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?

Hey maja.

DS2s 20 week scan showed the nuchal fold to be thicker than it should be. I was sent for a nuchal scan which lead to a referral to a cardiology consultant.

He did a very detailed scan on DSs heart to make sure everything was OK there.

I'm guessing you assume these scans and tests are simply to find out if the baby has DS or similar to prepare the parents but they are actually a lot more important than that.

If something is found then the baby may need special care to be taken at the birth.

Referrals can take time.

Yup, 5 weeks to see the cardiologist and that was fast.

I specifically declined the NT scan, as I did not want to know the risk of DS etc. I wasn't aware that the nuchal thickness was measured regardless though, and this wasn't communicated to me at all.

I am still not sure of the benefit of having the nuchal measurement done at 12 weeks though.

It's best looked at early on because the base of your baby's neck is still transparent.

It is better to know these things as they can be a sign of other problems with the heart, kidneys etc and those need investigated as with DS2.

Maja, yes some abnormalities do necessitate further scans prior to 20 week scan

I Am a sonographer. If the nt is over 3.5mm then it can indicate a heart Abnormality and you would be offered an extra cardiac scan at about 24 weeks gestation. This is totally separate for screening and it is important to pick up heart abnormalities so that we are ready for them when baby is born. i.e in a specialist hospital with he right doctors on hand. We always eyeball he nt - an measures it of if looks big. Have been doing that way before screening officially became something that was offered as an extra.

So hard to get clear information on choices around screening tests.

Are there heart abnormalities that can be picked up on the 12 week scan but not the 20 week scan?

And duelling. The nt - varies throughout gestation it isn't fixed. Just because one so called specialist got a different measurement to he first one doesn't mean they were right or better. You should also never repeat an nt as it gives inconstancies. Most specialist doctors are trained by sonographers to scan when they first start scanning. They also do far less scans overall as it isn't the mainstay of their job. I know who I would rather have do my nuchal any any day of the week.

I feel very sympathetic to Maja; I was 47 in my last pregnancy and 44 in my first, both for very much wanted babies. I had also had multiple miscarriages before.

The problem with the tests for Downs is that they give such little helpful information. To be told that you have a 1 in 10 risk for Downs would sound terrifying and yet you would have a 90% chance that the baby does not have Downs.

To get a definite answer you would have to do an amniocentesis or chorionic villus sampling; there is a real risk of miscarriage with these. We would not expect parents to readily accept medical testing with a real risk of death to the child after birth!

There is an additional issue in that the more stress and pressure a pregnant woman is under, the greater risk of miscarriage, especially in the first 12 weeks. So if you are anticipating the 12 week scan, but are fretting because you supposedly have a 1 in 11 chance of Downs, the risk of miscarriage will be increased. It is already terribly high for an older mum. And an older mum may well be over the moon to be pregnant, be willing to do anything to preserve the pregnancy and very willing to accept the baby, even if there is a degree of disability. There may be a reduced chance of a subsequent pregnancy if this one doesn't succeed; the parents may have waited a long time already to conceive.

I have read a statistical analysis of the value of Downs screening; the estimation was that for every Downs pregnancy diagnosed, a large number of women would be greatly distressed and it was likely that a small number of healthy pregnancies would be lost, variously because of miscarriage secondary to stress, or secondary to CVS etc.

Now, some people would far rather lose a healthy pregnancy that risk a Downs pregnancy, because they could not face that as an option, that is their choice. If anything, that has become a sort of cultural norm, and the testing regime in pregnancy is geared up to this as a preference.

Other people would accept a Downs pregnancy and would do anything to avoid losing the baby they are expecting, that is their choice too.

If I had asked not to be told about DS markers on scanning, then I would be disappointed if this were not respected.

I would think it very reasonable to feed this back to the scanning department. It would be possible to feed back positives also, to balance this out.

A significantly raised nt at 12 weeks can indicate a problem with the heart but the 20 week scan looks at the detail of the heart and helps pinpoint specific heart problems. However subtle heart abnormalities are very difficult to pick up at 20 weeks. We still only pick up something like 40% of heart abnormalities. That is why if there is any indication of a heart abnormality or family history of one we offer a scan at 24 weeks when heart is a bit bigger. It's like a second chance to catch anything missed. That's all.

I think it's important to realise that the scans are essentially for dating, and abnormality screening - so if you really wanted to know nothing, declining all scans would be the best bet.

I think what the sonographer meant was probably that he hadn't conducted a nuchal translucency scan, as you'd declined it, but as part of the scan you had agreed to he had looked at baby's head and neck - so wasn't particularly looking at the nuchal fold, but it all appeared top be normal?

There are some very severe abnormalities like anencephaly (absence of the top of the head and part of the brain) that can be seen on a 12 week scan - and severe cases of spina bifida too. So I think the sonographer probably meant that he hadn't seen these things...does that make sense? Perhaps his words could have been chosen more carefully.

A scan - any scan - is to detect abnormalities. If you don't want to know about that then you should decline ALL scans, otherwise if anything is picked up you will be told and you will have to deal with it.

It seems to me the OP wanted it both ways. I don't think that's a failure of explanation though - surely common sense would tell you this much?

Perhaps you have missed them but several posts indicate that a thicker nuchal fold can indicate cardiac abnormalities. The benefit of knowing at 12 weeks is that you can see a cardiologist sooner and they can monitor the condition for longer. If you didn't want to know any of this, then the scan really was pointless.

Your missing the point herecomesthesun. The sonographer said it was normal for a myriad of reasons not all to do with screening. Patients are bombarded with tons of info at their booking. They can't be expected to understand everything. And even midwives don't understand the full complexities of the scans as they don't do them. Why can't patients just let us do our job and look after them. The sonographer essentially told the patient it was a normal scan -nothing to worry about. He/She would never have said the nt was raised to the op unless they were concerned about other things - like heart problems. Ie an nt of 3.4mm would probably increase your odds of downs but would not get mentioned but an nt of 3.5mm would get mentioned due to the implications for he heart.
Plus it isn't even as simple as that. I have seen cystic hygromas of less than 3mm and told the patients about them as there was a high risk of fetal death in the coming weeks and I have a duty of care to prepare them for this -even though they may have declined screening.

She didn't give you any risk of ds. She told you that, as far as her cursory glance permitted, everything looked fine
I think you need to calm down a little, you appear to have lost perspective completely on this. She was trying to be nice, and you're focusing on a what if situation that didn't actually happen.
Move on and for God's sake don't complain

Can you see a cardiologist sooner candy? I'm still not clear if there would be an extra scan before 20 weeks.

I declined the nuchal scan so wasn't expecting to be told anything about nuchal thickness northernlurker - where is the common sense there?

but the sonographer could just say "Congratulations, that's great. all looks fine" and smile nicely. That would also be looking after the patient.

Saying ""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", well, why bother going there, what does it add to the patient's care other than conveying an element of flouting her request not to be told the NT info. I wouldn't have liked that either. Speaking as someone who has been there as a patient and is also medically qualified.

No, declining the nuchal scan means you don't get a measurement and you don't get that combined with bloods for an overall risk. Accepting an abnormalities scan - which you did - means you get told everything looks fine (or not). I think you are hugely over-reacting here. Might be best if you decline the 20 week scan. Would never do for you to be given reassuring news there too

I feel there has been very poor communication about these scans.

At my booking appointment, the midwife asked if I wanted to accept or decline the nuchal translucency scan. She explained it would only give me a risk and I would need invasive tests to be sure. I declined.

The sonographer also confirmed that I had declined the nuchal translucency scan.

I think it is therefore pretty reasonable of me to infer that the nuchal translucency isn't measured

It's become clear from this thread that the nuchal translucency is routinely measured at the dating scan regardless. The midwife and sonographer did not suggest this to me.

The sonographer's wording to me, "I know you declined the nuchal translucency scan but..." certainly suggested to both me and DP that our wishes not to have that test were not respected.

As a result of this thread I am less irritated with the sonographer, but more irritated that the specifics of this scan were not communicated to me.

NT is used as part if Downs screening, the measurement is combined with measurement if blood markers to give an overall risk (the combined test). I presume is what you declined. A large NT can also indicate heart problems. When I declined Downs screening I was informed that the sonographer would look at the nuchal fold but not measure it. If it was abnormally large just by looking this would trigger further investigation, such as detailed heart scans, just like if they saw another anomaly like a malformed heart or anything missing.
It's important to be aware of what you are agreeing to when you have the anomaly scan. There are lots of things that can be picked up apart from Downs. By having the scan you are automatically agreeing to some screening, because this is what the anomaly scan is for. This is a big subject and midwives usually give a booklet about antenatal screening at booking to explain what all the scans and tests are for. I remember reading the bit about the NT and asking the sonographer to clarify when I had my scan.
So yes, you YABU, but it doesn't sound as if you've had what you are agreeing to or declining properly explained.

Bit of a silly leap there northernlurker that declining one specific test means I wouldn't want to know about any abnormalities.

They probably didnt measure it, but instead looked to see if it looked obviously big.

NT measurement taken during scan is not only indicative of possible Down's syndrome, a high reading can be indicative if numerous other chromosomal disorders. The OP said she didn't want to know if the baby had DS, but she did want to be notified of other anomalies.

I do not see what the sonographer did wrong

OK, well whether looked or measured - I certainly wasn't informed that declining the nuchal translucency test meant I would still be told about whether nuchal translucency was normal or not.

You declined a screening test. You did not decline them looking at the nuchal thickness. We look at the baby as a whole xxx you can't expect the sonographer to avert their eyes. Like I said we have a duty of care. Maybe their choice of words wasn't perfect so if you want complain go ahead - give the poor sonographer some grief, as if we don't Get enough already.