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Re: counseling after amnio results are in From: J. Hellriegel (jhellrie@pce.net) Sat Mar 18 10:01:08 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Deborah Wage, FNP,CNM: "Re: Cash only services?" Previous message: Gordon: "Re: Cash only services?" In reply to: Efrain Ramirez: "Re: counseling after amnio results are in" Next in thread: Efrain Ramirez: "Re: counseling after amnio results are in" Reply: Efrain Ramirez: "Re: counseling after amnio results are in" Based on the biochem data and US screen the MFM "calculates" a risk ratio. For example, if the age related risk is 1/75 the calculated risk may be 1/300. This is done at the time of the US exam and explained to the patient by the MFM. The patient has the option to proceed to amino if the calculated risk is equal or greater than the age related risk at 35 years of age. If the calculated risk is less than this, the MFM will typically discourage amino. Sometimes it is a bit complex. For example a patient with a positive triple screen, 34 years old, and no US risk factors. The MFM deals with the explination. This may seem like a turf job on my part, but they know more about the relative risks than I due. Particularly since there seems to be new data daily. I receive a report with the US report, numbers, summary of discussion, and conclusion. To date my patients have been happy with this approach. The newborns have not had chromosomal anomalies, but the odds favor normal babies. -- J. Hellriegel At Fri, 17 Mar 2000, Efrain Ramirez wrote: > >You can certainly decrease the odds but by how much--IMHO it depends a >lot on the one making the ultrasound --how much expertise,etc. -- what >are you going to say to a patient (35y/o)with a positive screen -1/75 -- >and the MFM says that he could not found an US marker? in other words-- >what does the MFM says in his written report --odds? --does he >recommends *not* to do an amnio -- what are their specific >recommendations? > >At Fri, 17 Mar 2000, J. Hellriegel wrote: >> >>There is a trend in this area to use some biochemical markers and >>ultrasound (US) for detection of chromosomal anomalies. With the >>movement in this direction, I have not done a "genetic amino" for about >>a year. >> >>Current combination is US plus triple screen, but movement is toward >>using US plus free beta HCG and PAPP-A (Pregnancy Associated Plasma >>Protein-A)for detection of chromosomal anomalies. >> >>I do not perform the US. It is done by MFM docs. who have experience >>evaluating "US markers". >> >>Is this occuring elsewhere? Have you found it to be accurate and >>acceptable to your patients? >> >>-- >>J. Hellriegel >> >>-- >>John Hellriegel, MD, PhD >> >-- >"The things you learn after you know everything are the important ones" > -- John Hellriegel, MD, PhD Next message: Deborah Wage, FNP,CNM: "Re: Cash only services?" Previous message: Gordon: "Re: Cash only services?" In reply to: Efrain Ramirez: "Re: counseling after amnio results are in" Next in thread: Efrain Ramirez: "Re: counseling after amnio results are in" Reply: Efrain Ramirez: "Re: counseling after amnio results are in"

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