Nurse wants me to do 8 wk ultrasound for 'advanced maternal age' and PCOS ?? help pls

[Ophelia]

I didn't plan on doing any ultrasounds this pregnancy, I thought I had too many the last time (I think it was 3-4, including 8 and 20 wk).
If I decide to do ANY this pg I would think the 20 wk to detect for any issues that we could prepare for. Can't they check for more at the 20 wk than the 8??

So, the same nurse I talked to the other day called and left msg for me. That is the only reason I can think of why she called, to try and get me to do the 8 wk. I am looking for a midwife and will not be going to the clinic for prenatals unless something comes up.

Is anyone here familiar with ultrasounds, 'advanced maternal age', PCOS, and why the 8 wk would be so important for that? I will be 39 when baby is born.

I would have to do the 8 wk this week or by early next week.
Thanks!

[CorasMama]

I don't know what an ultrasound would find at 8 weeks that would be for AMA. However, if you are thinking of an ultrasound to look for markers for down's, etc, you are talking about 12 weeks, the nuchal scan, not 20 weeks. It's done on the same day as the quad screen (the information from both the scan and the finger prick mean more if done at the same time.)

[Ophelia]

Thanks! What is AMA?
Yes, I was thinking if I do one it would only be for birth defects such as spina bifida (unfortunately I did not start on the prenatals until I took the pg test a couple weeks ago), MAYBE downs, etc.

I know the clinic means well, but I feel they are being pushy and I'm concerned about long term unknown effects of ultrasound. When we had the 20 wk done for my son, he kept trying to 'hide' behind the placenta and I didn't realize until much later that those things are very LOUD to the baby and I regretted putting him through that.

I did have low-lying placenta the first time which corrected itself, but my understanding is a MW can check that too.

[Masel]

The main reason I wanted an 8 week ultrasound was to check for multiples. AMA (advanced maternal age) can mean multiple eggs. My grandma was 40 with my mom and she had a twin. I was 38 during my pregnancy and had some other issues including PCOS but mostly I was concerned about multiples (and a little OMG I'm really pregnant after all this time but that was clearly just me.)

[matey]

I had a 7 week scan, but it was a viability scan. Why dont you just ask them to explain their reasoning.

[artemis33]

I would definitely ask what their reasoning is, but if you are going to do an 'early' one (ie, first tri) consider that it is between 11-13 weeks when you'd want to have the one the PP mentioned - to measure neuchal fold, take blood to check for other things.

If I was only getting 1, I'd do the 20 week when they can do a thorough check of anatomy, heart and brain dev., etc.

FTR, I am 39 and due with my 2nd babe next month I decided to have both of those because I was feeling very anxious and depressed about possible problems. I know they aren't perfect detectors, and that they do bother the babe but I decided that it was the least invasive way to at least get some peace of mind.

[CorasMama]

actually, there is no proof that an ultrasound bothers the fetus, and certainly drawing 5 drops of blood from your finger doesn't bother it, either. Also, they're not diagnostic, they're screening. All they can do is give you a percentage chance (so, it'll tell you that your baby has a 1:X chance of having whatever genetic problem,) so you can make more informed decisions about whether you want a diagnostic test (cvs or amnio) or just to be more prepared or more at ease. Of course, the vast, vast majority of women who get the screening done get put more at ease by it.

[katelove]

Originally Posted by CorasMama

actually, there is no proof that an ultrasound bothers the fetus

That's true. However, on the flip side, there is no proof that it isn't distressing either.

OP, off-hand I can't think of a valid reason for an 8 week ultrasound based on advanced maternal age. As other's have mentioned there is the nuchal fold test between 11 and 14 weeks but that is really only helpful if you are sure (or pretty sure at least) that you would want an amnio to definitively diagnose before birth.

As for the PCOS, my understanding is that it does increase your risk for certain pregnancy-related problems but none that will be helped/diagnosed by an ultrasound.

I think it would be quite reasonable to refuse it based on the info you gave in your first post. If you're undecided though (or just for fun ) do what someone else suggested and keep asking them what information specifically it would provide.

[staceychev]

Originally Posted by CorasMama

Of course, the vast, vast majority of women who get the screening done get put more at ease by it.

With all due respect, this may be the case if you are happy with your results. I came back with a 1:39 chance of Downs during my first pregnancy at the age of 32. We declined the amnio because of miscarriage risk, and stressed the entire pregnancy. The first 3 weeks after my screening and before my L2 u/s and genetic counseling were hell, and my practitioner (I switched, FWIW) was an uncommunicative jerk. I've spoken to many women online who have had a similar situation, and when I declined the quad screen and nuchal scan this time, my midwife's response was "Yeah, that's really common for people who had a bad experience with another pregnancy."

Anyway, to OP: I think the 8-week is either due to your practitioner or to your PCOS. I work with a pretty mainstream midwife group, am advanced maternal age (37) and have treated hypothyroid. I've had 3 growth scans with a fetal medicine doc because of my thyroid, but my age hasn't been an issue, and they never asked for an 8-week.

[potatocraft]

The PCOS and ama can both increase your chance of multiples. You have a better chance of releasing more eggs at a time with both.

[mediumcrunch]

IMO, the AMA reason is bogus but with PCOS checking for multiples and dating the pregnancy are not out of hand. Of course, refusing is your option and wouldn't/shouldn't be a big issue.

[MiaMama]

My first appointment with this pregnancy, they tried to do an internal ultrasound at 8-9 weeks for dating purposes. I was 25yo.

I say they tried to, because they wheeled the machine in the room and I was like "what is that?" and they said "oh, its for your U/S."

I guess its standard practice now at that hospital. I declined.

[Lilcrunchie]

This is my third pregnancy and I've had early USs with each pregnancy.

However, my first DC was conceived via injectables/IUI under the care of a reproductive endocrinologist, so they check for multiples, etc. early on. (had several early USs in that pregnancy).

With my DD and my current pregnancy, I had early USs but because there was NO way I could date my pregnancy otherwise (conceived with metformin but without fertility drugs). I have very irregular cycles. DD was conceived after a 100+ day cycle for example. My current pregnancy was conceived during a really, really long cycle too. I really would have had no way to date them. I didn't relish having an early US but agreed to it because I didn't want someone trying to make me "post dates" excessively early either, kwim?

I have never had anyone suggest to me that there was a need for me to have an US in pregnancy for PCOS otherwise though, kwim?

[Ophelia]

Thanks for your opinions and suggestions, that helps a lot! I know I don't want to do 8 wk, but still thinking of 12 or 20 wk, whichever has the better chance of detecting anything. At least I have some time to decide.

Yes, I was thinking of calling her back and probing specifics. I'm really not concerned about multiples because for me I think that would be rare, plus I would eventually find out anyways later due to size if no ultrasounds at all.

I find it a little crazy that PCOS'rs are prone to spit out more than one egg at a time, seeing as I seem to have trouble ovulating in the first place! I believe you, it just seems crazy.