Would you try for an earlier 20 week scan if your nuchal measurement was above average?

[LaCerbiatta]

I had an NT scan and the nuchal measurement came back quite high: 2,9 mm at 11+5 weeks. Did CVS and all is fine but I'm now worried about heart problems.

Should I push for an earlier scan, at maybe 18 weeks? How high is the risk with this measurement?

Thanks!

Hi, what has made you worry about heart problems?

If you are worried, ask for an earlier scan. I just had an additional scan at 18w as I was worried about NT defects, and am still booked in for the full anomaly scan at 21w. The MW seemed quite happy to book me in for the extra scan (i.e. didn't make out that I am a paranoid freak, which I probably am).

meemarsgotabrandnewbump: high nuchal measurements are associated with heart problems. This are apparentely recent observations so it's not very well documented yet.

fiziwizzle: did you also have a high measurement? How much was it?

I see. I would discuss it with your mw. It could be the case that at 20 weeks they can pick up anomalies better than at 18 weeks.

But if it makes no difference, and would put your mind at ease earlier, I would see if they can see you at 18.

Good luck.

I would say 2.9mm isn't too high at all. In some areas anything over 3mm is considered high risk but the cut off seems to vary at different hospitals.
If you are worried you could speak to your MW about another scan but this would usually be a seperate cardiac scan performed by a specialist in this field.

We knew there was a good chance our DS would have a heart defect as he had a very high nuchal fold and confirmed DS and I had the scan at 19 weeks. It was performed by a cardiac specialist from GOSH and even then he said the defect was very small and would probably not have been picked up at the standard 20 week anomaly scan so for this reason you need to be at least 18 weeks in order for them to be able to check thoroughly.
Hope all goes well.
Hope all goes well

Thanks peanut. I suppose it's worth having the detailed scan in case there is a problem and something can be done about it.

I know that in many hospitals the cut off is 3 or 3,5mm but this depends on the stage, right? Looking at the charts that came with my scan report, at 11+5 weeks 2,8mm is way above the lines. The normal measurement increases with time and then sort of plateaus, I think.

Anyway, I think I should speak to a doctor about it. My mw is pretty much clueless...

Hi again tugamommy, Yes the NF does depend on the stage of your pregnancy 11-14 weeks being the most relevent I think.
There is a some information on the web about nuchal folds and the link to heart defects (can't recall exact sites but you could try a search) in the mean time I hope your doctor can help and although I'm sure everything will be fine, wishing you lots of luck I know how worrying it can be trying to find the answers.

Hi,

I'm pregnant with DC3 and had a nuchal measurement of 3. Was referred to fetal medical unit and saw them at 15 weeks. Consultant said that until 20 weeks the view of the baby isn't really good enough for them to check everything thoroughly. As I was there he scanned me anyway but he was adamant that they had to see me at 20-22 weeks for a proper check over.

Had the scan last week at 21 weeks and all was fine as far as they could see.

So from that I would say no point pushing for early anomaly scan.

Fetal Medicine Centre will do cardiac scans from 13-24 weeks but website states usually around 20 weeks. Of course these are private scans - might be worth speaking to you GP re possible NHS referal in first instance.

Have just noticed that you are tugamommy not tugamummy - does that mean you are US-based? If so don't bother checking out FMC - it's in London! Hope all goes well for you.

Hi Kitty, no I'm not US based! English is just not my first language and often my spelling plays these tricks....

I've spoken to a gp about it yesterday, who again was pretty much clueless, and she said she would send my results to the maternity for the consultant to have a look. I'm not so much concerned about the timing of the scan, but more with the quality. The gp mentioned that the scanner (the machine) used for these more detailed anomaly scans was different, so I assume it has a better resolution.... She also said that I would probably have to pay for it, which is fine I suppose.

Hopefully I'll hear back soon.

Thanks everyone

JAsmeen: glad to hear everything was fine with your scan!

Hi tugamommy, I was actually worried about Neural Tube defects rather than having a high nuchal fold measurement, sorry getting my acronyms in a bit of a twist. I've just had a very thorough scan at 18w looking at heart, spine and all sorts (because baby has a single umbilical artery which is a marker for congenital defects - not that I knew that before the scan). I have no idea about the resolution of the scanner (??) but the consultant clearly thought that 18w was big enough to do a thorough check.

Can you speak to someone at the hosp directly rather than going through your GP who seems clueless?

Hi tugamommy - are you London based at all ? If you are going to have to pay I would hugely reccomend the Foetal Medicine Centre like KittyTN - Nicholaides is practically a God in the world of anomally scanning. The detail to which the sonogrpaher goes to is worth every penny and the money goes to Nicholaides' charitable foundation. If you really want to inform yourself you can actually download his training handbook for sonographers. It is pretty medicalised as you would expect but if you are that way inclined it can be very informative. I found it very useful when faced with a soft marker at each of my scans which indicated chronic heart problems in the absence of any other Down's markers.
Good luck

Thanks Toppy: Where can I find that training handbook?
And is this the Foetal Medicine Centre? How easy is it to book? Would 4 weeks in advance be enough, for example?

Unfortunately, I haven't had the opportunity to speak to a consultant who could explain what my NT measurement really means and whether it is advisable or unnecessary to have the detailed scan.... All my information has come from mumsnet and the web...

I agree with Toppy, FMC are wonderful. I did not have my actual 12w scan there but at King's in London but because of a very active baby the scan itself took ages and we weren't done until 20.30 in the evening when everyone was tired and basically wanted to go home. They picked up a reverse flow in the Ductus Venosus and I didn't feel like they explained it properly to me so I got very worried and upset. I emailed the FMC and gave them my results from the scan and asked them if they could give me some better information and if there were scans they would recommend me to take. Eventhough I had not had my scan there a doctor phoned me up the next day and took the time to explain things to me in a way which made me a lot less worried.

So if you feel unsure of what you should do, email or give the FMC a call and talk through your situation - they really are very good!

Best of luck!

Thanks Vallmo. If I call them, will someone talk to me? Even if I haven't been there before? Someone who knows what they're talking about?

Yes, I emailed them and they called me back the day after (I emailed on a Sunday and a doctor called on the Monday). I had not been to their clinic once so they do talk to you and advise you despite you're not having had a scan with them. At least they did that for me. It's worth a try. And they definately know what they are talking about. Give them a call and explained that you're worried and you can ask them if they think you should have another scan and if so, can you have it with them.

Sorry tugamommy - been away from the PC but luckily Vallmo has some excellent advice. Yes that is the website. You can get the training side if you click on Foundation as opposed to Centre. 4 weeks is fine. I have always got an appointment there when I needed one. Nicholaides works there I believe on a Wednesday (he works the rest of the time at Kings) - this can mean long waits as he scans difficult cases and there is no time limits set on this which is fantastic if you need the extra attention but not so good if your scan is routine. Best to book a morning appointment so you don't end up with the knock on effect of any delays. My first 20 scan took 5 scans over an 8 hour period as the sonographer could not get the baby's spine in view - all at no extra charge.

Vallmo - I saw that you also have a reverse flow in the DV. Did you ever read the thread I started a few months ago here I was pretty worked up about it especially after it was followed up by a second soft marker at 20 weeks. This baby is due in one week so I will unpdate it accordingly

Tugamommy - if the cost is not a problem I would def go for a FMC cardiac scan just for the peace of mind. Might be worth checking that they would do all the usual anomaly scan checks at same time - not just heart. If not you could always keep you NHS anomaly scan too.

Toppy - wishing you all the best for next week. Hope the delivery is a good one too, I bet you have sort of overlooked that with all the reverse flow/soft marker business?! Did you opt not to have an amnio?

Thanks everyone. I'll call the FMC today to see if they're able to advise.

I'll keep you posted!

I've just called the fmc and was told that any results from scans done elsewhere can't be trusted and they aren't able to give advise based on them; I would have to have it done there. I explained that I can't have the NT scan repeated, seeing that I'm now 16 weeks but I don't think I got through to the not-very-nice-or-helpful lady on the other side.

I can understand that they don't give free advise over the phone, but there's no harm in saying it!! No point questioning other clinic's results, specially if they can't be repeated, and, if nothing else, can be taken hypothetically....

Will try emailing now to se if I can get through to someone different....

Tugamommy, so sorry you didn't have so good experience with the FMC. My experience was totally different so maybe it does depend on who get end up talking to. I hope by emailing them, a more helpful person will call you back. I did stress in my email that I was very worried and concerned and really would appreciate some clarity. In the call the doctor kept repeating "if your results are what you have put in your email there is no reason to worry" so he only gave his opinion based on the facts I had given him (I wrote down exactly what all my findings were from paper I got after the scan) and general information. I know it's not as satisfactory to get more general advice rather than specific relating to your situation but perhaps that's better than any advice at all? I really hope they do contact you following your email and that they can give you some reassurance.

Toppy - yes, I did come across your thred when I was completely panicking about the reverse flow and did loads of google searches. Your thread made me feel so much better and gave me a bit more peach of mind, not to mention that it actually contained information which was understandable, unlike all the other things that a google search turns up (might as well have been in Chinese!). I was so grateful that you had posted all the information that was there along with all your (and the other womens) experiences. I am having my 20 week scan at King's in 3 weeks time and they have promised take a very thorough look at the heart. I am staying positive and am feeling well but when I think about the scan I am feeling nervous. I so hope and want everything to be well with the little one.

Really excited to hear your news so please do update us on when you have given birth and best wishes!

Tugamommy - that does sound like a rather dysfunctional phone call. FMC woman seems to have missed the point. You want to know when is the best time to have a detailed cardiac scan not can they confirm that another hospital's nuchal measurement was accurate -isn't that right? I have to say I think I may also have spoken to this person too. But the clinicans at FMC are great - those are the people whose opinions you're really interested in. I think if you end up speaking to this person again just know what you want - all she has to do is book your appointment.

Thanks Kitty. But do I want to book an appointment? I'm getting confused.... No one (as in mw or doctor) has told me that I have an increased risk of heart problems and should do a detailed scan. All this has started from information I got from here or from the web....

I just wanted an appointment or a phone talk with a specialist consultant to discuss the risks from my result and what I should do next. I don't want to go ahead and book the scan without having discussed it first...

How about speaking to the consultant at the hospital that did your original nuchal and CVS? Should be easy enough to contact via his/her secretary. You might also try your hospital's screening co-ordinator or the charity ARC (antenatal choices & results). My experience of the last 2 was good but they were quite clear that they were not medically qualified, but very sympathetic.

Hopefully since you have had a CVS and your case presumably has been looked at by a consultant with a fetal medicine interest they don't feel you need a higher level scan than the anomaly scan at 20 weeks? If it was me I would need to ask that question though. I don't think MWs or the average GP would have enough specialist knowledge to comment on cardiac risk with a borderline high nuchal measurement. You need a consultant to put your mind at rest (or recommend a specialised scan). How many weeks are you now? Do you or your dh have any family history of cardiac defects or unexplained miscarriages/ neonatal deaths?