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Discussion Starter · #1 ·
Ok, so DH and I went for the Maternal Fetal Medicine consult yesterday.
Yeesh.

I knew I could be stepping into intervention-land, but I figured I'd get to see the baby again, and, well, maybe I'm just weirdly curious about things, but I wanted to know what would happen. So now I know.

DH and I drove there yesterday -- I'm in a smallish town, so it was 90 minutes away, but I didn't expect the office to be in the barrio. It was a slightly run-down office building, mostly vacant offices, and the ladies' room was locked when I tried to go in. So I went into the physician's office (they had a restroom I could use, but it had someone's urine sample sitting out on the counter and no paper towels, but I digress).

I should interject here that the ultrasound place my doc/midwife send me to is fantastic, immaculate, and professional, so I had (previously) some faith in their ability to recommend a place.

Went in for u/s. Tech was nice and seemed competent, though the only monitor was one early-90's era CRT monitor that we all three had to share, so I saw everything at quite an angle. She took tons of measurements, but only once each. You know how these things are -- it was fast and nothing seems all that precise. She said it all looked really good, and on-track. Head was a tiny bit big (not out of range, though), but this made me laugh, as I have a hard time buying hats to fit my giant noggin.

Doc invites us in. Picture a used car salesman here, complete with the little piece of paper he's writing numbers on and showing them to you periodically. He's telling us that everything looks pretty normal, but then the amnio pitch starts. He gives me odds for chromosomal issues at my age, then claims that amnio only has a 1 in 1100 loss rate. So, you see, he says, it makes more sense... DH and I are not interested. We tell him we had the nuchal screen/blood test combo and I'm in normal range.

So then he pulls out his best card: turns out that baby's femur to head ratio is small. For the calculation they do, they want this ratio to be 0.91 or higher. Baby's is 0.89. Seriously. Off that tiny screen with a single point-and-click, he wants to pretend to get two significant digits of measurement precision and that this is significant. So significant, he tells me, that it changes my nuchal odds they gave me by more than a factor of 2. (2.2 to be precise) Which puts me borderline low/high risk. As in, even there not all docs recommend amnio.

So, let's grant that this tech is so good that she can do a single measurement and doesn't need to repeat it, and then grant that she is accurate to within 1%. And that the cutoff is so sudden that the difference between 0.91 and 0.89 results in more than a factor of two in risk. Let's grant all that without question. So, all the other stuff being perfect didn't improve my odds? I mean, the nuchal screen odds can't take into account any of these measurements, so new info would change them in either direction, right?

But anyway, the doc didn't inspire confidence. And if I wanted an amnio, I wouldn't go to him. I obviously don't know if my baby has any chromosomal issues. But nothing this guy had to say was in any way inspiring me to have him stick a needle in my uterus.

Oh, and as an aside, I have a fairly normal-sized body. I can buy off the rack for most things. I'm 5'6", and healthy. There are two parts of my body I joke about being disproportionate. You guessed it -- my giant head and short femurs. Seriously. As in, I've been shopping for gliders lately for the baby and every chair I sit in I have to ask for a pillow behind me so I can reach the back and bend my knees at the same time. So, I suppose the baby comes by it honestly.


Oh, but there was one thing that made the trip worth it: the tech says she's "positive" we're having a girl!!


DH and I are very excited! She showed us a closeup with the parallel lines and everything. I'm only 14 weeks, so I suppose we'll confirm at the 20-week, but she was pretty sure and like I said, I think she was quite competent. So, it's a girl!
 

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Congrats on your girl and standing your ground with that Dr.
That is not always an easy task but I imagine the 'used car sales man' look made it even easier to do. I just love reading about everyone finding out the sex of their babies.
Congratulations to you and your family again!
 

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Originally Posted by Surfacing View Post
Thank goddess for critical thinking skills.


I hope you and your big head and short femurs enjoy your beautiful daughter.


 

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congrats on having a girl!


what a crazy place! Love your description.
you are right on to have stood your ground. Those ratios/"normal scale" are based on averages, and measurements should have been taken more than once on a newer machine for accuracy!
 

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Discussion Starter · #7 ·
I just checked his stats he gave me, and now I'm even more annoyed. He quoted 1 in 1100 for losses from amnio. The American Pregnancy Association says it more like 1 in 200. And by all the sources I found online, even with his adjusted risk rate for me, I would not be recommended amnio.

I'm definitely irritated by this, and will bring it up to my midwife tomorrow and ask why this guy was chosen.
 

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ddc crashing here... first off CONGRATS ON YOUR LITTLE GIRL!!
I too am having a girl and am so excited! ok so to the point now.

I wanted to share my story. I went in for my 20 week anatomy scan but for some reason my dr sent me in at 19 weeks not 20. Add to that that my drs dates are off so according to them I was only 18 weeks. I get there they say everything looks good but because Im not the full 20 weeks they have me come back 3 weeks later which according to them I would be 21 weeks when in reality ill be 22 and a couple of days. So I come back and it was the first day after new years so they were SUPER BUSY. I waited for close to 2 hours. I must say that I know this dr is fantastic at what he does. He is known nationwide for his state of the art equipment and professional background. He is at the top of the lists for celebrities for their pregnancies. So having said that I know he knows what hes doing but he is human after all, right? ok so he starts doing the scan and sees that the measurements are pre filled. He turned to the nurse and mumbled something about someone having done them already today before he walked in... though no one did. What he was looking at were my measurements from my previous appointment 3 weeks ago. But for some reason I just didnt say anything. So he looks at the heart which looks great and then he does the nuchal fold measurement. He tells me the baby has an enlarged nuchal fold. he told me its a soft marker for downs. He said my baby had no other indicators but it was rather large. I asked what the measurement was and he said 7mm. I asked what the normal range was and he said he didnt like to give ranges
what the heck is that? so I spoke with the nurse after he left and explained that I am actually further along then what they think and if my measurement was still on the large side and she said she thought it was. So they had me sit with the genetic counselor. She gave me the schpeal about the amnio which I refused. I asked her what my specific odds were to have a child with downs. Keep in mind I am only 26, the babys father is 27 and no history on either side of downs. she said she would have to take into account my AFP test which was negative. She said it wasnt about being negative or positive but about the numbers. And wouldnt you know it, she couldnt find my results so all she could do was give me general info till she got my results. The general info scared me half to death and I was a crying mess all night and got no sleep. Also forgot to mention that while he was doing the nuchal fold measurement he was interrupted twice with people coming in to ask him questions so this could have thrown off his measurement. So later that night I did my research on the web and found that this test should be done between 14-17 weeks...18 latest and that anything done after that was not accurate. I was also told at 19-21 weeks gestation the average measurement was 5-6mm... 7mm isnt that far off. its 1 friggin mm... that could have easily been due to human error and the fact that they were so busy that day. So the genetic counselor called me back in the morning saying she got my AFP test results and that my numbers were really low and that was fantastic. She said this this new finding it brought my odds to 1 in 8454 births. Percentage wise she told me it was less than 0.1%. 0.1%!!!! you had me worried about 0.1% wow.... I am still refusing the amnio and wont know 100% till the baby is born but with each passing day i am less and less worried about it. Drs have a way of trying to scare us, its horrible. Oh and as for the stats... they told me the risk of the amnio was 1/1600 for his practice... Considering there is a higher risk that something could happen as a result as the amnio than my baby having downs that alone is a valid enough reason to not do an amnio. seriously.... do they think about this?

Anyway, sorry, didnt mean to write a novel or high jack this thread but Im sure your baby is fine. Dont let what he said get to you.
 

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Originally Posted by violet_ View Post
I'm definitely irritated by this, and will bring it up to my midwife tomorrow and ask why this guy was chosen.
Yeah, I'm curious to hear what she has to say about that.
 

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It's weird that he recommended an amnio. At my MFM office, they don't recommend, only offer, and even then only to some. We had a 30% chance of chromosomal issues, because of the omphalocele, and they still only offered. Of course, we said yes with that kind of risk, but it was only offered.

The miscarriage risk really does vary doctor-to-doctor. It depends on so many variables, including equipment and doctor skill, that the overall average risk doesn't say a whole lot.
 
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