Re: Oligohydramnios, dolicocephaly and elevated AFP
From: Larry Glazerman (l.glazerman@rcn.com)
Fri Jun 24 10:56:35 2005
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
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