Re: Down Syndrome: New screening methods questioned
From: Terry J. DuBose (tjdubose@uams.edu)
Wed Aug 14 15:46:59 2002
Does the NT protocol of Professor Nicholaides, et al in clude the embryonic heart rate as a routine? Have you noticed any abnormal variation of the EHR in those with cardiac anomalies? This is a particular interest of mine.
Thanks. Terry J DuBose, M.S., RDMS
Little Rock, Arkansas USA
ultrasound@obgyn.net writes:
>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
>
>HotJobs - Search Thousands of New Jobs
>http://www.hotjobs.com
>
Peace, Terry J. DuBose, M.S., RDMS
Assistant Professor & Director, Diagnostic Medical Sonography Program
University of Arkansas for Medical Sciences, CHRP
4301 West Markham St. Mail Slot #563
Little Rock, Arkansas, 72205 USA
501-686-6510
DuBoseTerryJ@UAMS.edu
http://www.io.com/~dubose/
http://www.uams.edu/CHRP/dmshome.htm
http://www.obgyn.net/us/panel/panel.htm
