might be affected by labour choices and availability of cardiac paeds team. In London, this might mean delivery in a hospital which does both labour and top notch paeds - would you like to be stuck, even if only briefly, in hospital A whilst your baby was in hospital B, when you could have arranged it so no separation was needed? And there are a few conditions in which a treatment plan can be begun before birth, with better outcome than if they have to take the time diagnosing after.

Fortunately, most babies do not need immediate, specialist intervention and it is totally your choice.

GingerJulep Sat 09-Feb-13 11:06:03

Hmm... interesting responses. Seriously, all your replies are genuinely helpful in making the decision. Thank you!

I'll be giving birth with care from UCH because it is closest to me and seems good. It is also where I'd be referred from elsewhere if any complication was found as far as I can make out. So, given that as far as I can tell most ops (e.g. for bowels having grown outside baby/heart/kidney issues) that we could be prepared for need to be done/started within days rather than hours at the soonest I'm not sure how much difference the being ready makes for a UCH birth? (If I was far from a large teaching hospital/specialist children's hospital that would obviously be different).

In terms of placenta position I was rather hoping for a 34+ week scan (which is offered at UCH) as I think that is what they do anyway if they see it is low during the 20week one? (Apparently they can move a bit during pregnancy?!?) Plus that would give a better idea of likely presentation which could make a difference to VB/CS choice (as far as I can tell VB is now still recommended for most things they can find at 20weeks, even the bowel-out-side-of-baby one which surprised me).

Has anyone had any experience of a positive intervention for the baby?

SamSmalaidh Sat 09-Feb-13 11:10:57

So you are planning to have another scan, but you just want it at 34 weeks rather than 20?

GingerJulep Sat 09-Feb-13 11:12:57

Ah, more replies - thank you noblegiraffe and scaevola, I hadn't seen your responses when I typed the above.

With regards to the kidney thing I'd be really interested to find out why they couldn't just scan the baby's kidneys once born to diagnose, although I have been told it is not usually done I'm not sure why?

With regard to transfers scaevola I totally agree - if I wasn't where I'd almost certainly end up being transferred to to start with that would be a major factor for me.

GingerJulep Sat 09-Feb-13 11:17:54

SamSmalaidh - the original MV I spoke to didn't particularly encourage the 34+ one unless there was a cause for concern discovered later but I think baby & placenta position would make a difference to my birth plan (e.g. MLU in hospital vs consultant lead ward) so, to an untrained eye it seemed like a good plan.

Plus, baby much more developed (I know lot is done by 20wks but they also pick that date as it is easy to get a pic of whole baby in one go beofre it gets too big) by then so I'd be less concerned about the brain.

GingerJulep Sat 09-Feb-13 11:19:31

So, I guess not 'planning' a 34 week one yet (will speak to MW nearer the time) but I can certainly see good reasons for one for me more easily if that makes sense!

LadyMargolotta Sat 09-Feb-13 11:23:39

The scan for ds at 20 weeks did pick up on a minor kidney abnormality. This meant he needed an ultrasound at birth, and if it had been bad enough, would have been further treated (treatement is fairly conservative eg. antibiotics). It's exactly the sort of thing that is picked up on earlier rather then later and if necessary can be treated immediately.

As it happens, he is probably left handed, but then so are two of his aunties and grandparent.

I know another mother who's 20 week scan picked up on a serious heart defect. The mother was given medication and the baby was delivered safely and went on to have further treatment. That problem would have been fatal if the scan had not picked it up.

purpleroses Sat 09-Feb-13 11:25:54

My nephew had kidney problems, picked up at 20 weeks scan. Wasn't much they could do before birth, but meant he was started on antibiotics a few hours after, to prevent kidney infections. Wouldn't have been picked up otherwise until he became very ill.

And my friend's baby was picked up as failing to grow properly at 20 week scan - they had no idea previously. She was monitored closely, given steroids and delivered early as he had more chance that way - he was very small for dates though so clearly hadn't been growing properly. He's fine now, but most likely wouldn't have been if they'd not picked up the problem when they did.

I don't think it's just about picking up severe abnormalities and offering abortion choice at all.

galwaygirl Sat 09-Feb-13 11:30:38

Like others have said the main benefits are to identify any issues with baby that might need specialist help at birth and to check the position of the placenta. I had understood that it can actually be harder to see things in a much later scan as the baby is so squashed?
We didn't have the tests for Down's syndrome as we knew we wouldn't take any action based on that but wanted the 20 week scan for the baby's sake - in case it needs help when born.
If there's something seriously wrong would they not sometimes schedule a section so they can be sure the right people are available when baby is born rather than if you have birth in the middle if the night or at the weekend?

BebeBelge Sat 09-Feb-13 11:43:26

The example you mentioned of diaphragmatic hernia really struck a cord with me as that is precisely what my son was diagnosed with. Like you, we did not consider termination. But having the diagnosis meant that we were given extra and specialist care in pregnancy and labour and because his condition was known, there was a team of about 10 various doctors/nurses waiting to 'catch' him and he immediately got the life-saving attention he needed.

Without the antenatal diagnosis, he could have died before we ever knew what was wrong with him. As it was, we still knew he could die but had had weeks to prepare and read up on the condition. So, for me, the opportunity to prepare myself was what made the scan/diagnosis worth it. And chances are your 20 week scan will be totally fine. Please don't worry!

LadyMargolotta Sat 09-Feb-13 11:45:46

GingerJulep - it would be a logistical nightmare to scan all new born babies's kidneys on the off chnace that a small percentage of them will have this kidney problem.

It would mean new mothers queing up in the waiting room witing for the scan when they should be at home resting and bonding. So it is only done when there is cause for concern following in utero scans.

It is far more convenient - faster, more economical - to check the kidneys along with all the organs and limbs and placenta checks, amniotoc fluid checks and all the other things they do at the 20 week scan. Can you imagine individually scanning all the organs after birth?

mb2512cat Sat 09-Feb-13 11:54:01

Personally I don't believe there's anything wrong with scans or we would know by now. And if there was, it would be at the 12wk scan or earlier as its the first three months of a baby's development that are most crucial and vulnerable. So a scan later in pg is less likely to be damaging. On your other points, having TFMR-ed at 20wks and 29wks, don't have a scan until after 24wks as after that they'll only put TFMR to you as an option if any condition is fatal/seriously serious. It's not something undertaken lightly. I don't think you'd be risking much with your baby by having a scan post 24wks than 20wks if that would make you feel better. Anyway, the vast majority of scans never identify any problems; just in an unfortunate minority. I'm sure you'll be just fine.

jellybeans Sat 09-Feb-13 11:59:13

Actually there are illnessess that can be found at 20 weeks and treated saving the babies life. Hydrops, pleural effusion, acsites, etc. This alone is reason to have one. Also for severe birth defects (missing skull/brains etc) finding out in advance and preparing could make a lot of difference. In addition although people say they would never do soemthing they never actually can say for sure until faced with it, trust me I was one of them!

As for the safety of scans, I had one every 1-2 weeks all the way through as had massive complications, previous stilbirths and losses. DS is very healthy and very very bright. My DT's I also had loads of scans and they too are fine. One of the 3 are left handed but that is no problem they are bright. In addition scans can help bonding with the baby for mum and dad/siblings.

scaevola Sat 09-Feb-13 12:06:34

Yes, you can scan a baby; once you have some idea of what you're looking for, and after the baby has had the full gamut of crash interventions when they haven't a clue what's wrong and have to throw everything at it to maintain life before investigations start.

I suppose it's a case of whether you want foreknowledge to maximise the chances of best possible care, or if you're happy to play the odds that most babies do not have life-threatening conditions. If you find the one (inconclusive) study more persuasive on safety than the other evidence (no general rise in LHness) and this is a real concern to you, then of course turn the scan down.

LadyWidmerpool Sat 09-Feb-13 12:17:52

A relative's baby had a heart problem diagnosed in utero. Poor scone has had loads of treatments throughout his life but is doing well now at 9. Apart from the clinical reasons I think it would be much emotionally better to know in advance and to get the chance to put support in place.

poshme Sat 09-Feb-13 12:25:59

I know someone who did not have a 20 week scan (was abroad) but luckily had a scan close to birth due to possible breech as they discovered hydrocephalus which meant baby had a big head & would not have been possible for VB.
Had they known earlier they would have induced earlier, meaning baby would've had shunt put in earlier meaning less risk of brains damage.
The scan also meant they could do the section at a hospital which would also do the neuro surgery, meaning no sudden hospital transfers just after birth.
I think you'd be crazy not to personally. For your own health- and for your baby.

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