to Screen or not to Screen

[BreeQuinn]

Hey all. Im 11 weeks and I am wondering about screening for genetic disorders and early scans (before 20 weeks). I have been doing research and I am not sure I am completely comfortable getting a scan before 20weeks. There is an argument that the sound waves (from the ultrasound) heat fetal tissue and are harmful to the development. Although of course the NHS would never say this. But there have been studies in Sweden. Anyway my question is to Screen or not to Screen for genetic disorders. I have had four miscarriages and this is the first pregnancy where I can gone this far and been sick. I am 33 and very healthy. It seems I can only get genetic testing by start with the NT scan.

An ‘argument’ isn’t evidence.

Ultrasound at the levels in a pregnancy scan are PROVEN to be totally safe. You’d need to hold the probe in one spot for long enough for it to heat the skin (like over half an hour) before you got anywhere near even mildly ‘harmful’ levels.

Totally up to you of course, but I wouldn’t refuse based on groundless safety concerns.

Ps congratulations on your pregnancy :)

Did you know that multiple early scans in pregnancy are proven to result in fewer miscarriages?

You can have a Harmony or similar blood test with no scan that looks for chromosome abnormalities but genetic conditions are usually determined through very invasive testing (amino or CVS) and are not standard. Why do you want genetic testing carried out? What conditions are you looking for - your age and health with have no bearing on them.

Thanks for input ladies.

I am wanting genetic testing as my four miscarriages are an indicator of compromised egg health which increase chances of chromosomal abnormalities. The Harmony test or the NIPT, as the NHS calls it, has to be done in combination with an NT/dating scan. I asked my midwife today. She said there is an older test I can do at 16 weeks but is less accurate.

The trial done in Sweden is some evidence. It was a controlled group of 9000 women. 450 of then had no scans and 450 of them got the usual 12/20week scans. No fetal deaths in the first group and 20 fetal deaths in the scan group.

We also have an anomaly of 'missed miscarriages' that occur after a normal early scan (heartbeat detected). When the loss is finally detected and the woman is given a D&C the foetus is the gestational age of the week of the scan. Something people shrug at and say we don't know why it happens.

Not saying this is all absolute but something I am considering.

Breequin Can you link to that study? I'm having trouble finding it.

ok Swedish study referenced in this medical journal
onlinelibrary.wiley.com/doi/full/10.7863/jum.2008.27.4.499

Another discussion in midwifery today
midwiferytoday.com/mt-articles/ultrasound-weighing-propaganda-facts/

And lots of studies in book form from chinawww.<a class="break-all" href="https://amazon.co.uk/dp/B00X06QDYS/ref=sr_1_5?linkCode=g12&slotNum=0&s=books&keywords=jim%20west&imprToken=dZwUHSJBjfjeHUXr2YiXWg&creativeASIN=B00X06QDYS&ie=UTF8&sr=1-5&tag=mumsnet&ascsubtag=mnforum-pregnancy-3725267-to-Screen-or-not-to-Screen" rel="nofollow" target="_blank">amazon.co.uk/dp/B00X06QDYS/ref=sr_1_5?slotNum=0&s=books&keywords=jim+west&ie=UTF8&sr=1-5&linkCode=g12&imprToken=dZwUHSJBjfjeHUXr2YiXWg&creativeASIN=B00X06QDYS&tag=mamanatural-21

Just realised this first journal doesn't have the Swedish study it references something else. I can't find the Swedish study online either and that probably because its in Swedish not English. But a bit of food for thought in those other links.

You've clearly made your mind up.

I had 2 miscarriages before this pregnancy (currently 33+5) and work in a charity health background. I wouldn't question scans at all. I also know that you can find research for almost anything now.

@BreeQuinn your midwife is wrong. The NIPT test can be done privately and does not need to be done alongside the nhs 12 week scan

I had a ivf pregnancy and was offered it privately at my clinic from 10 weeks

I'm sorry about your previously loses and congratulations on your pregnancy. I can understand how this can be a potentially stressful time for you.

I'm no expert on this but having read the abstract of the Finish (not Swedish) study you reference (Saari-Kemppainen et al., 1990), I do wonder whether the opinion pieces are selecting facts slightly.

The abstract doesn't mention an increased risk of miscarriage but does refer to a significantly decreased rate of perinatal mortality in scanned pregnancies, which they link to an increased number of major congenital anomalies being detected earlier in pregnancy.

I couldn't find the full text of the article in my quick Google (it's from 1990 which probably doesn't help!) so it's difficult to know if the miscarriages were associated with other factors e.g. congenital anomaly or not and whether this was a significant number.

If you can, I would recommend trying to look at scientific journals for information, rather than what is in books or articles. Journals often have strict guidelines around publication which is designed to (though may not always) reduce bias in reporting and reduces the risk of opinions colouring the facts, which can happen in books, where an author is writing their interpretation.

But regardless of what might have been written, you have to make a decision that is right for you. And whatever decision you make, I wish you all the best.

Thanks for your input again ladies.

I appreciate your perspectives and we haven't made up our mind just yet hence the discussion about it.

@PrayingandHoping I think the point my midwife was making was that they wouldn't perform a NIPT unless they medically knew my due date (from a scan) due to the test only being viable after 10 weeks. Im confident with my due date as I track my cycle but that just my word. Im guessing as you are IVF they know your date of conception is pretty accurate.

Anyway yes good point @AlexaC. Medical journals are the way to go. I guess I have the fear. As many of us do. I have been a doula for the last 8 years and I've worked with many women with differing options about scans. I guess the truth is scans can't prevent they can just inform. Do I want that information now or later and I can't possible know everything anyway. Those of us who have had recurrent miscarriage tend have a little extra fear perhaps?!

Anyway thank you for the kind words that have appeared in this thread.

@BreeQuinn well yes you have to be 10 weeks. But unless you meet certain criteria you won't be eligible for an NIPT on the nhs anyway, you'd have to pay privately

Why don't you wait u too there's no doubt you're over 12 weeks even going by variables if you really don't want a scan

You can have an NIPT test anytime through the pregnancy though. So if you are going to have the anomaly scan have it then?

Given that the driver behind this is your concerns about your egg health, keep in mind that the screening only checks for 3 or 4 conditions anyway. You could have NIPT come back clear, only for there to be other health issues which may have been possible to identify through an ultrasound.

I can’t find that study either. I’ve never heard of it either.

Having scans doesn’t mean you have to have screening for everything. I simply had dating and anomaly scans, I didn’t go for any downs screening etc.

I totally understand your concerns though given your history. Really wishing you good luck, whatever you decide.