Growth scan showed 3rd centile measurements so referred to specialist - yet private scan showed no concerns????

[Beastycat]

Hi all,
A slightly odd one, would very much appreciate your opinions.

At my 21 week scan, my little girl was maasuring small on the femur (5th centile). They booked me in for a growth scan at 23 weeks (yesterday) at which point they were very concerned and referred me to the consultant as the leg and abdominal had hardly grown. They wanted me to have a doppler scan and maybe amnio, depending on what that showed.

They couldnt fit me in for two days, so i booked a private scan today. I was astonished to find at this that not only were all the measurements well within the normal range, but that when we discussed dates and how i was completely sure about the conception, she moved my dates in accordance with that and found the baby to be bang on average. Some of the measurements went up by 2/3 mms. My question is, how can thismuch discrepancy be possible?! Should I still be worried? which would be more reliable, private or NHS? I should point out that after the 21 weeks scan i also had a private scan with this same sonographer, so she was able to measure the growth against her own scan.

PErhaps also worth pointing out that my NHS hospital, who shall remain nameless, had to call me the morning after my 21 wk scan to apologise that some of the measurements had been mixed up with the couple after me....!

Am desperate to be reassured by today's scan but seems to good to be true, that actually all is normal. Would love to hear thoughts.

All best wishes to you all.
E

I had a similar experience...the problem was the hospital wouldn't believe my dates..they were worked out on 28 date cycle and mine is 20 days, and the measurements weren't panning out as they should! I went for a private scan and it was very reassuring. Obviously nothing is 100%, but the consultant at the scan said he was confident it would all be ok, and indeed a healthy 10 lb (ouch) baby was born, around about the date I expected! I think with the measurement mix up, it would be fair to ask for a review of all your scans with your obstetric consultant at the NHS hospital, and, if wanted, a further scan to consolidate it all! Personally, I think you and your little girl will be absolutely fine.

Did you have a dating scan at 12 ish weeks? if so they should have calculated your conception date and due date according to the measurements at that scan (which is much more accurate than going by last period and cycle length).

Thanks so much both for your replies. They did do a dating scan but have to say i dont really trust it given the discrepancies in measurements so far!!!
The consultant today found the measurements to be around the 5th centile so not far off the ones they did on MOnday. It seems that there is just a big difference in what they do within the NHS and privately!

It's not NHS or private, but who is doing the scan. A consultant will be far more skilled and experienced than an ordinary sonographer (whether you are paying him or not) so it is that opinion I would go with. at one point my baby was measuring off the scale for abdomen but at a further scan a few weeks later it had come at the top of normal range and then well within it - my consultant said the range on all the measurements is very tight at this point (21-26 weeks) and it takes very little variation to fall outside it. So hopefully it will be the same with you - they will keep a close eye and it will all normalise over the coming few weeks. Good luck.

Actualy hettiebull, quite the opposite! A Sonographer scans as their career choice! A Sonographer is first a Diagnostic Radiographer (imaging specialist) who studies Ultrasound for 2-3 years post grad depending on the disciplines mastered...

A Consultant in most cases will have had NO formal Ultrasound...scanning is simply a feather in their cap. Some Doctors do take formal training but sadly this is not always the case.

Why would you think that a Consultant would be far more skilled in Ultrasound when they have Sooo many other things to do in their day and so many other tasks in their remit?!

Sadly Ultrasound unlike X-rays are completely unregulated and anyone- you included! Can buy a machine and start scanning...

Sorry to go off topic OP! First of all- don't worry. 5th centile is on the small side but you are being looked after and small can be normal too. NHS scans are subject to certain controls that private scans are not and I would be interested in knowing whether the growth charts the private Sonographer (and I assume it was a Qualified Sonographer?) was using as they are not all compatable and the charts can give false impressions of growth.

Your dating scan has a +/- 5 days accuracy and growth scans depend on baby's position, image quality based on a host of factors and Sonographer discrepencies (I myself tend to over measure femurs when I look at my plots against colleagues!)

The important thing to keep in mind is that the scan is a trend in growth, not an exact science. I often tell ladies in your position that we (Sonographers) can cause lots of uneccesary worry...your baby May be small and ment to be that way- we are vastly different as a race and perhaps had you never been scanned the Midwife would deliver her and would think 'what a little dot!' without any of this worry!

Best wishes.

Oh, and by the way- very confused that they could have got the lady after you mixed up with your measurements? We report after the scan and send you on your way before thednext one?! PACS systems (standard at most hospitals) prevent such errors too.

Agree with everything andyflo has said!

why then if a sonographer finds an issue do they refer you to a consultant if the sonographer is actually far more skilled? why then do you hear people saying "the sonographer had to fetch the consultant/refer me for a specialist scan" if actually the sonographer is the real expert?
Obviously am talking about going to a proper fetal medicine consultant who specialises in scanning. I wouldn't ever recommend going to some bloke off the street who'd just bought an ultrasound machine. That would be pretty stupid really.

hettiebull, I only ever come across 'the sonographer had to fetch the consultant' in Mumsnet land and on tv! Not ever in my vast clinical experience. We diagnose the problems. We refer to Consultants AFTER diagnosis as we are great at finding problems but not at the 'what happens next bit'...
The Sonographer is more skilled in ULTRASOUND SCANNING. Not management of pregnancy. That is the Consultant's remit.
Given the rather aggressive tone of your response I have obviously upset you somehow. I apologise for that.

Or it may of course be a consultant sonographer. We refer our abnormalities to a cons. Sono. But not something like this. But then we wouldn't do a growth scan before 24 weeks either.

I hope your scan goes well and you receive the care you should. Do you have a specialist mw you can call to discuss these issues? Or else make sure you ask when you go back for your repeat scan.

Beastycat - I hope all goes well, and that any confusion is cleared up very soon. I can certainly relate to how difficult it is going for scans, waiting for results etc.

Andyflo and TittyBojangles - I hate to derail further, but genuine question - if what you're saying is correct, why have I only seen a fetal medicine consultant for all four of my scans in this pregnancy (and for my previous three failed PGs)? Currently 22 weeks PG, DH and I have an autosomal recessive issue which causes abnormalities incompatible with life and can only be diagnosed by ultrasound scan. Obviously we are monitored very closely with each pregnancy (unfortunately it has occurred in our last three PGs but hopefully it looks like we are in luck this time). Don't want to cause trouble, but I'm genuinely curious now as to why we don't just see a sonographer?

Thanks so much all for your reassurance and comments, much appreciated.

it was a sonographer that scanned me both times....but since posting have been back to see the NHS consultant. he measured the baby as on the 5th centile, but more concerningky found slight notching on one artery. This is very odd as the private scan the day before also measured this and found no notching!! Hmmm.
I am not sure quite what to believe, but have been booked for an nhs growth scan in 4 weeks so hope this means they don't think it's too serious. In the meantime am dosing up on protein shakes and resting as much as possible on my left side....read it ca help and willing to try anything....!!

Best wishes to you all and thanks again.
E

PetShopGirl- cannot comment on your trust- where I work scans are only performed by Sonographers. Docs and Consultants Can scan out of hours for presentation, placenta location etc...Given your history your trust obviously felt you would be better served by (an obviously Ultrasound qualified) Consultant or the reasons I stated previously- Sonographers can tell you the problems but not te prognosis. HTH?
Beastycat not sure why the private scan sampled your uterine arteries? Totally out of their remit and not something I would do unless requested to do so by a Consultant.