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?

volcan - ''what exactly did OP think the scan was for'' - having had the 12 week scan recently - i was told that if i didn't want the NT test then the scan would just be for dating, to assertain that the pregancy is 'viable', and have a quick basic check that vital organs such as the heart were present and correct.

If anything it sounds to me that the OP should have been counselled for the scan in more detail rather than there been a problem with that sonographer. If when she'd declined the NT they'd talked about what would be done/looked at in detail then the OP would have had chance to say yes or no to those things or decline the whole thing completely.

Now if the OP had said that she didn't want the NT scan and also said she didn't want the sonographer to look at the back of the neck/nuchal fold at all then the sonographer was wrong in what she did.

If the OP just said she didn't want the NT scan then I think she's assumed she's getting one thing, the clinicians have assumed something else. With better counselling and communication it could have been avoided.

I declined the Triple Test (as it was with DD1) and the NT Tests with DD2 as I knew that I would never risk a miscarriage by having an amnio just to find out for certain whether my babies had a genetic condition that I would never abort for.

As I would never agree to am amnio, I didn't see the point in being told a risk factor that would only make me worry throughout my pregnancy if it was high.

I knew that the more serious conditions that the 12-16 weeks tests pick up such as Edwards would be picked up at the 20 week scan so just didn't see the point of putting myself through that level of stress.

As far as I was concerned the 12 week scan was a dating scan only (which I believe is it's primary function anyway as the NT tests are relatively new). Plus it was a chance to 'see' my baby!

YANBU to be irritated, however, I think you probably would BU to complain.

I refused NT scan for all three pregnancies. In my experience I was counselled each time and asked what level of testing/assessment I was willing to have. I found with each scan I needed to state "please only look for things that are immediately life threatening or will have disastrous consequences during labour and birth" a simple no to NT would not be enough.

I would ask for help from your midwife to be able to be completely clear on what test etc you want/don't want.

I would be surprised and said 'thanks but I didn't want to know as its of no consequence to me' but wouldn't have taken it further than that. Maybe they are use to people refusing but getting to the point of seeing their baby and then needing to know, I don't know.

I think I had the same views as the OP Viva and I didn't need counselling. I wanted the scan for all the information it provides on conditions that could be treated/averted but not the nuchal scan, which is specifically for down's type syndromes, because I would not have had invasive testing or aborted for Downs and therefore there was no reason to test for it. I didn't test for any of the other things that can go wrong with a baby, because those tests don't exist.

If the sonographer had looked at my scan and seen something worrying, then I would have wanted to know, obviously, and we made that clear to her.

If the NS was a diagnostic test I might have wanted to have it, it was the vagueness of it that put me off. You have a 578 in 34,600 chance of having blah blah. My DH is a professional gambler and would probably stake our house on odds like that, but when it's your baby, it's just confusing. If you're not going to have an amnio, no point in agreeing to the nuchal.

Yabu - even if you declined the test they are oblidged to tell you if there is something that could signal a problem anyway e.g a thick nuchal could be a sign of a heart problem which would require medical assistance/additional monitoring it is not necessarily just about down sydrome.

At 20 weeks your scan looks for fetal abnormalities in great detail. Even if no matter what you would continue your pregnancy you still need to know about any problems so that you can make informed choices about birth/medical intervention and management of your pregnancy.

Sorry, I'm not using counselling in the terms of seeing a counsellor. In medical terminology it means more having a detailed discussion with the client/patient and making sure both sides are clear about what's going to happen and that its an informed decision.

Underdoggy, you say "
If the sonographer had looked at my scan and seen something worrying, then I would have wanted to know, obviously, and we made that clear to her. "

To my mind that's what happened with the OP. the sonographer looked at the scan and if she'd seen something worrying she'd have told the OP. maybe the OP didn't make that clear though that she did or didn't want that to happen.

I'm still not sure what the OP would have or wouldn't have wanted to be told. But if she didn't say I'm only here for dating, count limbs and make sure there's a heart beat then it really isn't the sonographers fault.

Why would you not want to know whether your baby is healthy or not? I am very

Because some people would choose to keep their baby regardless and want to avoid spending the rest of the pregnancy resisting pressure to terminate. We all know this does happen with regard to Down's especially.

I declined spina bifida screening (blood test) when pg as I wouldn't have terminated. I have it and dd was actually born with it.

But at the 20 week scan if they'd seen a big, gaping hole in her back I wouldn't have minded them telling me.

I think this is an interesting thread as it throws up the very real possibility that other women are in the same position regularly. I'm sure it's not the first scan that this particular Sonographer has done where the patient has refused testing, and I'm sure she's said the same to them. Do women, especially first-timers, really know that a dating scan isn't just for dating? and the duty of care the staff have to inform.

Hmmm, interesting. Maybe someone should ask someone from the Royal College of Obstetricians to comment on this topic.

Do women know that they can say no to scans and other tests?

I didn't with my first, but it's a few years ago now, so communication may have changed.

We declined the nt scan with ds2 , the sonographer told us it was thick, we were instantly referred to a consultant who pushed us to more tests and I spent the rest of my pg trying to avoid even more tests!!!

However, I can see that from a medical practitioners point of view NOT sharing a potential problem is hard and a real moral dilemma. We wern't cross, it just meant we had more interesting conversations with the hosp

( oh and in one of the resultant heart scan and asymptomatic heart condition was diagnosed, so it was worth the further assertive conversations with the consultant )

The very booking ultrasound scan itself is a screening test. There are many markers of underlying abnormality being assessed. I'm not really clear on why you have made such a fuss about a normal examination. You obviously attended for the ultrasound in the knowledge that it is to assess your baby?! Or did you only want to know about some anomalies and not others?

Or did OP just want confirmation of her dates?

Declining Down's screening including an NT measurement and accepting or declining the 'dating' scan are very different things. We provide an A4 sheet detailing the purpose and implications of each routine scan and I always mention that if the NT measurement is enlarged that the sonographer will record that and inform the parents as part of the screening for abnormalities that the scan involves. It could indicate a cardiac problem entirely separate to Down's Syndrome.

x-posted!

Even people who attend private scans for a DVD or sex of baby are told if something deviates from the norm, even when thats not what they have gone to be scanned for, it is not just the NHS who have this duty of care, it is all HP's
All scans are screening, not just dating and not necessarily diagnostic and best to steer clear if you want avoid grey areas of 'what if's'

I would just be grateful everything is ok, there are bigger things to worry about.

I am 99.9999% certain this is a communication issue.

The nuchal test is an exact detailed measurement of neck thickness and a blood test. This is a specific test to screen for risk of Down Syndrome. You almost certainly did not have the test performed against your wishes because this test was almost certainly not done.

The dating scan includes a check for obvious abnormalities which includes a check for cystic hygroma (swelling of the area around the neck). Regardless of nuchal testing this would be checked in the sam way they check for other structural anomalies. She was telling you that this was normal - it is different to the nuchal test and maybe she should have made that clearer.

Please do complain though because it will demoralise a well meaning member of staff, take up lots of staff time completing an investigation and in no way change your experience because you are annoyed and will remain annoyed convinced you have been badly treated.

I agree with what HenWithAttitude said.

She didn't do the test, just confirmed that visually everything looked OK.

That's interesting bee I didn't know the nuchal scan could indicate anything other than DS, we weren't told that.

At my midwife's appointment, we discussed the nuchal scan and when I explained that we had discussed it together (using their leaflets) and decided that because DS for us would not be grounds to terminate, we would decline this part of our scan. The MW said this was fine.

There are other conditions that would have been grounds for us to terminate (i.e. conditions incompatible with life of child) and we would of course definitely had any medical intervention that would have helped my or the baby's health which was the important thing. I asked the sonographer to exclude the nuchal fold measurement from our scan because I wasn't having the blood test and like the OP, I didn't want enough information to worry me and take the edge of the happiness of my pregnancy.

However, when she told me, against our wishes, that the measurement was good, even without the blood test, I was obviously delighted, relieved, happy. I'm sure it's not hard to understand that everyone wants good news.

I did not deny any of the miracles of modern science!

Thanks for the info Hen.

I imagine if my sonographer had taken a worrying nuchal fold measurement she would not have mentioned it, and I would have been none the wiser, as requested.

I was happy to have the dating scan, I had one in my first pregnancy.

It was not made clear to me that even if I declined the nuchal translucency scan, the nuchal translucency would still be checked. I am still not clear about what this information would give me, and whether it would be useful to me if I was not prepared to have invasive tests.

Surely if there is any abnormality that shows up they would be duty bound to tell you, regardless of whether you opted for the NT test or not. It needn't be related to that, surely the pointed having a scan is to check that the fetus is well and growing normally, and if there are exceptions to that then they are picked up on the scan and discussed with your consultant?

To be honest, I think you are being a bit precious. She wanted to reassure you because most pregnant mothers - especially first time - are neurotic the whole way through the pregnancy, if you aren't then that's great but she didn't know that. I think if you have a problem with her comments then you need to think about why you are having a scan in the first place. It's not just an opportunity to see your baby for goodness sake.