40+ and pre-natal screenings -- Tia's ramblings

[Tia38]

I no longer post or lurk over here -- happy to say 2 healthy pgs come and gone (one at 39, one at 41).

A few folks have asked me about pre-natal tests/screenings so I thought I'd post my experience. Most of my comments are sprinkled on my other posts, but they're buried and dated at this point.

My best advice is to find a support group, whether it's here on this board, or from a due date club.... it helps to have someone to bounce things off.

I believe most folks know that b/w (triple screen) for 35+ often gives false positives... and so often a different protocol is used.... more details here: http://www2.massgeneral.org/vincent/...omanover35.htm

With pg#1 (at 39) I was determined to get any and every possible test, as early as possible. After reading up on CVS and talking to my OB I decided to hold off -- to wait and see what my nuchal scan revealed.

The nuchal was good (thin, although I don't remember the #s) and they saw a nasal bone (I think that's they see it or they don't); b/w #s came in about a week later and based on no red flags I skipped CVS (you can only do that in an early time window as I recall) and postponed the amnio decision until after my level 2 (sometimes called anatomy) scan, which I scheduled as early as possible (I think around 18w).

There were no red flags or markers on that second u/s, so we decided not to do an amnio. DD#1 was born w/o any issues (other than my pre-e, but
that's for another thread).

With pg#2 (at 41) we followed the same path. My initial numbers were not as good this go around, purely based on age. While things get 'worse' after 35, they get 'worse faster' after 40.

Nuchal was fine (thin and nasal bone present, although it took them a while to find it); b/w improved my numbers a bit, but this time the probabilities were higher (although still relatively low) for issues. I don't recall exact #s but I think I had a 1-2% chance of one of the chromosomal abnormalities, not sure if it was Downs or one of the others. I think based purely on the numbers they would have recommended an amnio, but I wasn't willing to take the risk that early. I know amnios usually go w/o incident, but I didn't want to be the 1 in X that had a problem.

Our level 2 u/s was more detailed, but they saw no markers and no red flags. They spent much longer this time than with pg#1. They assured us there wasn't anything in particular they were looking at/for, but it did nibble at me right up until delivery. We did not do an amnio this time either. DD#2 was born w/o issues (although, pre-e again this go around). [She was 10+ pounds, so I didn't ask about the fingers and toes... just to recheck the weight.]

I was pretty stressed with pg#1, especially before the level 2 u/s, and even to some degree after. One of my first questions upon delivery was "10 fingers, 10 toes? No visible problems?" Even a few days later I asked my sis (a pedi who works with newborns) if there was a chance that there was some problem (hidden Downs or other internal issues).

I was a bit more relaxed with pg#2, although still worrying a bit.

I don't know where the threshold for me would have been to do an amnio. Someone told me to consider what I'd do with the results. If the answer was 'nothing' then don't bother with an amnio. More on that below.

I suspect if I had been told > 50% chance of issue at my nuchal or with the b/w then I might have gone for the earlier amnio. I suspect if they saw two or more markers on the level 2 u/s I might have gone for amnio.

But even if they only saw one marker on the level 2, I might have asked for amnio. OR IF MY GUT TOLD ME TO DO IT. I am more of a believer in instinct after my two pregnancies.

I'm less convinced that I might have done a CVS... if I did I would have looked for someone with lots of experience. At the time, my clinic (MGH in Boston) didn't do them and would have sent me to another Boston-area hosptial.

Keep in mind that the u/s and b/w are screenings, not diagnostics. They give probabilities (possibilities) of issues... you still don't know for certain if one exists or not.

On the topic of chromosomal abnormalities... I think there's a board here for 'raising a special needs child' or something like that. You might want to check over there.

Also note that for amnio it takes a few days (week?) to get the results. There is usually an option (that you have to ask for BEFORE the test) that can get you partial results more quickly. Sorry I don't recall the name or the details, but it's something you should know and ask about BEFORE if you are going to get an amnio.

Hope it helps someone.
-Tia

Sensitive topic mentioned below.....
please no flames....
space added in case someone doesn't want to read it.
-----------------------------------







(more content below)








If your testing reveals that there is an issue/problem with your baby and you might decide to end the pg you should ask your doc what the time line is for such things. Many (if not all) states have some cutoff after which it is much harder to end a pg. The longer the pg goes, the harder it is physically on the woman to terminate (not to mention the emotional side of things).

It is a very tough decision to make. I never had to face it, but I wanted to know up front if I had to ever make it, what was the time line. I think it was somewhere around 22w in MA.

Many women would not terminate, but still want to know, so that they can prepare themselves for the future. Or just to know one way or the other.

I don't encourage or discourage either path. Whatever choice you make is the best choice for you. I don't envy anyone who has to make it. And I believe that while each of us suspects what decision we would make, you can't know until/unless you are actually faced with it.