Re: Oligohydramnios, dolicocephaly and elevated AFP
From: R. Daniel Braun (rd.braun@gmail.com)
Fri Jun 24 11:22:26 2005
Amen.
Dan
On 6/24/05, Larry Glazerman <l.glazerman@rcn.com> wrote:
>
> Agreed, although in my experience, the question about whether the
> pregnancy
> would be terminated often enters into the decision about whether to have
> an
> invasive test performed. IF the patient would not choose to terminate even
> an abnormal pregnancy, many of them choose not to have a test. I do agree
> that some patients will choose testing just for "advance warning" of a
> problem. I feel strongly that they need to be informed of all of the
> issues,
> and use that information to make their own choice. I remember when I was a
> resident, some folks wouldn't do an amnio if the patient wasn't interested
> in termination. I disagree with that (as the physician's choice - if the
> patient chooses that, it's obviously appropriate, IMHO)
>
> Larry R. Glazerman, MD
> Ob-Gyn at Trexlertown, PC
> 610-402-0161
> l.glazerman@rcn.com
>
> > -----Original Message-----
> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne
> > Bulley, MD
> > Sent: Thursday, June 23, 2005 11:17 PM
> > To: Multiple recipients of list OB-GYN-L
> > Subject: Re: Oligohydramnios, dolicocephaly and elevated AFP
> >
> >
> >
> > Yes - if you do a test - then you have to have the concept that the
> > results will indeed help plan for the next steps in care. Otherwise -
> > if the results will not somehow alter the care ... then do not do the
> > test in the first place.
> >
> > Wheteher or not one terminates is not the question -- if one KNOWS ahead
> > of time that the infant will have problems -- some of which are known
> > and others that are unkown - then the greiving for the child not being
> > perfect at birth is begun ahead of time and the plans for the needs of
> > the infant being born are also begun ahead of time.
> >
> > So the prenatal diagnosis helps either way -- whether one would choose
> > to terminate or to carry the pregnancy.
> >
> > Joanne
> >
> > At Thu, 23 Jun 2005, R. Daniel Braun wrote:
> > >
> > >The real question is not the absolute risk of various procedures. The
> rea
> > >question is what will you do with the results? i.e. will you terminate
> a
> > >Down's? a trisomy 18? a trisomy21? an elevated AFAFP & AChE ???? or
> not?
> i
> > >not? then just hang in there with much anxiety for the next 2-5 months
> unt l
> > >you get the answer by delivery. Otherwise get the procedure done and
> act
> o
> > >the results.
> > > Just MHO
> > >Dan
> > >
> > > On 6/23/05, Jim Wang <jimwangmd@yahoo.com> wrote:
> > >>
> > >> Thank you so much for the responses from Lynn and Dan.
> > >>
> > >> Oligo on 18-week US is indeed quite subjective. Three USs performed
> by
> > >> radiology dept in the past 7 days resulted in diagnoses of
> > >> "mild-to-moderate" oligo on first scan; "severe" oligo on the second;
> > >> and "moderate" oligo on the last (AFI measured only on the third US
> to
> > >> be 5.6)
> > >> The head, brain, spine, stomach, heart, kidneys and bladder appear
> > >> normal on US. Placenta is low-lying, but not abnormal.
> > >>
> > >> The patient is actually my wife. Our desires, like most first-time
> > >> expectant parents, are to be conservative and safety of the baby and
> > >> mother first. In light of the numerous signs (slowly rising BHCG,
> > >> oligohydramnios, dolicocephaly, elevated AFP) of a possibly abnormal
> > >> pregnancy, amniocentesis would be very helpful. We have been told
> that
> > >> the risk of amniocentesis in the setting of oligo would be "higher"
> than
> > >> usual; and the chance of finding spinal bifida or chromosomal
> > >> abnormality is relatively "low". However, we find it difficult to
> make
> > >> a decision when the risk of the procedure and the probability of
> finding
> > >> abnormality are not quantified (i.e. in numeric percentage). If the
> > >> risk % clearly exceeds the test positive rate, we would not wish to
> take
> > >> such unfavorable gamble.
> > >>
> > >> I can understand that the risk is relative and that a numerical risk
> > >> estimate may not be exact. Yet, without a quantifiable risk/benefit
> > >> analysis, we would not be able to make an informed decision. Greatly
> > >> appreciate any input to help us decide whether or not to proceed with
> > >> amnio-infusion/centesis:
> > >>
> > >> 1. Estimated risk of amnio-infusion/centesis in the setting of oligo
> > >> (AFI 5.6)?
> > >> 2. Probability of finding spinal bifida or chromosomal abnormality in
> > >> light of anatomically normal US?
> > >> 3. Utility of delaying any procedure at this time and repeating US in
> 2
> > >> and/or 4 weeks to see if more detailed anatomy can be visualized?
> > >> 4. Optimal timing for amnio-infusion/centesis?
> > >>
> > >> Thank you,
> > >> Jim Wang, MD
> > >>
> >
> > --
> > Joanne Bulley, MD
> > Keene, NH, USA
>
--
R. Daniel Braun
Kinky for Governor
|
|
