What tests will you get, if any? - Page 2 - Mothering Forums

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#31 of 51 Old 02-18-2011, 11:00 AM
 
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I know ultrasounds are very popular and everyone expects to get one, but research indicates that routine ultrasounds, without any medical indications (i.e. you are not having bleeding or any other problems) do not improve outcomes. This means that the same number of babies have problems before birth/at birth/after birth whether you get an ultrasound or not,  if you have a healthy pregnancy. You can find more information in this 3 part series about ultrasounds at http://www.mothersofchange.com/2010/06/routine-ultrasound-part-i.html


Again, if you had read the research that is presented in the articles you linked to, you would see that that the study the author quoted from was on the use of doppler ultrasound, which is a very special test used to examine blood flow in the umbilical cord and the uterus. This "evidence" the author presents in her article has nothing to do with the testing being discussed here.  Another Cochrane review that is often misquoted as finding no benefit to routine ultrasound looked only at the relevance of routine ultrasound in late pregnancy. This did not include the routine anatomy screen around 20 weeks which identifies most anomalies of the baby and placenta,which again, is the topic of this discussion.

 

I am not advocating for any of these tests during pregnancy, but women need to make these decisions based on factual information.

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#32 of 51 Old 02-18-2011, 03:39 PM
 
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I will have a 20 week u/s for my husbands peace of mind(and to find out gender while we are at it lol, but I wouldn't have one just for that reason.) If my midwife felt the increased need for me to get a test then I will decide, but if there is no indication in place I won't. I don't test for GBS because I deliver too quickly to get antibiotics during labor so I act as if I am positive and do hibiclens rinse and monitor baby closely afterward.


Wendy,loving wife to Brian, happy mama of Trinity(15), Christian(15), Gavin(13), Logan(11), Griffon(9),Jubilee(7), Epiphany (4), and Lucian Danger( born 18 April 12) <3
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#33 of 51 Old 02-18-2011, 06:46 PM
 
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I got the whole list of tests they do today (it was my nurse intake appointment). No pressure, just "this is what we offer." I'm declining the CF test. I'll probably do everything else. My practice still seems to be doing the quad screen. I get ultrasounded to death because I have hypertension and take beta blockers and the baby's growth needs to be monitored.


The only one that annoyed me was being asked to do the 1hr GTT already. Mostly because of their policy: they ask everyone over 200 lbs to do it, so they can rule out existing Type 2. In my case, it's actually not a bad idea (I'm seriously insulin resistant and was on Metformin + Byetta pre-pregnancy) so I'll do it, but if I knew my sugars were totally normal I would have refused.


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#34 of 51 Old 02-18-2011, 10:02 PM
 
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I'm generally against a lot of testing, but do have some considerations due to my age (43). I already had a quick peek u/s this week, and will do the NT scan and the 20 week u/s. If the NT scan gives me bad numbers, I will do an amnio.

 

My midwife does a modified GD test which involves eating a McDonald's pancake breakfast and then testing blood sugar. I still hate this because the carb load makes me sick, but it's much better than the glucola.

 

We don't bother testing for GBS. I was positive in one pregnancy, so we just treat as if I'm positive again with a course of antibiotics before and during labor.

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#35 of 51 Old 02-18-2011, 11:38 PM
 
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The best evidence to date indicates that routine ultrasound screening at any point in pregancy does not "reduce adverse outcomes for babies" quoted from the Cochrane review http://www2.cochrane.org/reviews/en/ab007058.html
However, "Early ultrasound improved the early detection of multiple pregnancies and improved gestational dating which may result in fewer inductions for post maturity."

More research may be needed on this topic, as the Cochrane Review admits that the evidence is not robust, but this is the best evidence we have right now.

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Again, if you had read the research that is presented in the articles you linked to, you would see that that the study the author quoted from was on the use of doppler ultrasound, which is a very special test used to examine blood flow in the umbilical cord and the uterus. This "evidence" the author presents in her article has nothing to do with the testing being discussed here.  Another Cochrane review that is often misquoted as finding no benefit to routine ultrasound looked only at the relevance of routine ultrasound in late pregnancy. This did not include the routine anatomy screen around 20 weeks which identifies most anomalies of the baby and placenta,which again, is the topic of this discussion.

 

I am not advocating for any of these tests during pregnancy, but women need to make these decisions based on factual information.



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#36 of 51 Old 02-18-2011, 11:59 PM
 
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"A huge Canadian study demonstrated that the only effect of routine glucose tolerance screening was to inform about three per cent of pregnant women that they have gestational diabetes (20). The diagnosis did not change the birth outcomes." Quoting from Dr. Michel Odent at http://www.wombecology.com/maternalemotional.html and the study he quotes is Wen SW, Liu S, Kramer MS, et al. Impact of prenatal glucose screening on the diagnosis of gestational diabetes and on pregnancy outcomes. Am J Epidemiol 2000; 152(11): 1009-14.

 

I know that many midwives look for ketones in the urine strip, and if there is an indication of ketones then they recommend the woman eat a meal high in simple carbs (white rice or pasta with a dessert) and then test their blood sugar using a glucometer at intervals after the meal. I would be interested in a link to the research that indicates that urine strips are not effective.

 

Dr. Michel Odent recommends (at same website as above) "Another routine screening practiced in certain countries is for so-called gestational diabetes. This is the reason for using the glucose tolerance test. If the glycaemia (amount of glucose in the blood) is considered too high after absorption of sugar, the test is positive. This diagnosis is useless because it merely leads to simple recommendations that should be given to all pregnant women. These are recommendations regarding lifestyle, particularly dietary habits and exercise."

 

I also know that there is much debate about the current method of testing for gestational diabetes, because it is not an actual measure of how a woman's blood sugar would fluctuate, since hardly anyone would drink such a sugary drink as part of their diet. Some midwives think that using a glucometer is more accurate because it gives a more accurate overall picture of how eating a meal affects the woman's blood glucose levels.

 

It is my understanding that Group B strep is another controversial issue, where the evidence is not entirely clear, particularly when it comes to treatment.  I would be interested if you could point me to the research you are referring to about the tests being accurate for 5 weeks. I think it is also important that women are aware that even if in the majority of cases the tests are accurate for 5 weeks, in some cases there is no GBS at birth, which means if they opt to receive IV antibiotics during the birth they may be receiving treatment for something that doesn't exist. Also, it is not the testing protocol that is effective at preventing transmission of GBS, it is the IV antibiotics. And routine antibiotics for something like 30% of the birthing population, some of whom may not even have the bacteria present, has significant risks of its own. For more on this see http://www.mothersofchange.com/2010/09/group-b-strep-look-at-facts.html
 

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MDC should not be a forum for posting potentially harmful misinformation like that posted above.

 

Gestational diabetes can occur without signs. In several of your points you referenced research, yet you seem to be unaware of the research indicating that routine urine dips for protein and glucose in pregnancy are not evidence-based and it is recommended that they be abandoned. Also, I am not sure how you can claim that home glucose monitoring with a glucometer (that by industry standard is only accurate to within +/- 15%!) when recommended standard for the glucose tolerance testing is what has been shown by evidence to be the most effective at diagnosing gestational diabtes.

 

Group B strep is a normal bacteria to be found in the gut, not in the vagina or urinary tract. True, it is transient and just because you have it today does not mean you will have it when you give birth. However, again, the evidence is that the results of the test are accurate for 5 weeks, and that the testing protocol is the most effective at preventing transmitting group B strep to your newborn.



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#37 of 51 Old 02-19-2011, 07:16 AM
 
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Cochrane also says this:

 

"The detection of fetal malformation was addressed in detail in only two of the trials."

 

So, most of the studies in that meta-analysis weren't looking at the 20 week anomaly scan; they were focusing on dates, detection of multiples, etc. For which they say: "Early ultrasound improves the early detection of multiple pregnancies and improved gestational dating may result in fewer inductions for post maturity."


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#38 of 51 Old 02-19-2011, 10:50 AM
 
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DDCC to correct some egregious misinformation.

 

1.  Testing for ketones in urine is useless.  Very few people with glucose intolerance, either due to gestational diabetes or Type 2 diabetes will have ketones.  This is mostly a problem seen in Type 1 diabetics (insulin dependent), because they can not utilize the glucose in their body at all and their body in essence starts to digest itself.  I have had type 2 diabetics in my practice with blood sugars over 600 who are asymptomatic and have no ketones.

 

2.  Using urine strips to test for glucose is also useless.  For there to be glucose in your urine, your blood sugar has to be AT LEAST over 200 for a sustained period of time.  This is because it takes at least a level of 200 mg/dL to overwhelm the renal tubules and spill glucose into the urine.

 

3.  Informing "only 3% of women that they have gestational DM" in not insignificant.  That's about 180,000 women in the US per year.

 

4.  "This diagnosis is useless because it merely leads to simple recommendations that should be given to all pregnant women. These are recommendations regarding lifestyle, particularly dietary habits and exercise."  This is nuts.  This are not the only things that are done with a diagnosis of gestational DM.  Fingersticks are checked carefully.  Blood sugar level recommendations are stringent.  If diet and exercise don't do the trick, oral meds or insulin is given.  The baby needs to be watched carefully for signs of respiratory distress and hypoglycemia.  Plus, the mom is at risk of developing Type 2 DM later in live.

 

I apologize for the DDCC.  However, as a physician, I was really alarmed by the incorrect information being given.

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#39 of 51 Old 02-19-2011, 11:09 AM
 
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I, for one, appreciate the ddcc WildKingdom and NashvilleMidwife.  Asheya, I'm sure you mean well and it's obvious that you care greatly about woman's birthing experiences and helping them make informed decisions which is great. But if you are posting to this DDC in your capacity as a birth educator, I think you are majorly overstepping your bounds with your posts here. Pointing people towards information so they can make their own informed decisions with the help of their health care providers is great. Saying, "Here are some studies you may want to look at and bring up with your doctor or midwife" is fine. But trying to interpret medical studies and reviews and then give advice based on them is just not something a childbirth educator is qualified to do. There are many valid reasons that a heath care provider would recommend any one of these tests to their patients. 

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#40 of 51 Old 02-19-2011, 11:34 AM - Thread Starter
 
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I, for one, appreciate the ddcc WildKingdom and NashvilleMidwife.  Asheya, I'm sure you mean well and it's obvious that you care greatly about woman's birthing experiences and helping them make informed decisions which is great. But if you are posting to this DDC in your capacity as a birth educator, I think you are majorly overstepping your bounds with your posts here. Pointing people towards information so they can make their own informed decisions with the help of their health care providers is great. Saying, "Here are some studies you may want to look at and bring up with your doctor or midwife" is fine. But trying to interpret medical studies and reviews and then give advice based on them is just not something a childbirth educator is qualified to do. There are many valid reasons that a heath care provider would recommend any one of these tests to their patients. 


yeahthat.gif  I, for one, am kinda annoyed by Asheya's posts. It's different to say "hey, I was passing through and thought you all might be interested in these links to read and discuss with your care provider". But that's not what she is doing.


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#41 of 51 Old 02-19-2011, 11:40 AM
 
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I'm sorry if my post was interpeted as offering advice for particular situations, or a blanket recommendation. I was trying to point women towards information about the tests, and I did say "it can be important to look at the research, weigh the benefits and risks and your particular circumstances, and make an informed decision about your care." I also tried to provide links to articles with research so that women can look at the information for themselves to make an informed decision, rather than taking my (or anyone else's) word for it.

 

I also realize that this particular viewpoint (the nocebo effect and the ineffectiveness of routine testing for all women, without taking into account their particular circumstances and weighing the benefits and risks in that case) is not particularly popular, and does not sit well with many health care professionals. Nevertheless, there are midwives and doctors who do agree with it, and in fact those are the health care professionals that I have learned from. I am not a health care professional, so I am not qualified to offer advice to women about their particular situations. As a childbirth educator I can offer information, and I think it is important that women are aware that there is not unanimous agreement on these issues, and that some of the most respected voices for improving maternity care question the validity of routine prenatal testing.

 

I agree that "There are many valid reasons that a heath care provider would recommend any one of these tests to their patients." What we have been discussing is routine testing.

 

It seems that my information about urine strips may need to be assessed, which I will look into. A midwife I know uses this as part of her screening protocol for gestational diabetes, so I will ask her about it and look at the latest research.

 

The key here, which I think we are all trying to promote, is informed choice for each woman in her particular circumstances.

 

I think that my 'advertiser' identification is also detracting from this discussion, and I am not particularly impressed with mothering.com's recommendation that this would be a good way for me to let people know about my services. I will not be posting any more comments to the October 2011 DDC, as I can see that this is not the right place for me.

 

 

Quote:
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I, for one, appreciate the ddcc WildKingdom and NashvilleMidwife.  Asheya, I'm sure you mean well and it's obvious that you care greatly about woman's birthing experiences and helping them make informed decisions which is great. But if you are posting to this DDC in your capacity as a birth educator, I think you are majorly overstepping your bounds with your posts here. Pointing people towards information so they can make their own informed decisions with the help of their health care providers is great. Saying, "Here are some studies you may want to look at and bring up with your doctor" is fine. But trying to interpret medical studies and reviews and then give advice based on them is just not something a childbirth educator is qualified to do. There are many valid reasons that a heath care provider would recommend any one of these tests to their patients. 



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I think that my 'advertiser' identification is also detracting from this discussion, and I am not particularly impressed with mothering.com's recommendation that this would be a good way for me to let people know about my services. I will not be posting any more comments to the October 2011 DDC, as I can see that this is not the right place for me.

 



I cannot comment on who recommended that this is a good way for you to let people know about your services, but you might consider posting your info in the regular "pregnancy" forum and not the ddc. It is seen almost as an intrusion to have someone who is NOT part of this ddc to come in here and attempt to tell women what to do. If a person posts in the pregnancy forum then they are generally more open to different opinions OTHER than what they would find in their ddc. I would find your comments much more appropriate in the pregnancy forum rather than in the ddc.


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#43 of 51 Old 02-19-2011, 04:12 PM
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I cannot comment on who recommended that this is a good way for you to let people know about your services, but you might consider posting your info in the regular "pregnancy" forum and not the ddc. It is seen almost as an intrusion to have someone who is NOT part of this ddc to come in here and attempt to tell women what to do. If a person posts in the pregnancy forum then they are generally more open to different opinions OTHER than what they would find in their ddc. I would find your comments much more appropriate in the pregnancy forum rather than in the ddc.


I agree. It isn't the advertiser flag, it's the lack of awareness of MDC culture. Asheya, generally, DDCs are pseudo-private, meaning that although they aren't truly private (this is, after all, a public forum) they function as if they were. Generally, people only post in them because they are due in that month. That's why others who aren't in the DDC are prefacing their posts with DDCC -- it means DDC crashing and is a sign of respect for the group dynamics.

 

I should also say that although I personally find Asheya's posts intrusive and agree that a number of her statements are factually incorrect, she isn't wrong on everything. There are genuine academic debates over, for example, whether everyone should be screened for gestational diabetes or whether screening should only be initiated for those with particular risk factors. The nocebo effect is a real phenomenon (though the term is typically used to apply to drugs administered, not to screening tests), and there can be value in considering what you actually will get out of a particular test. No tests have perfect sensitivity and specificity, meaning that they all have false positives and false negatives, and it's also worth considering whether the knowledge gleaned from a test will change your actions or outcomes in any way.

 

Anyway, as for the original question, I am over 35 and type 1 diabetic, so I will get most standard tests plus some extras, like a level II ultrasound at 18-20 weeks and regular biophysical profiles at the end of pregnancy. I am leaning towards skipping a few of the early screening tests (CVS, nuchal translucency), as they have somewhat high false positive rates, don't give a clear diagnostic one way or the other, are a pain in the butt for me to do, and wouldn't change my actions, but I am leaning towards an amnio. Haven't decided for sure yet either way.


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#44 of 51 Old 02-19-2011, 04:32 PM
 
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One last thing--I checked with the midwife I know, and I was wrong about the urine strip being used as a good marker for gestational diabetes. I am sorry for that misinformation, thank you for pointing it out to me, and in the future I will make sure to check before I post!

 

The midwife I know does not, however, routinely screen all her clients for GD, but only those who have risk factors. She does this either by having the woman use the glucometer at home or by doing the sugar drink/blood draw, depending on the circumstances.

 

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#45 of 51 Old 03-10-2011, 06:38 PM
 
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meh I usually skip most testing and vaginal exams. If a midwife wants to test my blood cell count as part of being willing to be my midwife or backup to a UC I'm okay with that. I try to eat a healthy diet that I would be put on if I had GD, but I only have one risk factor for that so it's unlikely anyway. Would like an ultrasound because I've done the 'let's be surprised' thing twice and felt horribly guilty for being disappointed at the birth. An ultrasound let's me warm up to the idea of having another boy.    


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#46 of 51 Old 03-10-2011, 07:09 PM
 
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I would like to get a 3D u/s later in the pregnancy and for that we need an anatomical u/s first.  Grrrr!  We don't want to know gender so would like to avoid all other u/s.  I am Rh-, but haven't been tested for antibodies before.  If I do that, I guess it will only be for peace of mind.  Other than that, no tests.

 

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#47 of 51 Old 03-10-2011, 07:34 PM
 
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I am too afraid to have any of the genetic screenings or tests done.  I got a false positive with my now youngest and was counseled to terminate without even testing further (she had a cystic hygroma aka a grossly abnormal nuchal fold).  She is smart happy and healthy except for asthma 2 1/2 year old right now.  I am also coming out of a second trimester loss and cannot even contemplate terminating not that I am opposed to it theoretically.  I simply could not risk the baby with a cvs or amnio no matter how small the chances of harm.  I had a cvs with my daughter and can't believe I put her life at risk because of some stupid measurement on her neck.

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#48 of 51 Old 03-10-2011, 10:59 PM
 
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I've already had 6 betas and 3 ultrasounds. I plan to keep the testing to a minimum for the rest of my pregnancy, though. We'll do the 20-week anatomy scan (although we DON'T want to know the gender) and the GBS test. I'm skipping the GTT this time around (I had GD while pregnant with my DS) and instead will be monitoring my blood sugar at home (currently 4x a day) for the duration of my pregnancy.

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#49 of 51 Old 03-11-2011, 08:39 AM
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Change of plans here. I decided to get the integrated prenatal screen after talking it over with DH. If he didn't care, I would skip it, but he does, and I am fine to go his way on this one. The u/s and first blood test are scheduled for next week.


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#50 of 51 Old 03-11-2011, 09:01 AM
 
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I am getting CVS (I will be 39yo when this bebe is born) and plan on 2 USs total if I can help it.  This is a personal decision and one discussed with my husband over many months (even before getting pregnant).

 

I hope everyone has a blessed pregnancy and the birth that they want.

 

 


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#51 of 51 Old 03-11-2011, 10:02 AM - Thread Starter
 
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Interesting all the different responses! mythik- you are correct in that it is a very personal decision and what one person/couple decides isn't what's right for everyone thumb.gif

 

I think we decided that we would get the early ultrasound (had it done at 7w1d and saw the heartbeat) and we will get the 20 week ultrasound. I will do the gestational diabetes screening as well. Other than that, I think we'll skip everything else. DH didn't care one way or another on the early testing and we both decided that we wouldn't terminate anyway so we're just skipping them. I do want the 20 week ultrasound so that we can be prepared if there is anything special the baby will need when it's born. If anything else pops up then we'll make the decision at the time.


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