Question about the Nuchal scan/triple test.

[Besom]

How do they present the results to you? Do they just say you are high risk or low risk or is it more complicated than that?

I didn't have it last time but am now nearly 39 and I'm trying to decide whether or not to have it this time. (Have been told I would need to go private as NHS will not do it within the required time frame).

I'm fairly sure at this stage that I would not want to have an amnio, so I'm not sure it is worth having the triple test at all? On the other hand I would like to be prepared for all eventualities.

Any advice/info/experiences would be very welcome.

I had a NT test recently (I'm 37 going on 38). I'm sure you know anyway, but just in case - the nuchal scan and triple test are different things - the nuchal fold scan has to be carried out between 11-14 weeks pregnancy, whereas the triple test is done between 15-20 weeks.

I found this helpful - www.babycentre.co.uk/pregnancy/antenatalhealth/testsandcare/screeningfordowns/

I had to go private as the nuchal translucency testing is not available on the NHS in my area. It consisted of a blood test and a scan to measure the nuchal fold. They also took into account the overall risk according to my age.

I was given results in the form of 'risk' ratio (e.g. 1 in 2000). I got this both for the results individually - risk based just on blood results, risk based just on scan measurement, risk based just on age - and then the overall risk, which combines all the results to give a single figure for risk (1 in x).

As far as high and low risk goes - the 'cut off' point seems to vary between 1:150 and 1:250 depending on where you are. If you count as 'high risk' then you would be offered the option of having CVS or amnio as further testing.

However - if you know in advance that you would not have an amnio (which gives a 'yes/no' diagnois rather than a risk), then it's possible that NT/triple test wouldn't give you a lot of info, but might just give you a lot of stress and worry! IYSWIM. NT and triple tests just give you a risk figure. Even a 'high risk' of 1:150 means there is a miniscule chance of a baby having DS (less than one percent, clearly!). So the vast majority of women who are 'high risk' will have a baby just as healthy as those who are 'low risk.'

All this is a complicated way of saying that there are very good reasons for not having these screening tests. Certainly for women sure that they wouldn't have an amnio, and who would not consider terminating a pregnancy as a result, then I'm not sure what value the tests would have.

(other info - my private NT scan + blood test cost me £180. Costs seem to vary a fair bit depending on the clinic. I also asked to go and have my blood taken the week before the scan, so that I could get all my results back on the same day I had my scan. Otherwise I would have had to wait another week - too stressy IMO.)

Thank you barkfox - that's exactly the info I was looking for and extremely helpful.

Hi Besom

My risk factor from the triple test came back as 1/60 - high risk. I was very upset and stressed about it - until it occurred to me that the risk still added up to a less than 2 per cent chance of having a child with Downs etc.

The risk of miscarriage with the amniocentesis is between 0.5 and 1 per cent - less than my Downs risk factor. I decided to go ahead with the test, not because I would necessarily terminate a Downs child (I didn't know and nor did DH), but because I wanted to make an informed decision about it. If we were to have a Downs child, I wanted to have time to prepare myself. And of course, most of all, I wanted to be reassured that actually my fetus had no chromosomal abnormalities.

You must decide yourself what route you would take if the triple came back high risk - if you wouldn't chance the amnio and would keep a Downs baby in any case, I wouldn't bother.

Incidentally, my amnio went smoothly and the results of the test told us everything was normal - and we were definitely having a girl.

Still, this was the most stressful part of my entire pregnancy, but the relief was also tremendous.

Good luck with whatever you decide.

Thanks for sharing your experience. I'm glad it worked out for you.

I keep going backwards and forwards with it, but hearing from other people is helping me come to a decision I think. At the moment I'm thinking that I'm not going to bother.

Although I would probably not want amnio either, I still decided to do the "double test" (nuchal fold translucency and blood).

DP and I are both very comfortable with statistics. We found that we could easily make our own minds up as to what we'd think was problematic.

So although the high-risk cut-off here is 1:150, for us a risk in that region would most certainly NOT be high risk.

On the other hand, if the results came back saying 1:20 or similar, this would mean for me that I would definitely want to give birth in a hospital rather than at home, just for the off-chance that something indeed was wrong.

And if the result was something truly worrying, such as 1:2, we might have reconsidered and gone for amnio or CVS anyway. In order to either put our minds at rest (still 66% chances!), or, if unlucky, be prepared for what to expect. Mainly in order to know if it was indeed Down's or rather another chromosomal abnormality. Because if it had turned out to be Trisomy 13 or 18, we would have considered termination, rather than waiting for MC/stillbirth/neonatal death which are the most common outcomes.

As it is, I haven't received the results yet. NT was quite a bit higher than average but still non-worrying, and we will just have to wait and see what the bloods say.

Remember as you get older, some of the risks are higher at your age anyway - so a "high" risk result could actually be an improvement on your background risk.

E.g. I'm 40, my risk of having a baby with Down's is around 1 in 100. My text came back with 1 in 130 which is "high" and I was offered an amnio (though I didn't want one). But that result is actually good news in a sense, it's an improvement on what you'd expect for my age.

I think the terminology "high rick" is very misleading and upsetting, and people are having amnios when the risk of damage from that is as high as or higher than the abnormality risk.

But, though I wouldn't want an amnio, I did have the triple test because I think I would have liked to know if there was a really major problem eg the baby might not live - so I could be prepared.

test not text sorry

aargh and risk

why don't I preview?

I am 35. I had a nuchal scan plus some blood tests on NHS at the Royal Free Hospital in London. At the scan they said I'd probably be low risk because they could see the nasal bone and the nuchal size was lower than average, however they said I'd have to wait to get the blood results before I knew that for sure. They promised to call within 3 days if I was high risk.... they didn't call and then 2 weeks later got letter in post saying less than 1:50,000 risk. For my age thats a significant improvement (1:384 at age 35). However I would have had a amnio had the result be high.... personal choice.

If you wouldn't have an amnio or wouldn't terminate then I don't think any point because it would just lead to extra stress, and as others rightly point out its only really a screen for downs not for lots of other conditions.

I'm 35, so had the "double test" as it seemed like something I should do as I'm older (was 32 with DS1 and had risk of 1:2600 so didn't consider that I really could be high risk now), didn't discuss it with DH beforehand, midwife just ticked a box and had blood drawn at the same time as the Nuchal Translucency measurement was taken at the 12 week scan. I got a call a week later from a consultant at the hospital telling me that my result was just in the high risk category, the normal cut-off for my age is 1:150, my result was 1:140. It was a really stressful time, DH and I then had the discussion about whether or not we should risk the 1 percent chance of miscarriage from an amnio when our risk of having a baby with Down's Syndrome is less than that, and it was a clear no. We'd want to have the baby anyway. I just really wish I had discussed it with DH before having the test, because I wouldn't have bothered. It's still in the back of my mind now that there could be a problem, but then again, there could be a problem that they wouldn't be able to detect through the amnio ... so from my personal experience, I'd skip it especially if you probably wouldn't have the amnio.

I am 36 and am pregnant with my second child. I had a nuchal fold test with my first child, when I was 33. This had gone OK in that my risk, after the test, became lower than it was when based purely on my age.

With this pregnancy I felt I wanted the test again. I guess I want to avoid awful shocks after the birth as much as I can (but obviously I have to accept that it is not possible to know about all conditions that could affect our baby)

Anyway, my risk factor started at about 1 in 180ish for my age. It became 1 in 5 after the test.

This was hugely stressful as you might imagine. All concerns about miscarriage risk flew out of the window to be honest and I had a CVS the day after my results. This was also after I've already had 3 miscarriages, one of which was immediately before this pregnancy. However after a 1 in 5 result I felt I absolutely had to 'know' for certain as soon as possible.

My results turned out OK and, so far, I have not miscarried and the test was 3 weeks ago. My experience was awful but I don't regret my descision to have the test.

Personally I think that it is a good idea to be clear about why you are having the test.

Thank you everyone - you have all really helped me get my thoughts into order.

I've realised that I wouldn't want to terminate so there's little point in me having the tests. I can see the point about preparedness but I think I would just get overly stressed by the numbers. And Riven you're right - I need to be prepared to an extent for all eventualities anyway.

peanutpie - I'm glad you're OK.

Meita - I hope you get results to reassure you.

Hello all. This is my 1st pregnancy. We had the NT measured & bloods screened at 12wks by the NHS and I came back as high risk, 1:98 for Downs. The NT measurement was the reason our risk was recorded as high (my bloods were fine and I am 31yrs, so age not too much of a factor).
I immediately asked for a 2nd ultrasound,but the NHS refused saying it would conflict with the 1st?
The reason I asked was due to the sonographer - moaning throughout the scan that her shoulder hurt & every patient she had seen on this day had a sleepy baby, making her job v difficult. This was the first time we had seen our baby and in our opinion the sonographer was v impatient which made us question the NT reading - which was 3.5mm. I was handed leaflets by the sonographer about CVS/Amnio & Downs immediately after our 1st scan, which made me blub instantly.
We rushed straight to th FMC on Harley St,London and paid for 2nd scan & blood test after being told we were high risk by the midwife. This is the best £150 we have ever spent. The sonographer was fantastic, he spent time taking lots of measurements and we also were seen by the top porfessor who said I should go and enjoy my pregnancy. The NT measurement was taken 8 times and varried between 2.6mm & 3.2mm (this was a wk later than NHS scan)and my overall risk came back as 1:4400 - worlds apart.
This reading gave us instant reassurance and therefore we decided against invasive tests.
Since then, we have had our 20 wk scan with the NHS and the FMC and both were happy our baby appears normal, no signs of Downs.
Outside of the worry caused, my biggest niggle was the refusal by the NHS not to rescan. Surely the costs to the NHS for the invasive testing/possible termination or miscarriage far exceed the sonographers time?

I think babbilicious's post also shows something very important - that these tests are not always reliable, the results can vary a lot and things like nuchal fold results depend partly on the baby's position.

The triple test result also depends on your dates so if the dates they have are a bit out (eg they base them on your last period, but you may know better then them exactly when you ovulated) then they can be wrong too.

I don't think the nuchal screening they do on the NHS is as thorough as the ones accredited by the FMF. They don't take the nasal bone and other markers into opinion I believe.

Plus some of their scanners are not as good as the private clinics.