Any soft markers visible after 13+6 weeks?

[Beanbeany]

Hi there. I am new here and this is my first post! I am 36 and 13+5 wks and have had a combined test result of 1:99 for T21. NT was good - 1:4000 so it was the bloods that increased the risk. I've spent the weekend thinking about what to do and whether or not to have an invasive test and I'm sure I read online that it is possible to have a scan
at around 15 wks which can check for some soft markers for T21. However, I have just phoned the Fetal Medicine Clinic to ask and the receptionist says no, 13+6 is the cutoff. Obviously they must know what they're talking about but I wonder if anyone here has had or even heard of such a scan.

Also, does anyone happen to know if it is standard NHS practice to check for the presence of a nasal bone and/or other soft markers when they do the NT test? Or is it just something you only get at a private clinic? The sonographer I saw (NHS) didn't mention this on the report but that's not to say that she wasn't checking in the first place.

I won't be able to have a CVS as I have increased BMI and a posterior placenta which means they would prefer to do an amnio after 16 wks if I did decide to have it. So I do have a couple of weeks to make my final decision IYSWIM.

Hope this all makes sense. I was in touch with ARC as soon as I got my result and will be speaking to them again today but I'd also like a few MNetters opinions!

TIA. sense.

You can have a soft marker scan at around 18 weeks which checks heart, gap in toes, length of femur and looks for any other signs. Google scanning centres for more info because you can get them. In fact I nearly did so am suprised FMC don't do them.

Maybe they got confused as the nuchal is a different scan and does stop at around 13 weeks. The marker scan can't be done til about 18 weeks don't think. You would stil be able to have the amnio after this date also.

There seems to be alot of confusion IMO about what the NHS offer in terms of a nuchal screen. I know most private scanning centres factor in the nasal bone and heart issues into their risk assessment. You may need to check about this again to ask them. There appears to be a fair bit of variation in practice between hospitals on this.

www.mums.me.uk/markerdetail.html

This is from a private scanning centre I considered and explains marker scans.

That's a useful link, Fifitot. Thanks.

I was surprised about the FMC too. I could only speak to a receptionist as the doctors are all at some conference this week but I still assumed she knew what she was talking about. I did explain that I'd had a NT scan a didn't want another one but maybe I wasn't clear enough.

The NHS thing is so frustrating. I wish I'd gone for my 12 wk scan knowing what they could potentially look for. I was just so happy to see a heartbeat and a small nuchal fold that I didn't question it further. My DP thought the sonographer said something like "nice little nose there" but is not sure and in any case would have just thought she was pointing out things for us to look at. She is a very experienced sonographer and I wonder now if she was checking for soft markers even though she didn't mention it.

Ooh, so much to think about!

Having read the marker scan link I would say it sounds very like my 20 week scan with the NHS. She pointed out the good nasal bone, kidney function, with lots of urine, long legs and arms and examined the heart well. I don't think she looked at the nuchal scan but was very reassuring on all other levels.

I know someone who was in a similar situation to yours and she had a scan at the fmc to look for soft markers at 17weeks. She got much better odds after that!
Try calling the fmc again, maybe you'll talk to someone better informed!

My baby was born with DS. At around 18 weeks I had a scan to check the bladder, bowel, femur length and heart. It was a heart defect thar was picked up (around 50% of babies with DS have heart problems) everything else checked out "normal" he also had a nasal bone at the 12 week scan.
DS can be difficult to pick up on a regular scan especially if there is no heart defects hence the fact most babies with down's are diagnosed after birth.

The only way you will know for sure is to have the invasive test or if this is not for you look in to having a detailed scan from 15 weeks.

Adrienne, do you mind me asking if you had the 18-week scan for the same reasons as me? To specifically check for soft markers after a not so great (but not terrible) combined test result? Or was yours an early 20-week scan? Just tell me to mind my business if that's being too nosey .

Hello. In my area, there's also a further set of blood tests (the triple test) at about 14/15 weeks which they add to the nuchal/PappA blood result and give you a combined risk. This with the more detailed scan (18-20 weeks where I am) might give you more reassurance, or else you're still in time for the amnio if you'd rather know for sure. It might be worth asking your midwife if you get the other blood tests - particularly as it seems to be the blood results which caused some concern so far. As for soft markers, I had a baby diagnosed with Downs and he also clearly had a nasal bone at the 12 week scan so I don't think that's a great indicator. Very high nuchal fold though in our case (1:4 risk) so that made it more obvious. Best wishes.

I asked about the nasal bone at the scan I had (private) and was told it was there but since I had my results (1:80) I have researched it online and the nasal bone seems to be something completely different to what was pointed out to me by the woman doing the scan.

I kind of don't trust the woman who did mine as before we went in the main guy (Who we were meant to be seeing) seemed to be explaining to her how to use the machine and so since realising that she was just pointing out the nasal tip my confidence in the whole thing has dropped.

Beanbeany, My baby had already been diagnosed with DS via amnio (after a 1 in 3 combined test result) when I had the scan, we decided to continue the pregnancy.
I had two scans at 18 weeks, one a slightly more detailed 20 week scan which as I mentioned looked at the bladder etc and the heart scan which was performed by a specialist from GOSH.
Both commented that a normal 20 week scan would have not have raised any concerns, even the heart defect.
Of course soft markers can be picked up in some cases and if you would rather not have invasive tests this is the best route to go down in my view but of course nothing is certain, it's a difficult one.
Let's just say I will be going down a different route during my next pregnancy!

I haven't any experience of private care all my scans etc were NHS and I have no complaints (although I understand testing and scans offered can vary)
I hope I haven't confused you further just wanted to give my own experience and good luck with the choices you make.

Thanks everyone so far. And thanks Adrienne for sharing your story. It's not confusing at all, I really wanted to hear other's experiences. You can get so bogged down researching stuff on the internet - real people and real life, however daunting, is much more grounding.

actually my dd1 had a what was classified as a hard marker for down syndrome at her 20 week scan and we were referred to a fetal cardiologist to check a heart defect that resulted in us being told that if dd1 was born without down syndrome it would be quite rare.

With dd2 they picked something up with her heart again that they classified as a 'soft' marker and that it could raise the chance of her also having down syndrome.

I would check that again as our fetal cardiac scan was done at the Harris Birthright Trust at Kings Hospital where Prof Nicolaides works also. With dd1 we were given two very detailed scans around 22 and 24 weeks and lots of measurements etc were taken in terms of different aspects of her body etc to see what indications they may have shown.

Hi again. I just wanted to update this thread as everyone was so helpful and plus I've really found it useful to read all the different threads so wanted to share this with other people in case it helps anyone else. So....

The midwife who gave me my NT risk was wrong as it was 1:1000 not 1:4000! My blood results were 1:19 risk which is why the combined risk was 1:99.

I rang the FMC again and spoke to a different receptionist who was much more helful and knowledgeable and said we certainly could have a scan for soft markers after 13+6. We had that this week when I was 16 wks. It was very detailed and everything seems to be "normal". The original receptionist had also said they would definitely not recalculate my risk but they did and said based on that scan it's now 1:200. The revered Nikolaides appeared to chat briefly and basically fired questions at both of us in order to get some quick "from the heart" responses. It sounds a bit mad/rude but it was very useful and he was great.

And today I've had my NHS scan with my consultant which was booked in case I wanted to go ahead with the amnio. He is also an excellent and, I found out at FMC, highly-regarded doctor and that scan also put the risk at 1:200.

The upshot is we have decided not to have the amnio and to accept the risk as it stands. Both consultants were very supportive of this decision and also pointed out that you can still be the "one" even if you have the best odds in the world.

So thanks to everyone who responded to my thread and my thoughts to everyone out there who is going through this right now as it is such a tough thing to deal with.

Sorry, it's me, beanbeany! Not a name change but I am on someone else's PC and they logged me on as them!