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Old November 16th 05, 09:49 PM posted to misc.kids.pregnancy
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Default nuchal fold in 20 week ultrasound causing distress


"k_raps73" wrote in message
lkaboutparenting.com...
I recently had my ultrasound at 19 weeks and 6 days. The baby's
maeasurements indicated that he was bigger than the gestational estimated
date that was calculted. My doctor told me the baby was measuring at 20
weeks and 5 days. Everything was normal, i.e. his limbs, spine, brain and
heart. My quad test which was done at 16 and a half weeks came back
negative as well (normal). However the doctor noted that there was one
abnormality in the ultrasound and that was a nuchal fold found at the back
of my baby's head which measured much bigger than it should for a 19 week
and 6 day old baby! She said this could be a marker for a downs baby. She
offered us the option of an amniosynthesis and even abortion at a later
part if we choose to. I was apalled and very much distressed. I told her
that my quad test results were good and that there was no history of downs
in my or my husband's family. She told me that chances of me having a
downs baby was 1 out of 47. They want me to come back for an ECG of my
baby's heart in 5 weeks which I am going to do. I even asked the doctor if
the measurement of the nuchal fold was bigger because the baby was much
bigger than the calculated due date.She said that the measuremnt would
have not mattered had the baby been 20 weeks or more (as per his
measurements and not the previously calculated date of 19 weeks and 6
days).I cried when I came out of that doctor's office and having been
trying to stay positive. I console myself with the fact that the
ultrasound images look normal and my quad tests were negative. However I
am still so worried, I can't sleep and need advice on this topic.


Well, nuchal fold thickness is a soft marker in the second trimester
(meaning that it's not a strong indicator, but can be a warning sign and
reason to offer further testing). I find it interesting that she told you
the measurement "wouldn't have mattered" if the baby was 20+ weeks. I'm
thinking that she meant that it was a normal measurement for his size of
20w5d, but a high measurement for his gestational age of 19w6d. So, the
question then becomes...how sure are you of the 19w6d age? Is it possible
that you are really 20w5d along?
Unless you were charting ovulation I'm not sure you would know unless you
had a first trimester dating ultrasound. So, there's a possible
explanation....you're just further along than you thought and his size and
nuchal fold measurements match up.
However, if his nuchal fold is still high, offering amnio is a typical
response. The risk figure of 1/47, is that based solely on the nuchal fold
thickness or is it a combined risk that takes into account your quad screen?
Maternal age, quad screen and ultrasound markers can be combined to give a
revised risk. Remember that the quad screen is just that, a screening test.
While it's good that it was "negative", it doesn't mean that the ultrasound
results don't matter. Chances are (at least 46/47) that the baby does not
have Down syndrome. After you have the echo, you should get a new set of
risk figures, and only you can decide if you need to know for sure and what
you would do with that information.
BTW, a negative family history is irrelevant in calculating Down syndrome
risk, as almost all cases of trisomy 21 are not inherited.
So, give some thought to the possibility that you are just 20w5d along and
all the measurements are normal for that gestational age.

Amy