Ultrasounds during pregnancy - Sequential and Quad Screening

[SilverMoon010]

Geez, does the worrying ever end? Anyway, I am pregnant with my second.  I am 34. At my first OB/GYN last week (I'm 7 weeks), they did an intravaginal ultrasound.  She asked if that would be okay and since I wasn't expecting an ultrasound that early I didn't really research the ultrasound thing before our visit.  I had several ultrasounds with my son three years ago but back then, I really wasn't as informed about that kind of stuff as I am now. When I was that early with him, they just used the Doppler over my stomach to hear the heartbeat, never an ultrasound.  I never had the intravaginal with him.

I am now starting to worry about the safety of these ultrasounds.  Now, I plan to get this Sequential Screening which consists of screening for chromosome disorders and Down's Syndrome, and they tell me I have to go back twice for that.  Once at 12 weeks and then again at 16 weeks, ultrasounds and blood tests. When I was pregnant with DS, they only had me go one time for this test, now it's twice.  I feel like they keep adding more and more ultrasounds which makes me nervous.  I'm wondering if we should even get this screening test done at this point.  Although I do want to get it done, I'm thinking of forgoing it. We're not considered a high risk but I am older now and if there was a problem I would like to know about it.

Have any of you had the Sequential Screening done and what does it consist of (both times)?  Should I be worrying about all of the ultrasounds, or am I just being a totally paranoid pregnant whack-job ?

[cat13]

From what I've been researching, ultrasound technology is generally seen as harmless, but there is still so much we don't know about the long term effects of it. This is a great article about concerns in ultrasound technology, which mentions that the American College of Obstetricians and Gynecologists says that casual use of ultrasound during pregnancy should be avoided.

As for the other tests tests, I think it's important to consider what you will do differently if you get a "red flag." For example, if your test came back saying that your baby had a higher than average chance of having Downs Syndrome, what would you do differently in your pregnancy? Would this change your birth plans & location, would you get an amnio, would you terminate, etc? By knowing the answer to these questions (no one but YOU can know the right answer), it will help you determine if you want to do the test. This is a great article that outlines many of the pre-natal tests available. Keep in mind that these tests have a very high false positive rate, and one of the worst things for baby is living in a high-stress environment.

My last thought is that after you decide what you which tests you want to take/decline, be confident and stand up for what you believe in. After I decided to decline a 10 week ultrasound, I was bullied into getting it by the doc & nurse.  I was so upset afterwards because of my lack of will, not by the actual ultrasound. Now I come to my pre-natal visits armed with tools to help me even when I want something different than the "norm" in the office.

Good luck with making the right decisions for you and your baby, and congrats on the pregnancy!

[konayossie]

Don't know about sequential, but I had quad screen this pregnancy and there was no u/s, just a blood draw.

[SilverMoon010]

Cat13, Thank you for that article about the prenatal testing.  That was very helpful.  The more I think about it, I am not going to do the Sequential.  I feel like two ultrasounds like that in my situation are unncessary and overkill, especially since it wouldn't change our outcome anyway.  I have thought about the Quad since it is only a blood test but I've read about the false positives and how that could cause unnecessary anxiety, which is definetely not what I need as I have enough of that already! I also don't think I'd want to do an amnio if those tests came out on the high side anyway, but I'm still thinking of getting the Quad.  Haven't made up my mind yet on that one. It says it is only 75% effective at detecting Down's syndrome.

I'm wondering if there are many people who decide to forgo the Down syndrome and neural tube defect testing entirely around my age.  Anyone?

[Jaimee]

Originally Posted by cat13 
As for the other tests tests, I think it's important to consider what you will do differently if you get a "red flag." For example, if your test came back saying that your baby had a higher than average chance of having Downs Syndrome, what would you do differently in your pregnancy? Would this change your birth plans & location, would you get an amnio, would you terminate, etc? By knowing the answer to these questions (no one but YOU can know the right answer), it will help you determine if you want to do the test.

   I decline almost all prenatal testing.  I am 32 and I would do so at 34 as well.  I have gotten early u/s before b/c of dating issues and I have gotten the 20 week scan with my previous two.  The blood tests have extremely high false positives as you've read and can lead to unnecessary worry and further interventions.  For me, there is no reason to get the quad screen or the 12 week nuchal translucency scan at all. 

As far as u/s and doppler use goes, there is some evidence that the doppler is actually worse than an u/s because it uses continuous energy output vs. the intermittent output of the u/s.  But duration has much to do with it as well and if the doppler is only on you for a brief period and u/s is on you for much longer that is something to take into consideration as well.  The vaginal u/s is the worst since there is very little tissue between the instrument and the baby when done internally vs. externally. I asked the tech to put it on the lowest power setting possible (so no sound) when I had one done with my second.  But IMO, it's really about risk/benefit and moderation.  I decided that the risk of interventions like induction later on in my pregnancy is worse than the risk of an early u/s.  I also decided that I want the 20 week scan because I find it one of the most enjoyable parts of pregnancy, but I decline the doppler in favor of the fetascope to moderate things.  Plus I prefer the fetascope since it allows you to hear your baby's actual heartbeat instead of an electronic representation of it.  Usually you can start using it around 19 weeks.  

Anyway, there is always a lot to think about with pregnancy and parenting!  It's all a learning curve so definitely don't beat yourself up for what has already happened.  Just keeping researching and stand up for what you want from now on.

[cat13]

I've also been declining the Dopplar for the fetoscope for now, although I'll probably have my MW use the dopplar during labor because of the convenience of it. I'm doing shadow care at the OBs office, and when I asked the first time, both nurses had never heard of a fetoscope! The doc had to go dig one out of an old box in his office. Just one of the reasons that the nurses give a big "sigh" when I walk into my appointments... yes, it's THAT patient again.

[SilverMoon010]

Here's a question....How do you avoid induction if you have complications that require inducing? I ask because I had preeclampsia with my first and needed to get induced at 37 weeks for mine and baby's safety. I just did everything they told me leading up to the end of my pregnancy, ie., went to the office twice a week and they monitored the heart beat and NSTs, etc., because it was very scary and just wanted to make sure my baby was okay. I'm truly praying I don't have to go through that again for the sake of me and my baby and am wondering how you would avoid it or what other options there were in those circumstances.

Quote:

Originally Posted by Jaimee 

I decided that the risk of interventions like induction later on in my pregnancy is worse than the risk of an early u/s. 

[cat13]

I don't want to put words in PP's mouth (keyboard?), but I think she might be referring to dating. The early us is more accurate for calculating your due date, as opposed to estimating on size in the 3rd trimester by palpations or us.  So if you've had an early us to confirm dating, a doctor won't be as likely to change your due date later on because you are measuring large in the 3rd trimester, and then pressure induction for being "overdue" when in fact you may only be 38 or 39 weeks gestation. 

[Jaimee]

Yep, cat13 is correct.  With my previous pregnancy my hCG levels were through the roof for how many DPO I was and my charts were a bit strange.  I thought I knew when I ovulated but there was a small chance that it had been the previous cycle since my temps never actually dipped below the next cycle's CL.  Anyway, I consented to the early u/s for dating purposes b/c I didn't want to deal with an incorrect due date that could cause panic in the third tri and possibly induction.

As for pre-E, there is some evidence that most cases can be prevented by diet changes. Not always certainly, but it could be worth looking into.

[SilverMoon010]

That makes sense I didn't know much about dating, so now I see what you were referring to.

I'm assuming every practitioner has a fetoscope, correct? I will be asking for that each time I go in from now on.  I know the NP said next visit we should be able to hear the heartbeat and I don't want the Doppler, especially since they just did the u/s. 

Also, when I had the vaginal u/s, there was no sound at all, so I'm assuming that is better than sound, but are there still sound waves traveling through, just less I'm assuming, right? Still learning!

[Jaimee]

You're not far enough along for the fetascope to work- usually 19ish weeks or so, but much depends on baby's cooperation and placental placement.  And no, hardly any practitioners will have them.  Midwives are much more likely, but I would not assume CNM's in an OB practice would have one either.  You'll probably have to request it.  You should be able to simply decline the dopplar and wait until the hb can be heard with the fetascope.   They won't be happy about it and will ask you why so be prepared.

No sound on your vaginal u/s means lower power, so yes, that's better. 

[SilverMoon010]

Originally Posted by Jaimee 

They won't be happy about it and will ask you why so be prepared.

Oh great! Another thing to add to the list that I'm going to have an issue with, along with other medical interventions I don't agree with too!  Lookin' forward to it!

Does anyone have a good article about the harm of fetal dopplers so I can be armed with info when I go? Everything I see on google (mainstream) says they are safe.  I can't seem to find anything otherwise.  Also, I've never been to a midwife but they do have a midwife in the practice I go to, I believe she's an N.P.  Would I have a better chance having less of an issue if I see her?

[Jaimee]

Midwives will have a credential like CNM, CPM, LM, PM, or DEM and if she's practicing with OB's it is much more likely that she's a CNM.  If she's been through midwifery school then it is more likely she will be more naturally minded than your typical OB, but not automatically.   It's also more likely she will have a fetascope stashed away somewhere, but again, you may have to call in advance and request she bring it to your appointment (around 19 weeks).

Listening to the heart rate at every appointment is so common these days that it is often relied upon to assess fetal well being.  Whenever I have declined it at an OB or hospital midwife practice they get really uncomfortable even though there are plenty of other ways to assess growth.  Are you feeling any movement yet?  I know it's a bit early, but I felt movement at 14 weeks with #2 and at 12 weeks with #3.  When's your next appointment?  Keep in mind that it can be a bit early to even hear the hb with the doppler at 10 to even 14 weeks depending on baby and your placental placement.

I know I've read a few articles about doppler.  I'm not finding them easily right now so I'll have to do some digging.  Hopefully I can post back with them.  Otherwise if you feel strongly about declining it, just stand your ground.  If they refuse, personally I would consider switching practices.  Is there a reason you aren't considering a midwife?  It seems your inclination is toward less interventions and OB's will throw those at you left and right unless you get one that is more laid back and/or known to be more naturally minded.

[lookingforaname]

It's a great sign that your office already has a midwife, and yes, I'd definitely request to start seeing her.

Just IMO, I agree with people here that the quad/sequential screen are unnecessary unless you were planning on being willing to abort.  I personally am fine with Doppler and ultrasounds (as long as you aren't getting the ultrasounds every visit or for no real reason.

[Jaimee]

Well here are a few great articles on u/s & prenatal testing, not hand held dopplers, but I thought I'd add them to the mix. 

http://www.mothering.com/pregnancy-birth/what-you-should-know-about-ultrasound?page=0,0

http://www.midwiferytoday.com/articles/ultrasound.asp

http://www.midwiferytoday.com/articles/ultrasoundwagner.asp

http://www.mothering.com/pregnancy-birth/prenatal-testing-and-informed-consent?page=0,0

I'll keep digging.

[SilverMoon010]

Thanks guys.

I really didn't start thinking of the harm regarding ultrasounds until I went to the doctor last week and she presented me with the vaginal u/s that early.  I surely didn't expect that. I thought I would have time to research it beforehand.  I was totally caught off guard and wasn't really sure about it or what to say because I didn't know enough about it but went along with it.  After that, I surely came on here to research and am certainly thinking towards less interventions.  Especially if I have complications towards the end and need some kind of interventions.  I would feel more comfortable with that knowing I didn't have much during the beginning of the pregnancy.  I have pretty much been more of a mainstream/conventional medicine person in the past for myself, but since I had my son three years ago, that has ALL changed.  I always look towards more natural approaches and don't agree with a lot of the technology today.  So much is pushed on us anymore that is not necessary, and I believe a lot has to do with $$$$$$.   I just could never do a natural childbrith though. I guess that's why I never considered a midwife but I think I could at least see her now and if need be see a doctor later on.

I know it's routine for them to check the heart beat on visits but if they don't do the doppler and the fetoscope doesn't register until 19 weeks or so, how do they monitor the baby to make sure there are no complications with the heart beat and growth? That's the thing that's getting to me.   Do you guys just assume everything is okay unless you feel something is wrong?

Thanks for the articles Jaimee -- Doppler articles I notice are harder to find.

[SilverMoon010]

Just curious for your opinion....How do you feel about Dopplers every visit? I don't really remember....do they do Dopplers every visit? I don't think they did with my son.

Originally Posted by lookingforaname 

It's a great sign that your office already has a midwife, and yes, I'd definitely request to start seeing her.

Just IMO, I agree with people here that the quad/sequential screen are unnecessary unless you were planning on being willing to abort.  I personally am fine with Doppler and ultrasounds (as long as you aren't getting the ultrasounds every visit or for no real reason.

[cat13]

Originally Posted by SilverMoon010 

Oh great! Another thing to add to the list that I'm going to have an issue with, along with other medical interventions I don't agree with too!  Lookin' forward to it!

That's me too, the trouble maker!  

[Jaimee]

Usually they do a doppler hb check every visit (starting around 10 weeks).  I decline them until the fetoscope can be used.  When you can hear with the fetoscope varies.  I've seen 16-22 weeks, 19 being average-ish.  And yes, I rely on instinct, fetal movement and fundal height growth to assess progress.   Really there is nothing to be done with the information... at least that's my take for ME.  Some people find it comforting to hear and that is a valid thing, especially if you're dealing with losses.  But if a problem was detected- like it can't be found or it's slow- they would order an u/s and if there appears to be a problem what are they going to do?  You have to wait it out anyway to see what happens- does it resolve or does the pregnancy end and you m/c?   If the u/s confirms there is no hb then you have the tough decision of deciding on medication to induce a m/c, a d&c or waiting for your body to m/c naturally.  Versus if you didn't know there was a problem, your body would almost definitely m/c on its own when it was ready- decision made.  

It sounds to me like you and a midwife or at least a pro-natural OB would be a good match.  Just curious... why do you say you could never do natural childbirth?

[SilverMoon010]

Originally Posted by Jaimee 

It sounds to me like you and a midwife or at least a pro-natural OB would be a good match.  Just curious... why do you say you could never do natural childbirth?

Well, no reason in particular except for TOTAL FEAR! LOL!

I'm certainly no wimp and consider myself a strong person but that is one thing that just scares the heck out of me!