ULTRASOUND Messages for August, 1998: Re: Baby Coming

Re: Baby Coming

From: James S Smeltzer MD

gaperina@mindspring.com

Tue Aug 11 18:08:01 1998

Ask for a referral to a place with a registered sonographer or find one you trust yourself. For this sort of planned & non-emergent sonogram, in-house vs out-of-house should not matter to the OB provider. As you are aware the 20 weeks scan is an excellent compromise between anatomy & dating for most.

Re: Triple screen. This is a SCREEN for Down's syndrome risk that is based on the observation that the modal AFP & estriol of Down's Synd babies is LESS than that of non. HCG is higher. Combine these & adjusted risk is possible. For some reason which is unapparent to me, this is not used by some labs to lower risk in women over 35 below the amniocentesis threshhold (although it is legitimate (and ethically imperative) to do this).

Nuchal thickening at 12 weeks is MORE sensitive, MORE specific for detection of Down's & other aneuploidy & also provides rock solid dating. A 20 week targeted should cost the same as your OB's primary sonogram & yield the same information plus significantly superior sensitivity for other major anomalies and Downs 13 & 18 risk as well [Superior both to triple screen & to basic US]. These potential benefits are semi independent & it may make sense to get all of these tests, depending on how beneficial it would be to you to know that a baby had Down's or a neural tube defect NOW vs later.

Re: AFP [Part of triple screen] detection of NTD, it is 90%, less than the detection rate by US in most hands at 20 weeks (95-98%). This leaves the benefit of detecting "Unexplained" high AFP - which used to be considered a major nuisance, but is now known to predict other potential trouble - preterm birth, growth restriction or stillbirth - in 40 to 50% of cases of its occurrance. As a perinatologist I know of patients who have had a major benefit from this "headache".

As a perinatologist, I know that a 20 week sonogram from one like me is worth it for the reassurance! The other stuff you can make your own mind up about as a consumer. When being a Dad it's also OK (& very imporant) to BE WHO YOU ARE!

The TRIPLE screen is for Down's. THe AFP part can give the same information about NTD and potential coming pregnanc problems. For the 20 week scan, you as a consumer & sonographer can weigh for yourself the difference between providers and the relative prices available to you, as a consumer. My touch stone is whether or not they will tape the exam for you. IMHO those who do not are depriving the patient of the patient's property (which is the exam) for the purpose of covering their own substandard behind & are not to be trusted.

At 05:21 PM 8/11/1998 -0500, you wrote: >Hi folks,
>
> Though I am RDMS in OB/GYN, I am a Father to be, and ask for
>advice. My wife came home from a visit with the OB Doc with a hand-out
>regarding the "triple test". This test involves testing for Down
>Syndrome, NT defects, using AFP's as indicators. I have never had kids
>before. I am a typical Father-to-be. I am nervous, and PROMISED I
>would ask the best people in the WORLD regarding these tests. Should
>she take the blood test? There are many false/positives involved from
>what I know. She is only 28, healthy as a race-horse. I have not
>looked. Yet! d:-)
>
>P.S.
>
>She heard the babie's HB on the pocket Dop at the Doc's office today,
>and is BEGGING me to look! The Doc want's to charge $350 to do a 20
>week US. No Registered Sonographer, No Overead. I said no.
>
>EDC MARCH 1
>
>Sincerely,
>
>Tom Whelan R.D.M.S., R.D.C.S., R.V.T. ( ..and I know nothing, but what
>the Lord allows me to know)
>

Women's Insurance Checklist from Auto Insurance Quote

use when must restrict search to only the ultrasound forum...
Enter search keywords:
	Returns per screen: Require all keywords: