ULTRASOUND Messages for February, 2001: =?windows-1255?B?4fLw6envOiBDYWxjdWxhdGlvbiBvZiBSaXNrIGZvciBEb3du?

=?windows-1255?B?4fLw6envOiBDYWxjdWxhdGlvbiBvZiBSaXNrIGZvciBEb3du?

From: zalel

zalel_y@netvision.net.il

Fri Feb 23 09:57:51 2001

I think the combination of hyperechogenic bowel and borderline nuchal fold requires an amniocentesis, regardless the tripple test results .

Best regards

Yaron Zalel, MD

>----- Original Message -----
From: Allen Worrall <jworrall@alaska.net> To: Multiple recipients of list ULTRASOUND <ultrasound@mail.medispecialty.com> Sent: Friday, February 23, 2001 8:11 AM Subject: Calculation of Risk for Down

> I am aware that a negative ultrasound can reduce the risk assigned by a
> triple screen, by about 50%.
>
> What about a patient who has a very low risk Down Triple screen result,
> but one soft marker is found? Can the soft marker likelihood ratio be
> applied to alter the triple screen risk?
>
> Case in point: 35 year old with 4 previous C Sections, triple screen
> risk 1:7600. I found hyperechoic bowel (it seemed to me it was as
> echogenic as bone, but I find this a little subjective), 19weeks
> gestation, nuchal fold 5.4 mm, and a scan was not requested at 11-14
> weeks. On today's scan I found no other anomalies or "soft" markers. (I
> think Dr. Nyberg would consider a nuchal fold of 5 mm or greater as
> significant, Dr. Benacerraf 6 mm or greater).
>
> If we say the nuchal fold was normal (not yet 6 mm or greater):
> hyperechoic bowel has a likelihood ratio of 5.5. If we consider her age
> related a priori risk, it is ~ 1:302 at twenty weeks. Apply the
> likelihood ratio for the hyperechoic bowel and her risk is now ~ 1:56,
> clearly an indication for amniocentesis. Also if we use Dr.
> Benacerraf's scoring system, age 35 and score 1, amniocentesis should be
> recommended.
>
> Or should the 5.5 likelihood ratio be applied to her triple screen risk
> of 1:7600, which would increase her risk to 1:1382,and thus
> amniocentesis not indicated?
>
> I suspect the answer is that the patient should be offered
> amniocentesis, but I would like to see what others think about this.
>
> --
> Joseph A Worrall MD RDMS
> Fairbanks, Alaska
>

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