NT scan and bloods on Friday - what will they look for? What is normal? What should I ask?

[leepod]

Hello ladies ..

I am trying to wrap my head around what to expect at my NT scan on Friday. I am picking up lots of information off these discussions, but also finding myself easily confused and definitely overwhelmed!

Can anyone help me understand this all?
What will the look for?

• nuchal fold measurement
• nasal bone
• heart beat (and valves?)
• hormone levels

But, what hormones at what range?
What is the range for a healthy fold measurement?
What should the heart be doing? What heart rate?

What are the questions you wish you had asked while there?

Did I yet mention this is all a bit overwhelming...?

Hi there

At my Nuchal scan they didn't specifically mention the nasal bone, I had to ask so make sure you do.They also didn't look at the heart at all.

I think the fold should be anything below 3 to be 'normal' but mine was 2.4 and I was told it was a bit on the high side so maybe anything below 2 is better?

The hormone levels they are looking at are worked out with some special calculation to do with your age so will be different for everyone I think. I thik they don't want the hCG to be too high and the PAPP-A to be too low.

Hope someone can come and give you more ingo.

Is this a private scan or NHS?

My experience was that they took the bloods 2 days before so the results were ready on the day of the scan. They are looking for raised or diminished levels of 2 main hormones.

IME they looked at the size of baby, whether nasal bone present, the valves of the heart and the nuchal fold.

The range, measurements and heart rate - I am sure they will all be explained to you there and then. If they detect any problems they will explain it. You could research what they should be but not sure this is helpful. Wait and see what comes up - or doesn't - they are looking at the big picture. This is important.

Once they have all the facts and fiqures they feed it into software to give you a risk factor, along with your age.

It is usually very straightforward. I didn't have any questions that weren't answered as had a really good sonographer.

I didn't use the centre on the following link but they have some really good explanations of the screening tests they use.

www.mums.me.uk/nuchalsummary.html

Good luck.

Remember these tests only give you an idea of risk they don't give you definative answer!

Ask when the blood results will be back. I had it done on the NHS over a fortnight ago and I still haven't had the blood results - I was told 3 weeks! Which then prompted us to go private the next day as the results were back within 24 hours.

Thank you all so much for the the replies

Duelingfanjo - thanks for clarifying the numbers for me - will be crossing my fingers for a result below 2 then as optimum..

I will certainly make sure I ask about the nasal bone - thanks for the tip!

fifitot - the scan is private. We opted to go for one in the 12th week (12+6 to be precise). My NHS scan is next week but I was a bit worried that if my dates were slightly out, that would have pushed me out of the date range for a nuchal fold measurement, so we opted for one privately.

In hindsight - reading some of the posts about the conflicting measurements taken at different scans, I am not too sure this was such a good idea.... Seemed so at the time tho!

Thanks for that useful link too! It had the following information which was very useful for me:

"A detailed ultrasound assessment is then undertaken:
? To measure the fluid under the skin at the back of baby?s neck (nuchal translucency)
? To determine the baby?s heart rate.
? To assess the blood flow through the valve on the right side of baby?s heart (Tricuspid Regurgitation)
? To assess the blood flow through a vessel close to baby?s heart (Ductus Venosus)
? To assess the presence or absence of the baby?s Nasal Bone."

It doesn't mention what the range for optimal fold measurements (but thanks to duelingfanjo for that info), but does mention that a result of between 1:2 and 1:150 is considered to be high risk result.

I am confident that things will be explained as I go along, but I also know that it will be a lot to digest for me, and I would prefer to have some sense of knowing what I need to know..... (if that makes any sense?)

topsi - thanks for the reminder, I am indeed aware that only a diagnostic test can give you a definitive result.... I sooooo hope that I don't even need to contemplate that......

axisofevil - gosh, that is a long wait for blood test results. I am not sure what the turn around time in for bloods are in my local hospital, but your timescales make it a good enough reason to get a private one for me too!

But don't be scared if your Nuchal fold is above 2, many are. Your age and bloods will be a big part of it.

My overall risk came out quite high and I did have the Amnio (I know lots of people don't) and all was well so a fold of over 2 doesn't mean there is a problem.

My results came back very low but at 20 week scan abnormalities were found and after an amnio my baby was confirmed to have Downs and other related problems. The results from these tests mean nothing!
Get them to give you a break down of each of the blood tests and what they mean individually.

Topsi I don't think it's helpful to say the results from the tests mean nothing. They do mean something - they give you a risk factor. It is then up to the individual to decide if they need an individualised result. Aslong as you are clea what the risk means then it can be helpful in deciding what to do next.

The 20 week scan is always going to be important too.

There are always going to be false positives and false negatives in any screening process. The accuracy of a good nuchal screen and associated blood tests is about 80% research has shown so to say it means nothing isn't quite correct.

Duelingfanjo - if I may ask, did you choose the amnio over a CVS? Does one carry a higher risk of miscarriage than the other, or was your decision based purely on the timing of finding out the results and what tests are available at what times?

Hi topsi - sorry that you had to go through with that. But thankfully the problems were picked up at the 20 week scan giving you time to decide what to do and/or how to prepare... Out of interest sake, did you have a low or high risk overall? Were you the one in the 1:1,000,000 or was it a riskier total?

fifitot - I will certainly be doing the NT scan and the 20 week scan... You say the accuracy at 12 weeks is 80%, do you perhaps know what the accuracy is at the 20 week scan to pick up scannable abnormalities?

Thank you all sooo much for your time and comments... I am going to be on tenterhooks for the rest of the week... xx

Leepod - I had a CVS privately and it was part of the reason I went privately for the tests. On the NHS I'd have missed the CVS window before the results came back (haven't yet) and would have to wait for an amnio. Mainly driven by the fact that if there were a major problem (and I had the CVS because I came back as high risk for T18) if I found I needed to terminate I'd much rather have done so at 12/13 weeks than 16+.

The fiqures for the NT scan are from the FMF (Fetal Medicine Foundation) as they combine bloods and other markers to give the risk factors.

Ultrasound scans at 20 weeks are like a checklist of issues and they are concerned with lots of things, not just the overall risk of Downs or other Trisomies. On it's own the scan can be quite inconclusive unless there are obvious problems - not all of which are related to Downs. Sorry don't know the exact accuracy.

The guidelines for fetal scanning is that the next best thing to diagnostic testing is a combined test - the NT and the bloods.

(Can you tell I had to go through all this myself?)

Think the risk was 1:25,000 and we were told it was low risk.
If you are the in the unlucky 20% where the tests are not accurate then they are meaningless.
Believe me you don't want to go through the process of having a termination at 20 plus weeks.

hi leepod it was too late for me to get the CVS, though I think the risk can be slightly higher than an Amnio anyway. I was about 16 weeks when I had the Amnio.

Yes I'm sorry you were the one but that is always the chance you take with a screening test. I guess you have to weigh up the odds of miscarriage against the odds of you being the 1 in whatever number.

Even then no test can pick up every potential problem in any event. I think, as someone else has posted on here before, the risk of cerebral palsy is 1 in 400 and there is no way of testing for this.

Most women are only offered the blood tests at 16 weeks or whatever anyway which has a much lower rate of detection. They can't offer amnio/cvs to everyone due to the m/c rates.

I think that for women who don't want to go through amnio/cvs then the screening is really the next best thing. At the end of the day I guess you need to be clear what you will do with the information anyway.

leepod - the fetal medicine foundation has an excellent online course on its website that explains clearly what the different tests are and what results of each can mean narrated by its head. If like me you want lots of info then I'd highly recommend it and I felt a great deal better informed after it.

Re CVS/amnio miscarriage rates I read up and the figures seemed inconsistent. In some cases slightly higher figures were quotes for CVS, in some cases they were shown as the same as with amnio. As we paid privately we had an experienced consultant do it which should help lower the risk.

thanks for signposting me to the course axisofevil - will definitely go through that ahead of the scan on Friday (and ask my OH to also watch the video too!)

Thanks to everyone for all the helpful perspective and suggestions... I /may/ just get some sleep tonight... xx

leepod - can I just ask, is there any reason you think you may be high risk? Such as age? Chances are unless you are over 35 then you will be low risk anyway. You may be worrying about absolutely nothing.

Sometimes these tests create too much anxiety for very little return.

fifitot - I am 34 next month, so statistically age is on my side

I hope this doesn't make me seem a ridiculous worry wart!! I have had a really rough couple of years in all areas of my life bar my relationship with my OH. I sooo dearly want this to go well. All truth be told, my mum is fading into another realm with her early onset dementia, and I desperately want my happy, healthy baby to 'meet' at least one parent from my side.... Things/emotions can be sooo complex

Following this discussion, I feel more confident about the appointment on Friday - so thank you all!

G'nite...

Wishing you luck and got everything crossed for you on friday leepod

I'm 37 (old git) and am having baby number 6, due jan. All other children fine and didn't have any tests done.

Last baby was born jan 2010, a healthy baby girl, but I'm in the same poistion now as I was last year should I or shouldn't I. Dh is so lovely but completely unable to discuss such matters.

Can I have the tests without telling him?

duelingfanjo was what it like having amnio, was it painful. I'm not scared of pain but If (god forbid) I miscarried would they still give me the result ie: I'd know I'd miscarried a healthy baby??

I'm such a mess worrying about it, last year once I decided Iwasn't having any test ie: if i was the one, then so be it and we'll face any challenges head on, but I am more worried now as I have 5 other children one of whom will only be 12months old.

I am so scared of losing the baby, but I watch all these pg programs and saw one where they operated on a baby in the womb to repair his spina bifida, and she didn't lose him so the odds have to be good, about a fine needle, right??

I'm rambling sorry.

Hi superparty, and thanks for the wishes.

I am pleased to say that the scan went well on Friday at the FMC and that our dcctor was very thorough in explaining what he was looking for and pointing out everything as we went along, from nasal bones, to thigh bones, to hands and feet, to blood flow... so yayayayay!!

As to your specific questions, I am sure you could technically do the test without telling him... but I am not so sure I would go that route if I was in your position....?

I think, for me, it was be a difficult secret to keep from my OH and it would be an emotionally difficult thing for me..

Not having had an amnio myself I cannot say how painful it would be. But I would certainly make sure I go to a clinic with the lowest possible rates of miscarriage. I think I would definitely opt for the FMC again.

Please don't apologise for rambling - this is obviously a big thing on your mind and heart at the moment... Do let us know how you get on and wishing you all best of luck and a happy pregnancy!

superparty sorry for not getting back sooner, I didn't see the question.

My Amnio was completely painless. I felt a small amoint of discomfort when the needle went in but remained very relaxed and really it was no discomfort at all. I didn't get cramping afterwards and no bruising.

they showed me the baby's heartbeat before and after the Amnio and I got my results the next day. I really don't know what they do with the results if you miscarry but it's really not often that people miscarry soon after the procedure. i was told 72 hours is a critical time where you shouldn't lift heavy things but you can also be at risk for up to 3 weeks. On tuesday it will be 2 weeks since my Amnio and I feel ok.

The risk of miscarriage is very small but only you can decide if it's a risk worth taking.

As for not telling your DH, you will need someone to drive you back from the hospital, they recommend you do anyway.

leepod great to hear the scan went ok, it sounds like they were very thorough.

Thanks ladies for your replys.

I didn't mean to keep it a secret as such, its just dh is such a wuss emotionally, it makes me more nervous. when i was 10wks with the baby i had in jan, i had bleeding, so i rang him and said to meet me at hospital. as soon as he saw me hes like sorry and crying, and sometimes i'm just like its not anyones fault your making me worse. he trys bless himand is really sweet but i need someone hard sometimes and say yes just do it iykwim.

i have 12wks nhs scan on thursday at 4pm so i'll post back and let you know how it went.

I was reading on here that someone said you have a 1in400 chance of having a baby with celebral palsy, so theres always gonna be something, i just consider myself very lucky to have 5 healthy children already and if they say everything looks fine on thurs then i'll be happy and relax i think, and no more tests x

Wow superparty - 5 healthy children! That's fantastic!

Let us know how the scan goes on Thursday...

G'luck (and strength to your DH :D )