Re: Down Syndrome: New screening methods questioned
From: art fougner, md (evsono@pipeline.com)
Wed Aug 14 17:49:25 2002
Terry -
i know Stuart Campbell's group at St George's was looking at FHR as an
adjunct to NT - haven't seen anything published tho.
art
At Wed, 14 Aug 2002, Terry J. DuBose wrote:
>
>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
>>
>>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
--
art fougner, md
ich bin ein New Yorker
