How important is the Nuchal Translucency screening??

[shawnnalady]

My obgyn is really pushing for it, but I plan on switching to a midwife to -hopefully- have a waterbirth.... the midwife says it's not always accurate and totally not necessary..

KINDA TORN HERE.

Anyone have any experience with it, or stories where you wish you did take it??

[AiryFairy]

I never considered it because the results wouldn't change anything for me.  I've read it has a high rate of false positives and it's not without risk of miscarriage.  Your OB is probably money motivated.

[dealic]

I skipped it because I don't like the high rate of false positives and negatives, because I wouldn't get the second test because it increases risk of miscarriage, and because I wouldn't abort in any case so it doesn't seem relevant. If I have a child with special needs, then I will deal with that. I'm honestly more concerned about autism than down syndrome and there is no test for that and I have a higher chance of having a child with it.

[sunflwrmoonbeam]

The NT screening is just an ultrasound at 12 weeks where they measure the spinal cord and I believe the bridge of the nose. Basically if you want a 12 week ultrasound you might as well do the NT, it's no more invasive than any ultrasound. It's the CVS test done at 14 weeks that has a high risk of miscarriage, as that involves a needle in the belly.

I had the NT with my last pregnancy because I wanted the 12 week ultrasound, but I'm not doing it this time because I got my "is it still alive?" ultrasound at 10.5 weeks.

[serenbat]

It's the CVS test done at 14 weeks that has a high risk of miscarriage, as that involves a needle in the belly.

 

 

this is incorrect - a CVS is not done in the "belly" that is an amino and some will do CVS at 8 weeks depending on the situation and it is far more in-depth and will give better info than a NT does- depending on what you want to test for

I did the CVS- I had more info then simply the NT

[shawnnalady]

Ok, thanks ladies.. 

So since I know that the results wouldn't change my mind for the baby, and that I wouldn't get the second testing if it was positive, there's really no reason for me personally to do it.

I had an ultrasound @ 9weeks to confirm pregnancy so I don't think I'll need another one for a while.

Thaaank you for the input!!!

[sunflwrmoonbeam]

Ah, I knew it involved a needle into the uterus, didn't know it went through the cervix. Still, yow!

[alittlesandy]

I want to chime in on the differences between the tests. Nuchal Translucency screening is a non-invasive ultrasound that is actually very accurate. It's the quad screen (blood work) that has a high rate of false positives. However, you can have a Nuchal Translucency screening without the quad screen blood work.

I am having it done because if there is a problem, I will NOT terminate, however, I live in a small town and they recommend that if there are complications (such as spina bifida or downs) that I transfer to a perinatologist in the nearby city. I am 40 and spina bifida runs in my family, so I want as much information as I can get. However, I will NOT be having CVS or Amnio because of the risks.

My last pregnancy was with a midwife and low-tech, but after two losses I now hate to admit that I am glad for ultrasounds.

[prettyisa]

I just want to throw out there that other than the possible reasons to transfer to a specialist OB (like alittlesandy mentioned) the other reason people who wouldn't abort might do these tests is 'to be prepared' in advance of possible birth defects so they can plan ahead. For me, it wasn't worth the stress--I figure there's plenty of time to rally support and figure out specialist care once the baby is here and I can see what we're dealing with--but some people might feel that they need to mourn the fact that their baby won't be 'perfect' and take the time to read up on these conditions and get an idea of what kind of support they'll need to have ready when the baby arrives. I think it's a pretty personal decision, although the false positives mean you could do some mourning unecessarily. And, of course, a baby born with Downs or other conditions is no less 'perfect' a child than one born without, just different.

[lalazap]

Originally Posted by alittlesandy 

I want to chime in on the differences between the tests. Nuchal Translucency screening is a non-invasive ultrasound that is actually very accurate.  However, I will NOT be having CVS or Amnio because of the risks.

 

I am a midwife, and agree that NT is more accurate than blood testing alone, but what it is particularly good at is RULING OUT conditions, not diagnosing them. If I were doing prenatal screening because I wanted access to this information, and my result came back positive/above the cut-off for a particular condition I myself certainly would want to confirm that with a diagnostic test, ie amnio. Especially if I were going to change my care provider or place of birth based on the screening result.

This is why:

The NT or NT+blood test result is still a risk estimate, ie 1:20 000, or 1:2000 or 1:200 or 1:20, and while the reassuring/low-risk/below screen cut-off/negative (however it's worded in your area!) results like the 1:20 000 or 1:2000 are quite reliable (ie. very few babies with the target condition are missed) the screening parameters are structured in such a way that many more women are identified as higher-risk/above the cut-off/positive than actually have babies with target condition. It's done this way on purpose so that very few people are missed. Some people call this a 'high false positive rate'. 

So if my result were positive, there's still a good chance that the baby does not have the target condition, and I'd want to know for sure before I made any big decisions about how to manage the pregnancy, whether it be termination or different care provider or different place of birth.

Check out this visual aid that I find super helpful in explaining this to my clients.

I'm not doing prenatal screening by the way, but spend a lot of time helping clients figure out if they want to do it.

Edited by lalazap - 9/30/11 at 12:17pm

[NicMom]

Just as clarification, either CVS or amnio can be done through the cervix or stomach.  It just depends on the location of the target specimen.  In CVS testing they sample the placenta and the preferred route is through the cervix, though through the abdomen may be required if it isn't reachable through the cervix.  For an amnio the target specimen is the amniotic fluid.  It is generally easiest to go through the stomach to reach the fluid. CVS testing can be done earlier than amnio but has more risks and isn't quite as reliable, though still 99%+ accurate.