Nuchal fold worry - Please help

[bamboo]

I've just come back from my first scan. The sonographer measured the nuchal fold and was a bit concerned. She dashed off to find one of the consultants but he was delivering a baby so wasn't available. She's booked me into his clinic for another scan on Friday morning - said she wouldn't use any other consultant because some of the others were rubbish . So, here I am all worked up. She said the measurement she was getting could be because I was having a relatively late scan (I'm 16 weeks), also said the machine was the worst one for measuring that sort of thing! And the baby wasn't lying in a v. good position. So what next? Was quite upset at the hospital but feel much better now I'm home. I have a younger brother with Downs so it's not anything I feel particularly scared about but understandably I'd rather Friday's scan didn't confirm any abnormality (I hate that word - my brother is quite normal in my eyes but can't think of a better way to phrase it). I'm just a bit mad at being put through the mill by health professionals. During my first pregnancy a midwife rushed me in for an urgent scan because she detected an irregular heartbeat but when I got to the hospital the next day, after a night of worry, the midwives couldn't believe she'd sent me in as they wouldn't have expected the baby's heartbeat to be regular at that stage .

Should I be worried? Any advice, anyone?

Oooh I feel so naughty using mumsnet before 6pm but it is extreme circumstances.

No advice but{{{hugs}}}. Hope everything goes ok on friday. xx

Well firstly they'll re-scan you hopefully with someone who at least sounds a bit more competant! Then they'll check to see if you've had the triple blood test and then they'll probably ask you if you'd like an amnio.... I thought that 16 weeks was too late for a nuchal fold scan, I might be wrong though!

Sorry to hear this bamboo - what a rubbish sonographer to worry you like that? Didn't think they did nuchal scans beyond 12 weeks x days for exactly this reason, it isn't precise?

How old are you, do you mind me asking?

Not sure whether you shoudl be overly worried but I woudl be very angry at the treatment.

We had a crap consultant nevermind sonographer! She couldn't bring herself to say 'penis' when explaining a kidney problem on the scan and had to say 'willy' and even then burst out laughing, I hope I don't need a C-section by her ever is all I'm saying!

Oooh, bamboo - it's really worrying when anything 'irregular' starts to happen in a scanning process, isn't it?
Did she say what the actual measurement was, because someone was posting last week with the 'normal limits in mm.
It sounds as if the sonographer herself was unsure - maybe because of the baby's position, maybe because of the machine - or her own experience in interpreting scans at 16 weeks.

I really sympathise with you over having to wait until Fri

A nuchal scan at 16 weeks won't be able to reveal anything with regards to Downs Syndrome, the reason the nuchal fold is done between 11 and 13 weeks is because that's where the statistics are available with how thick the nuchal fold measurement should be, past that date cannot be accurate

I am sorry you are going through this, I do not know what to suggest, I just know that a 16 week measurement won't be applicable and hope in some way that can help

good luck for friday, I hope they don't make you wait till the 20 week anomoly scan to find out what's happening

Even though it was too late for a nuchal fold scan you might find that they still ask you if you'd like an amnio, they would at my hospital...needle happy mumbles something naughty lol

If you wouldn't terminate the pregnancy for Down's, then it's probably not worth having an amnio - there's a not-insignificant risk of amnios going wrong.

What Twiglett says sounds right to me, I don't think they can get useful nuchal fold information at this point. They can see soft markers for Down's in the 20-week scan, if you're worried.

You might try giving the Fetal Medicine Center a call to see what they recommend, particularly if private scans are an option for you, and if you're particularly worried.

I'm 34 so a relatively older mum perhaps. Blu - no, she didn't mention any measurements, I guess she may just be being cautious.

I don't think I'd take the offer of an amnio - she said the consultant would go through all my options with me which just sounds alarming doesn't it?

I thought mnuchal fold scans were not reliable after 14 weeks - they haven't been calibrated for feotus's of that age.

If you would be ok with having a downs baby then just have the normal blood tests, and look for soft markers at the 20 week scan.

you seem a relatively younger mum to me bamboo

I might be inclined to call up and ask to speak to the consultant or the head sonographer to clarify what went on in your scan, just in case there's a chance that the sonographer didn't actually know what she was doing

They do seem to be incredibly alarmist sometimes, my consultant took me to the family room with a nurse and sat me down and said something along the lines of 'your son has enlarged kidneys and this could mean that he has Downs Syndrome, if you get the amnio done really soon we can still terminate...' ... I refused it because I didn't mind if he had Downs.. and he didn't anyway, just swollen kidneys FGS lol

Thanks so much everyone for your quick responses . What do you suppose they'll hope to gain from Friday's scan if nuchal scans aren't considered that reliable or useful at this stage?

I'm really sorry your silly sonographer is stressing you out like this

About what you were saying about crap consultants - I had an early scan at 10 weeks to check the age of my baby as we wern't sure of dates. The consultant looked at me during the scan and said the baby looked quite small which may have ment that i had had a miscarriage!!! He moved the camera about a bit and then said OH, its ok threre is the heart beat! Of course we were relieved that evrything was ok but he scared me half to death Surely a comment like this should have been kept to himself untill he was sure one way or the other!!!!!!!!!!!

Hope everything is ok fastasleep Your not old, lots of women have babies well into their 40's.

at that consultant.

srry, ment bamboo not fastasleep, got confused

Bamboo, I've read the sonographers training guide published by the Fetal Medicine Centre.

Obviously that makes me a total expert.

Quoting from same:

"The optimal gestational age for measurement of fetal NT is 11 weeks to 13 weeks and 6 days. The minimum fetal crown?rump length should be 45 mm and the maximum 84 mm.

The reasons for selecting 13 weeks and 6 days as the upper limit are firstly, to provide women with affected fetuses the option of first rather than second trimester termination, secondly, the incidence of abnormal accumulation of nuchal fluid in chromosomally abnormal fetuses is lower at 14?18 weeks than before 14 weeks, and thirdly, the success rate for taking a measurement at 10?13 weeks is 98?100%, falling to 90% at 14 weeks because the fetus becomes vertical making it more difficult to obtain the appropriate image. "

Hope Friday goes OK.

Bamboo - so sorry that you are being put through the mill like this. I had a scare a few weeks ago, unlike you it was my blood tests that got the alarm bells ringing. I completely agree with what everyone here says - 16 weeks sounds way too late to do a nucal fold scan and you are certainly not classed as an older mother. Easy to say but keep calm till Friday and hopefully you will be more in the picture then.

Good luck - SL x

I am appalled really at the sonographer. Sounds really immature and unprofessional, not just towards you and your emotions but also saying all the other consultants were rubbish. What has made her such an expert? My PCT does not do nuchal scans but enquired later when I went for Amnio at 18 wks. The consultant doing the amnio said that 14 weeks would have been too late to have one done.

I have no idea what they think they will get from a nuchal scan at 16 weeks. I honestly think that they are wasting your time and making you worry needlessly. Knowing what a shock it was to have the triple test come back as high risk in my case, I am frankly angry at this sonographer.

FWIW, I think that your baby will be fine.

Thanks everyone - feel much better too this morning.

I'm assuming it is a nuchal scan I'm going for - it will be on a better machine with a proper consultant and obviously the nuchal fold is their focus - are these the only differences between that and a general scan. Sorry, bit ignorant in these matters. They did say I could speak to a midwife before I left if I wanted but, you know how it is, just wanted to get out.

Will I just be given a risk factor, do you think then? I appreciate they want to give me all the facts but personally I wouldn't want a termination so I wonder whether it's all a waste of time - if nothing concrete can be said. I stll intend going on Friday, though.

Hi bamboo,

You walk into the room with a risk factor based on your age. Older women are statistically more likely to have babies with chromosomal abnormalities. (I'll use the word you used to keep things consistent )

The nuchal fold measurement is used to tweak this risk factor up or down. What they have found is that thicker nuchal folds tend to be found more commonly in babies with chromosomal abnormalities. (It's not 100% reliable though, so bare this in mind !)

So, they start with your maternal age-related risk, and then they adjust that depending on how thick / thin the nuchal fold is. By doing this, they increase the chances of 'catching' a fetus with a chromosomal abnormality. (I will repeat that even when they combine these two factors, it is still not 100% reliable).

Finally, the researchers found that if they do a certain blood test at the same time as measuring the nuchal fold, and analyse two substances in the mother's blood (they're called HcG and PAPP-A), they can increase even more their chances of correctly identifying a fetus with chromosomal abnormalities.

But, even with all these factors, these tests won't be 100% reliable 100% of the time. (If you know the mother's age, you measure the nuchal fold, and you do the blood tests, this is called 'doing a Combined Test' and will tend to catch about 90% of all fetuses with chromosomal abnormalities. This means that (1) they sometimes 'miss' problems and (2) they sometimes tell you they think there's a prblem when infact there isn't ! (That's called a false positive).

You're right in thinking that if you wouldn't have a termination, all these numbers can be argued to be pretty much irrelevant, but at the same time, it can sometimes help mothers prepare to care for babies with problems by knowing about what to expect as early as possible.

I hope this has clarified things for you.

I suspect that your pregnancy may be too far advanced for them to measure and advise you based on nuchal fold thickness, so you may well find that Friday is a general scan where the sonographer will look for a beating heart, nicely formed nose / spine and other magical little body parts.

I hope it goes very well for you. If you post your age, I can look up a standard risk factor if that helps.

hub2dee is right! and very well explained too! When I had my scan 4 weeks ago, the nucal was great but the blood tests brought my risk right down to 1 in 23. Apparently it was the PAPP-A measurement in my case and when I went for my CVS (see other thread for that saga!) the consultant implied that the blood tests can be flawed so make of that what you will! I work in a neonatal natal unit and my boss gently told me how there are no guarantees having children and that never stops as they grow up and you go into the whole parenthood thing knowing that so I think what everyone else has said to you here is exactly right. Glad you are feeling better and hope Friday goes well - sure it will do!
SL x

SL just read your thread. Bet there's a big smile of relief still on your face even now (unless you're still in vomit mode). Best of luck with your pg.