Amnio after high nuchal?

Hi Everyone,
I'm new here and very, very stressed. Had my nuchal done Fri @ 13 weeks and my measurement was 2.7mm (I didn't think that was exceptionally high). I am 34 and combined with my bloods, my risk for bub having Down syndrome is 1:32. My ob has called and says he wants to see me urgently and I'm so worried that I'll be pushed into an amnio without really being sure. I will not terminate however I am stressed and would like to know one way or the other so I can prepare myself and my family. Does the risk of losing bub outweigh the anxiety I'll feel for the rest of the pregnancy?
Has anyone else had an amnio and then miscarried? Or had an amnio after a high nuchal reading and been glad they did?? HELP!!

Hi and welcome to BB. Sorry you are going through this stressful time at the moment. There are many ladies here who have come back with a high risk and have gone on to have healthy babies, I'm sure they will pop in to put your mind at ease.

Regards,
Dianne

I am currently 13w and waiting for an amnio after my NT last week. My measurements were within limits (1.8) but risk is 1/58. I understand the risks but I need to know so I can be prepared before this little person arrives.

You don't need to have an amnio if you choose not to. There are risks, there are advantages but ultimately the decision in yours (and your partners) :hug:

My heart goes out to you...this is an awful time.

This happened to me this pregnancy. I am also 34. My bloods were great but the NT measurement was 3.8 and that was what gave me a 1 in 60 chance of Downs. I think it was 1 in 258 for the other Trisomy conditions. A good sign was that the baby was growing well. Most Downs babies are on the small side, even at this stage.

Because the baby was already measuring at 13w 2d, I couldn't have a CVS (cut off is 13 weeks for CVS), I had to wait to have an amnio.

The worst bit I think is the waiting. You can't have the procedure until between 14 and 16 weeks and I found that I could not stop thinking, wondering, worrying the entire time. Cried quite a few times too.

The great news (if there is such a thing) about having an amnio is that the results are 100% so if they come back clear there is NO chance the baby has Downs.

The accepted risk for miscarriage with an amnio is 1 in 200 (CVS is 1 in 100, so higher risk than amnio). However, if you go to an experienced practitioner the odds are much better. My ob made sure I went to a very experienced doctor and they told me the odds at their practice were more like 1 in 700 or even lower. There is, however, no way of telling who might miscarry and who won't, it is very random and there is no indicator of what woman would be more likely to miscarry.

When you conceive the chromosome pairs in the egg and sperm divide and the baby gets one from each pair from Mum and one from each pair from Dad. As a woman gets older, the chromosome pairs in the egg get "stickier" and sometimes a chromosome won't separate so the baby winds up with 3 chromosomes (2 from Mum, 1 from Dad). The age of the father is not a factor because sperm regenerate constantly but women are born with all their eggs (so we are the problem!!)

Depending on which chromosome it is, that is what "syndrome" the baby has. Downs babies are generally the "best case scenario". There are 2 other syndromes called Edwards and Turners and these 3 syndromes are usually the ones that would be the case if a pregnancy has made it past 12 weeks. An abnormality on other chromosomes would probably cause the baby the miscarry very early on.

So when you have the amnio they first do a really thorough ultrasound and check out the baby and how it is growing. I told them flat out that I wanted to know what they were seeing, good or bad, and not have to sit there in silence. The woman doing the ultrasound fully agreed with me and said that was her approach anyway. She was great, the first thing she said was "well the first thing I see is that the baby has a nasal bone which most Downs babies don't have which is an excellent sign". She also went on to say that the baby was growing beautifully, not small for dates, and the limb length was exactly normal (Downs babies tend to have short limbs). The high nuchal measurement had resolved itself and was now thin, so much so she didn't even bother to measure it again. She could also tell even at this early stage that there was nothing major wrong with the heart - that was the other thing with a high nuchal measurement, there could be something wrong with the heart.

She said because they do these ultrasounds all the time they can nearly always give a pretty good guess from the ultrasound alone if the baby is okay although they do occasionally get a nasty surprise when the results come back. Interestingly they didn't think my odds of 1 in 60 were too bad (I suppose it is all relative when you see high risk cases every day), it's when a woman comes in with 1 in 10, 1 in 12 odds that they think that gee, there really might be something wrong here.

After she was done the doctor came in to do the amnio itself. They swab your tummy with antiseptic and I was SUPPOSED to get a local anaesthetic but he didn't give me one. I had been warned it wouldn't numb all the way down to the baby anyway. But anyway, the doctor has a good look on the ultrasound to determine the position of the baby so he knows where to insert the needle. (Needlestick injuries to the foetus are very rare).

So he just jabbed the needle straight in and I was squeezing DH's hand for dear life. It was extreme discomfort bordering on pain but I wouldn't say it was as painful as, say, labour. It was a bit confronting because I could see the needle on the screen and it is quite long, but not thick (a thick needle hurts more) and he jabbed with a bit of force. The needle was quite fine so it takes a couple of minutes to get the fluid out. He got 2 syringefuls (but only one jab, he just attached the new syringe to the needle while it was already in me so I didn't get jabbed twice). The fluid looks just like wee, to be honest.

Once the needle was out there was no more discomfort and they let me lie there for a few minutes before I got up. I felt a little bit crampy (like very very mild period pains) but other than that absolutely fine. I did feel a bit crampy for about 24 hours afterwards but also very mild, not even worth taking a Panadol for. If you haven't miscarried in 48 hours then you won't miscarry...or at least, if you do miscarry after that timeframe, it is nothing to do with the amnio and you probably would have anyway. The fluid they take will have regenerated within a day or so too.

They tell you to take it easy the next day and not do any heavy lifting (but bed rest not necessary). The day after you can go back to your normal life. Thank God we had SIL staying over so she helped out with the kids and also we didn't have to take them with us.

The lab do 2 tests on the fluid samples, a FISH test (which stands for fluorescent something or other) which tests for the 3 most common trisomies (Downs and the other two) and the sex chromosomes to make sure they are okay. The other test takes about 2 weeks and they test every single chromosome.

With the FISH test you get the result back in about 24 hours so try not to get an appointment for Friday or you will be sweating over the weekend. If that test comes back all clear it is HIGHLY unlikely anything will come back from the full chromosome test and we were specifically told to chill out and relax after our FISH results. This is of course how we knew the sex so early.

They do the tests by collecting skin cells the baby has shed into the amniotic fluid. Very occasionally they might not get a big enough sample so they would skip the FISH test and go straight to the full chromosome test but that is very rare.

If something is wrong they will sit you down and talk about the prognosis for the baby.

So really, once you get your test results back, if all is well you are back to having a normal pregnancy but with an extra clean bill of health. In my case I suppose I didn't really get the full all clear until the 20 week ultrasound because they had to give the heart an extra good check then because the high nuchal reading meant that maybe a major organ wasn't functioning properly. So if anything is wrong now, it's just a nasty surprise like it would be with any other pregnancy if you know what I mean.

So that's all the practical stuff. The emotional stuff isn't as easy. I didn't talk about it to anyone because I didn't want to articulate my worst fears. I also didn't want to put people in the position of hearing that and then not having anything to say. What can they say? They can't say "It'll be all right" because really, how the hell do they know? It would have just been hollow, empty words. And it was a pointless exercise to speculate on the worst possible outcome when there was still a good chance that it was all a false alarm. There wasn't really anything anyone could do or say.

Sorry, DD is screaming at me I have to go. Huge hugs to you.

I am so sorry you are having a rough time right now. Basically you need to do what is right for you. As you said you will not terminate if the results are positive for chromosomal abnormalities so you need to weight up the pros and cons of going through with the test.

I wish I could help more but it is a choice that must be made by you and your partner. I wish you all the best and please let us know how you go.

Shelleybelle welcome to Belly Belly & I am sorry you are going through this anxious wait... :hug:

I have had amniocentesis & whilst it was uncomfortable & stressful (for me) it really was very quick. The practitiomner uses ultrasound image to guide the needle so there is very little risk of damage to the baby. Usually you are left with a small bruise & a tender spot that clears up over a couple of weeks.

Generally a risk factor of greater than 1:200 further testing is recommended. This is because this is the risk rate accepted as "average" for miscarriage due to the procedure. So, the risk of a baby with a chromosomal defect is greater than the risk of miscarriage.

You do not have to have further testing. This is a very personal decision. Some women choose not to & some women choose to.

How further testing can help is that if it is known that a baby has for example Trisomy 21 (Down syndrome) we know that there is a higher risk of cardiac problems etc. Sometimes this knowledge is helpful.

It is important though that you are fully informed. That you research the procedure and feel that you are making a decision that is your own. Rememver this is your body & your baby. So, do not feel that you are at the mercy of others with more information. I think this is important. :hug:

I wish you well my love & remember whatever your baby's result since you have decided that you will continue with your pregnancy - this baby is whatever he or she is... It sounds to me that the knowledge of exactly what it is your baby is facing is going to help you to have less anxiety.


Sending lots of love & support. xxx :hug:

Okay DD calm again.

Now that I am on the other side of it with the best possible outcome, yes, I am very glad I had it done. Fortunately it hasn't tainted the pregnancy for me...if anything I feel more secure because this baby has been given a far more comprehensive clean bill of health than I ever had with DS or DD. However, I cannot deny that as soon as she is born I will be very anxious to get the paediatrician to check her over.

When I said they talk about the prognosis for the baby if something is wrong, you may find yourself in the position of having to decide whether to carry the baby until you naturally miscarry...some syndromes mean that the baby will most likely die in utero or only survive for a few days afterwards. Then there are other scenarios where the baby will most likely survive but with disabilities and you have to decide if you are prepared to deal with that.

For us there was no question that we would have the test done. We simply had to know what was going on.

You do have the option of requesting another ultrasound with a specialist and then deciding to go ahead with an amnio if any red flags are raised then...but you won't get your definitive YES/NO answer unless you do have the amnio. A friend of mine is in this position right now and she has decided to go for the extra ultrasound first before committing to the amnio.

For me, such a high nuchal measurement was a huge worry and I had to know as soon as possible. I could not go through the rest of the pregnancy without knowing. I would not have been able to handle the stress of not knowing. Even those few weeks it badly affected my parenting and I thought I was being quite good until after I got my results back and got the all clear, I could then see how stressed I had been. Poor DS had no idea why Mummy would burst into tears for seemingly no reason.

The wait is dreadful, I can't sugarcoat it. I do highly recommend not thinking about the worst case scenario though unless you have to...it won't ease the pain, in fact it may prolong your agony unnecessarily. Trying to stay positive is the best way of coping.

I also recommend you be selective as to who you tell. Everyone will have an opinion or judgement as to what you should do and if they don't agree with you things could get very awkward.

Sorry, very long, but I hope you find some of this helpful.

Thank you all so much for being supportive. You must all be such lovely mums, and Curly, after reading your very informative post, I've decided to go through with the amnio and am booked in in 2 weeks time. I identified so strongly with what you said and feel that even though I don't plan to terminate, I cannot function for the next 6 months without knowing. I cannot be a good mum to my DD or a good wife, friend, sister etc. I need to prepare if the test is positive and relax and enjoy the pregnancy if negative :pray:
Thank you guys again for your support and encouragement. I will let you know the outcome.

Good luck SB, let us know how you go.
xx

Shelleybelle I'm so glad I could help you.

Just remember that getting the amnio does not automatically mean it is a question of whether to terminate or not if something is wrong. It would also mean that you would be able to be prepared and, if necessary, have medical support on standby if your baby needs it at birth.

This thread puts it far more eloquently...and I think it will also be of help to you:

https://www.bellybelly.com.au/forums...amnio-cvs.html

Hello Lovely Mums,

Just wanted to follow up with my results. I know that when I got the bad results from the nuchal, I trawled the net looking for other people's experiences and found them so inspiring and settling so hopefully someone else going through the anguish such a result brings will find this thread and gain some hope.

Went for the amnio on Thurs, lovely to see bub and see he's a boy!! Cemented our decision to have him and love him no matter what. Very quick & easy procedure, not at all painful and the doctor and sono were very professional.

Got the prelim results this arvo! All clear! Prayers answered and oceans of relief washed over me. So thank you God and thank you to everyone who sent me support and understanding! I am now going to enjoy this pregnancy with every ounce of my being and NEVER complain about lack of sleep again! WHO CARES?!?! If you have a healthy baby ~ you have EVERYTHING!

Love to you all!!

Shelley:itsaboy:

Congratulations Shelley, that is great news.

Regards,
Dianne

Congratulations Shelley!

There is no better feeling in the world, I don't think!

Sleep well tonight.

Congrats Shelley!!

Well you're the second fabulous amnio result for the day - an another boy!!!! This is beautiful news & I am so so happy for you my love! :happyforyou: