Re: Down Syndrome: New screening methods questioned
From: Dave Berck (djberck@yahoo.com)
Thu Aug 15 10:46:24 2002
Dr. Nicolaides does indeed measure FHR and it does
contribute to some small degree to the likelihood
ratio they calculate for T-21. However, the labs in
the US sanctioned by the FMF for PAPP-A and free BHCG
to not use FHR in their calculations.
--- "Terry J. DuBose" <tjdubose@uams.edu> 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
> >
> >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
>
=====
David J. Berck, MD, MPH
HotJobs - Search Thousands of New Jobs
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