Re: Down Syndrome: New screening methods questioned
From: viv souter (vsouter@yahoo.com)
Thu Aug 15 09:32:13 2002
The FMF have published at least two papers on fetal heart rate. The most recent reported that FHR does not add to the detection rate for T21 of first trimester screening (ie NT, age CRL). FHR (11-14wk) is on average higher in T21, T13 and Turner syn and lower in triploidy and T18 and so it can be helpful on a case by case basis. As far as I am aware the FMF continues to measure FHR but it is not part of their risk calculation
Viv
> Allen Worrall wrote:I may be wrong but I do not think Professor Nicholaides' group are doing anything with fetal heart rate. However, I have heard that there are other groups in Britain that use fetal heart rate as a screening method for Down. Allen----- Original Message ----- From: Terry J. DuBose To: Multiple recipients of list ULTRASOUND Sent: Wednesday, August 14, 2002 12:50 PMSubject: Re: Down Syndrome: New screening methods questioned
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
>
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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
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