Re: Down Syndrome: New screening methods questioned
From: Dave Berck (djberck@yahoo.com)
Wed Aug 14 15:30:10 2002
I have been doing NT measurements for the last 2 years
along with PAPP-A and free bhcg strictly according to
the Fetal Medicine Foundation Protocol. We've picked
up all sorts of abnormalities including cardiac
defects and chromosomal abnormalities. We picked up 2
trisomy 21s, and 1 trisomy 18. We did miss one trisomy
21 and a mosaic which were later picked up by AFP4
testing at 16 weeks. Once I got the hang of it, I've
been able to get legitimate measurements in 100% of
patients. Try it. You'll like it.
--- Allen Worrall <jworrall@acsalaska.net> wrote:
> Regarding nuchal translucency: it must be done with
> the greatest of care as
> Professor Nicholaides and his group have repeatedly
> stated. To obtain the
> results claimed for it, it must be done just as it
> is done in the certified
> centers. I have been doing it for several years.
> Like all ultrasound, some
> are easy, some are very difficult. I have a very low
> volume of patients, and
> none of the abnormal results (based on CRL, expected
> Nuchal translucency,
> MOM, and likelihood ratios) turned out to have
> anything wrong with them.
>
> When we read a paper about nuchal translucency we
> may not know just how well
> the nuchal translucency was done, unless the paper
> specifies the
> qualifications of the sonographers and the
> department. I have not read this
> paper. They may well have satisfied all concerns
> about their qualifications
> to do the test.
>
> I am going to put my faith in The FetalMedicine
> Foundation, Dr. Benacerraf,
> Dr. Nyberg, Dr. DeVore, and those types.
>
> As long as the patients understand risk assessment
> and how it differs from
> diagnosis, I think it is OK to offer all the forms
> of screening to our
> patients: 1st trimester NT and anatomic scan, 2nd
> trimester serum screening,
> 2nd trimester anatomic scan, and, for the 35-39 year
> old group,
> amniocentesis for those who want it after proper
> counseling. Those 40 and
> over should be advised to have amniocentesis
> regardless of how their risk
> assessment turned out. I have had no experience with
> 1st trimester serum
> screening.
>
> Terry, I am sending a copy of this to your uams.edu
> address incase this
> message is rejected by obgyn.net. I have started to
> have the problem again.
>
> Allen
>
> Joseph A Worrall MD RDMS
> OB/GYN Ultrasound at the Fairbanks Clinic
> Fairbanks, Alaska, USA
> jworrall@alaska.net
> http://www.obgynsono.com
>> ----- Original Message -----
> From: Terry J DuBose
> To: Multiple recipients of list ULTRASOUND
> Sent: Monday, August 12, 2002 4:51 PM
> Subject: Down Syndrome: New screening methods
> questioned
>
> The following is from the new health news service
> of the OBGYN.net, see:
> http://www.obgyn.net/newsheadlines/newsrx.asp
>
> scroll down to Down Syndrome: New screening
> methods questioned :
> "The team found no evidence that serum and nuchal
> screening improves
> antenatal detection rates or reduces rates of
> invasive procedure, such as
> amniocentesis. The districts that used serum
> screening detected 57% of
> cases, those using maternal age plus serum or nuchal
> screening detected 52%,
> and those using a maternal age of 35 or more and
> anomaly scans detected 54%.
> "
>
> "Their findings also suggested that the recently
> announced government
> initiative to introduce universal serum screening
> from 2004 - to increase
> detection rates and reduce the need for invasive
> procedures such as
> amniocentesis - will not achieve its stated
> objectives. "
>
> ""To avoid continuing the confusion that Down
> screening currently causes
> in pregnant women, we believe that new screening
> methods should be offered
> only as part of a controlled study until their
> benefit is proved," they
> concluded (Retrospective audit of different
> antenatal screening policies for
> Down syndrome in eight district general hospitals in
> one health region, Br
> Med J, 2002;325:15-17)."
>
> Well, what do you think... and the nuchal
> screening held out so much
> promise. Anyone seen the original publication? Is
> it good research?
> Coming from the British Medical Journal, I suspect
> it is.
>
> What do they include in "new screening methods"?
>
> Peace, Terry J DuBose, M.S., RDMS
>
> Little Rock, Arkansas USA
>
=====
David J. Berck, MD, MPH
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