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Re: Down Syndrome: New screening methods questionedFrom: Allen Worrall (jworrall@acsalaska.net)Wed Aug 14 15:14:06 2002
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 ----- 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
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