I'm afraid of invasive tests! Can I skip Nuchal if I do Harmony?

[Cheila]

I just found out I'm pregnant but I'm already researching all of this. I decided I really want to do a Harmony test and I'm fine with as many ultrasounds as they want to make, but I'm terrified of Nuchal and Amniocentesis and all sorts of invasive tests.
If I do a Harmony test and the results come out great, is it safe to trust the results and skip all invasive tests?

The nuchal screening at your 12 week scan is just a measurement they will review on the ultrasound; the midwife then takes blood from you to see if you have any high risks etc. So at that stage, nothing invasive at all. They would only need Amniocentesis if any of your results came back high risk and you can absolutely decline it, and look in to NIPT privately instead. I had the same concerns so asked all these questions to my midwife!

Nuchal testing is just done during your routine 12 week scan, it's not invasive. An amneo would only be recommended if there were markers for Downs, it's not a standard test

@Cheila I think the harmony test is more reliable than the combined screening test the NHS does. So I would go for it ! But just for your information, the combined screening test the NHS offers every pregnant woman is completely non invasive. It's just a normal ultrasound where they look at the amount of fluid behind the baby's neck and then a blood test- that's it! From what I read the harmony test is more reliable and more accurate than the NHS test. I personally just did the NHS test and hope that was enough 🤷‍♀️

The more invasive tests only take place if you're found to be higher risk in the first line tests I just described. All the best to you !

At my trust they do nuchal then NIPT now so hardly anyone has the amnio so all non invasive. I wouldn't want the amnio either.

You have completely misunderstood how the screening works. What on earth are you reading?

Oh? I could swear I read it was invasive somewhere 0__0
Well, PHEW!!
Thanks for the info and excuse my n00bness ^^;

OP just to add I had the harmony (early at about 10 weeks) because I didn't want to have invasive testing and was 35 so higher risk for chromosomal disorders.

Everything was fine and put my mind at rest - if you're in London, check out the fetal medicine centre which will offer a harmony plus scans package (or at least did three years ago!)

I had the NIPT and so the NHS didn't bother doing the nuchal test at my 12 week scan, they just dated. Nuchal is non-invasive though, you only need amnio/cvs if you come back high risk, and even then you can opt for NIPT first if you wish.

The Nuchal is slightly more accurate for some things than harmony, so worth taking up the offer. And several trusts now offer the harmony or equivalent if the nuchal results are at all concerning.
But you don't have to have any if you don't want them- it's worth thinking about what you would do with the information. If you'd keep the baby regardless there isn't much point testing.

I had NIPT at 10 weeks so I would know prior to 12 week scan.

It was just scan then bloods taken.

You're thinking of the CVS or whatever it is called when they stick a needle to baby's the amniotic fluid. From what I've read, (in Expecting Better by Emily Oster) it is the only way they can 100% say with accuracy if the baby has downs or other genetic disabilities. Even the Harmony test is not 100% is about 98, 99% which would be high enough for me tbh even though with modern techniques i imagine that the more invasive testing would probably be safer nowadays than some years ago.

As others have said you'd only need to do that if the nuchal tests came back with a question mark.

So depending on how you feel, if you want more certainty you could def go with the harmony tests anyway. The only time i bothered looking into that it cost ~£400 and i decided that as i had a very low chance it wasn't worth it. I'd take the small risk.

@cheila The nuchal measurement is part of the combined test they do on the NHS. I had Harmony in advance of this (because I'm 39 and the false positive/negative rate is higher for older women) so that we would find out as early as possible if there was an issue (you can have NIPT from 10 weeks). I had a scan before they took the bloods for that and the consultant measured the nuchal distance at that point. It was also remeasured at the NHS 12 week scan. Nuchal distance can show up other problems as well as trisomy.

I really advise you to read the ARC website to look this stuff up as it's clear and comprehensive. www.arc-uk.org

Thanks for the info, everyone! Sorry, I'm still learning all of this, so I must have confused different tests.

@MiniMaxi I will check out that clinic! Thanks!!

I had the harmony test at 10 weeks (it's just a blood test nothing invasive) and got the results back at the 12 week scan. As PP have said the Nuchal test at the 12 week scan is noninvasive and they combine the two sets of results to give you the likelihood of downs. Ours was something huge like 1 in 100,000. I don't think the NHS testing is that reliable so doesn't give such remote odds. My SIL is currently pregnant and has gone the NHS route and her result was 1 in 700.
If you can afford it I'd highly recommend harmony. You can also find out the sex from it if you want to.

My cousin had some worrying results from the NHS testing and because she wanted to avoid the amnio she at that point paid for the harmony test. That might be a good compromise.

DM if you want anymore info. I can recommend a place if you're in London x

My cousin had some worrying results from the NHS

I had NIPT so I didn't have the blood test they normally do with the 12 week scan. The midwives said it wasn't necessary.

Invasive investigations only arise if a problem is found on the non-invasive tests. And then you still have the choice to say no to it. Both I and my own DD (many years alter!) were told that there was a high risk of Downs and we were offered invasive amniocenticis. We both turned it down on the grounds that we would not abort a Down's baby anyway, so there was no point.

If you'd keep the baby regardless there isn't much point testing.

I really disagree with this- there are lots of advantages to knowing if your baby has a genetic problem prior to birth, for example you can choose to give birth in a hospital that can look after a baby with a heart defect or breathing difficulties rather than having to be separated after birth. For the more severe trisomies it gives you the opportunity to think about what sort of care you would like your baby to have when they are born, and also to plan for yourself- you might choose not to have a c-section in labour for a baby with a severely life limiting condition for example.

I wanted to get the harmony test at 10 weeks but the fetal medicine nurse said better to wait for 12 weeks as if the NT (ultrasound measurement) came out large thet would still recommend invasive testing as it could be other things liek cardiac problems so just didn't want to give me false assurance from harmony.

Fair point @WillaDaPeephole - although major, life limiting things do tend to show up in the scans anyway.

Sounds like from one of your answers you might be in London. If by any chance you are going to be at King's you will be offered Harmony for free if your combined screening risk is higher than 500:1.

I would second the recommendation for the fetal medicine centre. They so a scan at 10 weeks and the test then still do the 12 week dating scan including NT measurement and what can only be described as a mini anatomy scan with a doctor. It was 10 times better than the 20 week one I had on the NHS. If you have a high result then they do the CVS/amnio free which would be done by prof kypros or someone trained by him. This is a package which is £400, £450 for twins and only available at/before 10 weeks
Good luck