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?

Soup, I'm happy to know about actual problems, or things that I can do something about or will change the outcome. I declined the NT test because I didn't want to be given a risk.

Thanks Tarka, that's interesting - frustratingly it doesn't say what further tests might be offered though.

I have found lots of replies very useful, and it has clarified that the problem was the way the information was given/phrasing the sonographer used. So I am still a bit irritated, but as I have said repeatedly I recognise she was trying to be helpful and reassuring.

The worry I would have is that this person presumably isn't trained to do nuchal scans and might not be using the right equipment.

OP if I were you I would just be grateful that you have a very healthy baby groing in there. The sonographer would only have had good intentions, and you need o focus on that. Luckily, she didn't tell you the opposite and I would have thought that instead of wasting so much energy castigating someone who just tried to help you, you would be focussing on the fact that you have a happy, normal pregnancy.

Good luck with everything

It's ok, starting a thread on mumsnet wastes minimal energy. In fact I can do it sitting down while watching TV and doing childcare

It was a few years ago, but my friend's DD was pregnant and all her scans showed abnormalities. No neck, then body too short , head too big, and the baby was born perfectly normal !!

Rosh is right, the Nuchal can determine more than just DS, so sonographer was right to say nuchal looked ok. Maybe her sentence to Maja was not complete and should have said ' I know you don't want want the NT but the nuchal is also an indicator of other abnormalities, and it all looks fine'
But it's so difficult to predict how everyone will react and I'm sure she would be mortified to think she's caused this much debate and some annoyance for OP. I think she will have done it with the best will in world, and thought she was doing her duty of care by looking for other abnormalities as per her protocols.
Some better counselling or reading around of literature prior to the scan is a good idea too

If the nuchal is thick, do you know what subsequent tests are necessary to determine if there is a problem mamamidwife?

There's a difference between precisely measuring the nuchal fold to get a risk figure for the chances of chromosomal abnormalities (which you opted out of and the sonographer didn't do) and the sonographer looking at the baby to see if there are any obvious problems (which is what this sonographer did, including a quick eyeball of the nuchal fold to check whether it was obviously far too large). Looking to see if there are any obvious problems is the whole point of scans.

Dueling, a sonographer is a specialised radiographer, so I doubt that Tom, Dick or Hulldad Harry is allowed anywhere near their equipment

Sonographers do need to complete specialist training to dote nuchal scan though.

It was the same sonographers doing the nuchal and dating scans as far as I know, as she checked specifically that we were "just doing a dating scan today".

I would take it in the way Neo has described.

Maja for chromosomal abnormalities , like Downs and several others (turners for example) it's really more invasive procedures like amniocentesis or CVS,
For more structural abnormalities, further tests would probably come in the form of increased ultrasound scanning at frequent intervals to monitor problem and get a better idea of severity/extent. In these cases women are often referred fetal medicine units where scanning equipment is more sophisticated and staff more specialised

Does anyone know what additional testing is offered if there is nuchal thickness found at a dating scan?

I have always been wary of scans done by the NHS in a non-specialist setting, since two people I know where given outrageously high nuchal measurements which proved to be wildly inaccurate once a second (specialist) test was done. Also there's more than one part to the nuchal scan.

Sorry x post there mamamidwife. Would additional ultrasounds be offered before the anomaly scan?

YABU. She was trying to help

MaJa - the nuchal scan is not just about the scan, it is also about the blood tests and maternal age. All of which should be done within a certain date range and at the same time. If you are then classed as high risk you can have an amino or another test where part of the placenta is taken and tested. These also need to be done at a certain time.

FWIW I don't think you're being unreasonable.

I understand that Duelling, was just responding to your point that not all sonographers are trained to do the nuchal scan. At my hospital the sonographer who did my dating scan also does nuchal scans.

Gosh why is everyone so ready to complain. She was doing her job, trying to reassure you - obstetrics attracts more complaints than any other area of healthcare. Maybe all sonographers should just sit in silence for fear of offending anyone. Oh no people would complain about that too. We go into this job because we want to help people and get nohing but grief over the smallest of things. As a matter of fact sonographers tell everyone if the nt measurement is over 3.5 whether they decline or not they decline screening as it can indicate other abnormalities which is different form nt screening. So he was probably letting you know that it was under 3.5mm. Scans are there to pick up abnormalities as well as screen for downs. If you don't want to be told about them then don't bother having any more scans!

We had a similar situation at our 20 week scan. I'd refused any test that gave me a risk ratio as I was going to have the baby whatever the result was and didn't want to be sad and worrying though my pregnancy.
At the 20 week scan the lovely sonographer did tell us the risk of DS but only after having quite a long chat with us about how we felt and what info would be acceptable. He obviously knew it was good news but managed to discuss it in such a way that we wouldn't have known it was bad news if he didn't tell us. I think your woman's big problem was her mode of communication.

Also there is no duty of care to pass on results (good or bad) if the patient has capacity and has made it clear they don't want to know. You just make sure that patient knows the implications of their decision and you document it in the notes. Its all about consent.

I'm not surprised that obstetrics get the most complaints after reading all the threads about poor treatment during labour and birth on here!

I don't think the sonographer should sit in silence, but I do think she communicated what she was doing poorly.

Are you a sonographer Bodicea? Do you know what further tests would be offered and when if the NT measurement was found to be over 3.5mm?

I think detailed heart scans on baby are done between 18-20ish weeks (at least for diabetics they are). So, yes, before the anomaly scan.

I see what your getting at - why advantage is there in knowing this at 12 weeks instead of 20. But it could be as simple as making sure you are correctly booked in to see the required consultants etc. Referrals can take time.

so many typos!