To be irritated by what this sonographer said?

[maja00]

I recently had my 12 week dating scan. I declined the nuchal translucency scan, so was just going for the standard dating/measuring.

As soon as we got into the room the sonographer confirmed that I had declined the NT scan. The scan went as expected, baby looks fine etc.

At the end of the scan the sonographer said "I know you declined the NT scan, but I had a quick look at the baby's neck and it all looks normal. I would tell you if there was an obvious abnormality there".

Now, is it just me or is this not really in the spirit of us declining that test? If the sonographer had said it looked abnormal, then we would have been in exactly the position we wanted to avoid

I understand that the sonographer was trying to be helpful, but AIBU to be a little annoyed by this?

northernlurker "It's really remarkable that somebody could spend so much energy complaining that they were given good news they didn't want."

Remarkable indeed. I find it impossible to sympathise with her suffering tbh.

I honestly don't understand people's issue with the nuchal fold/area being checked anyway. It was looked at long before the NT test for DS was implented, and the test that gives you odds on the likelihood of DS is more than just a check of the nuchal fold.

I feel like I am repeating myself but I strongly believe that the OP has the right to choose if she has a test or not however she didn't have the test. She either misunderstood or the sonographer did not make clear the difference between NT test process and the dating scan showing a normal anatomy

Every woman should be given good information to enable them to make an informed choice about every test. The information can be complex (as is proved by repeated misunderstanding on this thread) so it's important that information is given in a standard manner and has been assessed, reviewed and agreed This is the official NHS patient leaflet. Every woman should be given one or directed to a link to look at it.

If a complaint is made it should be that this information had not been provided prior to the scan appt.

I'm guessing you didn't see this OP?

An extra thick nuchal fold would not be normal anatomy.

That is different from measuring and calculating a risk one in xxxx.

So measuring nuchal fold is routine measure,ent and had it been excessively large the sonographer would have been duty bound to inform that this part of anatomy wasn't normal.

As it could indicate diff health issues not just risk of downs .

In this case the sonographer should have simply said all anatomy looks fine and left it at that. So from that point of view yes it was wrongfor her to make that specific comment. But not wrong to pont out she would have said something had the measurement been abnormally big.

But telling someone nuchal fold is excessively large is not the same as giving a one in xxxx risk of downs.
Telling you the fold is within normal limits is not the same as giving a low risk figure either tho of course along with other bits of anatomy being normal it tells you risk is potentially low even if you don't get actual figures.

(I was told my sons fold was larger than normal I didn't want a risk figure for downs in any case... . He does not have downs .
He does however have a different chromosome microdeletion syndrome for which testing is not available in routine chromosome testing... )

Unless I have missed it, that leaflet doesn't explain what they are looking for in the early ultrasound, so why should the OP be expected to know?

And scans are to look for abnormalities.
That is their focus.
Not checking everything is fine.
We go to check everything is fine.
Their focus is on anomalies.

I agree with you, op.

In my last pregnancy in 2010 the NTscan wasn't available and we had a dating scan at around 12 weeks. This time we were offered and chose to have NT but our dating scan was too early for NT to be checked and despite rearranging twice a string of crap circumstances those few weeks meant I never got the scan.

In your situation I'd be pissed off at being provided with information I'd specifically said I didn't want.

The OP seems to be under the impression she has been told the baby does not have Downs. Or that she can infer this from the statement that the neck looks normal. Neither is the case.

Jolly, the op was not provided with information she didn't want. She didn't want NT testing that provides odds on the likelihood of DS. It wasn't done and she wasn't given that information.

Vivalabeaver the nuchal fold is looked at at the anomaly scan not the dating scan. We are duty bound to assess the nt at all dating scans wether you want combined screening or not. If, subjectively, it appears above normal limits we will measure it. If its within normal limits we do nothing.. If it is over we have to report it, wether you want the screening or not. A thickened nt is not specific to downs but other issues too. All scans are a screening test.
Maybe that sonographer could have phrased it better but she was still doing her job.

Very true, all scans all are screening , and are looking for anomalies and the sonographer was doing her job.
Maybe calling it the dating scan brings the misconception because although that is done, it seems a lot of women are not aware of what else being checked for.
However there are equally a group of women out there who aren't caught up in what the scan is for and go in blindly and just want a nice pic for their photo album!
This isn't good either!

Many of the responses on this thread have shocked me; there seems to have been a large number of people saying but don't you want to know if there is something 'wrong' with your baby? Firstly do we really classify downs as 'wrong' rather than different, I find that sad, can people really not distinguish that the op is saying downs would not be a problem for her, but she would want to know if there was , eg, a heart problem that would require treatment. Secondly the op has declined the nt test , no she doesn't want to know the risk of downs. The overwhelming response on this that she was given good news and should shut up ignores that she specifically asked for something not to be tested and was then given the impression it had been. This is very poor communication and does matter, as someone else said though, get used to it, you're pregnant - put up and shut up. As for complaining about the op wasting her energy posting on mn ; many of us come here as an easy way to get advice and information, I doubt the op expected this to run to 13 pages.

LaVolcan

You are right it doesn't which is a serious omission IMO.

The National Screening Committee is the govt body who oversee all screening programmes and obstetric screening is covered by them. hopefully link takes you to their advice on consent.

They give clear info about the remit of the 18-20 scan here but the dating scan is less clear in it's remit and standard...when I say less clear ..there is no standard

However they do say for all screening

Standard 2
All pregnant women must be offered up-to-date information on Fetal Anomaly screening based on the current available evidence. The NHS Fetal Anomaly Screening Programme recommends the use of the National Screening Committee leaflet entitled Screening Tests for you and your baby, available on the NHS FASP website

And

That pregnant women are offered two scans as a minimum
The first is an early scan, undertaken after 8 weeks gestation and used mainly for dating the pregnancy and confirming viability. This scan could also be used to measure the Nuchal Translucency (NT) if the woman chooses to accept the offer of Down?s syndrome screening

If first trimester screening for Down?s syndrome is declined, second trimester screening for Fetal Anomaly should still be offered A refusal of one part of the screening process does not imply the refusal of another
Pregnant women who decline Down?s syndrome screening should still be offered a dating scan. They should also be offered Fetal Anomaly screening at 18+0 to 20+6 weeks

At no point does it make clear the dating scan also includes fetal anomaly screening. This is an omission in my mind of NSC guidance to both patients and obstetric units.

This thread has shown there is lots of misunderstanding about what constitutes a Downs test and what the 'dating scan' covers.

I think the NSC should address that and will try and link them to this thread

Hen you are right, the better info I found wasn't from them, but was NHS website and royal college of obs & gyn

Well if other parents agree that info provided on the dating scan is inadequate to allow informed consent (let alone dictate working standards) this is the e-mail of the fetal screening committee

[email protected]

Which I'm sure they wanted me to share

Seriously though, this is a hole in their publications. All maternity units will base their practice on the guidance provided by the NSC

Now, is it just me or is this not really in the spirit of us declining that test? If the sonographer had said it looked abnormal, then we would have been in exactly the position we wanted to avoid

She would not have said anything if it didn't look normal. Yes, professionally she over stepped the mark, but she was being human and trying to do you a kindness.

Op in answer to your earlier question, I guess I am thinking about the sort of abnormalities discussed on this page

www.babycenter.com.au/a557439/ultrasound-markers

Are these things that you would want to be told about, they 'may or may not' mean 'this or that' just like the nt measurement.

Also when ds had his 20 week scan the sonographer said that he had a slightly short femur. Is this something that you would want to be mentioned, because again (and I did not know this when she told us) it can be a marker for Down's syndrome? Or it could be a growth thing? Or it could be nothing?

I will probably get flamed for this, but I do think that this is a slightly 'first world' antenatal care issue. It sound really trite, buy we are incredibly lucky in this country to get the sort of scans etc that we do, and all for free as well. I am NOT saying that women should have to 'put up and shut up' with crappy care, but this was not crap care. in the grand scheme of things, this comment really does not matter.

My understanding of NT is that it's a measurement in mm.
Having a quick look does not equal taking an actual measurement I think.
So I wouldn't have thought the test was actually "done".
I think anyway that if a baby is going to be born with Downs Syndrome in that hospital, then it is best for the hospital to know in advance so they can provide any special care needed at birth. Staff shortages are real and serious!

Quite the contrast of threads going on about scans in pregnancy on pregnancy boards,
it is about private scans, but so different to this thread!

No where has the OP ever said she would complain, she uses the phrase 'a little annoyed' she is not frothing or overly concerned or wanting the sonographer struck off. She made an assumption based on the scant information she had at the time that a test had been performed and communicated both without her consent.

It now appears (thanks to some posters on this thread) that the nature of the test had not been explained sufficiently and the OP acknowledged that the error lay in the communication rather than the testing procedure.

In my opinion nothing so far is unreasonable.

What is unreasonable is other posters having a go at the OP for her decision not to screen and suggesting she should not have any scans at all.

I declined blood tests and nuchal translucency tests with all my 3DC as I would not have done anything with the information about chromasomal abnormalities. I did however accept foetal anomaly scans. My second DC showed so called soft markers for chromasomal abnormalities at the 20 week scan. It found three potential heart defects and an echogenic bowel. We went on to have a more detailed scan at the foetal medicine unit and a foetal echocardiogram. At this time we were also offered an amnio.

We accepted the scans and echo but declined the amnio. At the time my reasoning was that knowing if we were facing a heart defect would mean a very different birth plan to the homebirth I had been planning and may need immediate surgery etc. The cause of the heart defect was not important at that time the treatment was.

To me the information that there may be a heart defect was important, the information that some people who have this heart defect also are affected by downs syndrome was not.

Excellent post, SneakyBiscuitEater.

The "dating scans" where I work are not all called dating scans. Depending in wether the patient wants the combined test or (after discussing it with the midwife at booking) they are then referred for the appropriate scan. If they want a nt scan the. They are booked for that (as we are given half an hour per scan) or if they only want dating they are booked for a 20 min scan.. (Not all if this time is always needed if baby is in a good position Etc) we will often have patients arrived for the combined screening scan and they have changed their mind or deny all knowledge of the midwife discussion it with them. But before we start the scan we should have again gained informed consent from the patient if they want it done or not.
I find it sad that they are concentrating on downs and trying to reduce the amount of downs babies born each year. I was told by our screening co ordinate (who is no longer anymore as the government removed her post and funding for the nt training) that as downs babies cost the nhs more than other abnormalities picked up these we're the ones targeted. other abnormalities picked up on triple or quadruple test were not such an issue as a majority of this abnormalities were not compatible with life and would not cost the nhs as much as downs do.

Personally I wouldn't have the test as there has been an increase in downs babies born since the introduction of combined screening. (More were picked up on the other tests) also the new harmony test (fetal blood testing from the maternal blood test) has shown that it is not detecting a good majority of female downs babies. For some reason we don't know yet as its still a new test. Kiprose is still to discover why.

Having grown up with Down's syndrome family member I wouldn't have tested anyway wether the test was 100% or not. It is very sad that they are targeting Down syndrome :(

I will just add,.. We so very often have women who have declined the combined screening ask us if the measurement looks ok. Even though we havnt measured it. And the amount of people who think it is a "needle in the tummy test" even though its supposedly been discussed with the midwife to start with..

And I'll apologise for my grammar.. Typing in phone