first prenatal questions?

[tabegle]

Had my first prenatal appointment this morning and was confused by a few things. I will be 36 when this baby is born, so I was told about some "advanced testing" (that I've been aware of from day 1 with my first pregnancy).

I was offered an amnio for when I am at about week 14. I wasn't prepared to be broached with the amnio question today. (I'm only 7 weeks). Since the dr brought it up, I asked about the NT screening and the CVS. She told me that she doesn't really know anyone that does CVS any more. She brushed off the NT scan as I would need to travel about an hour away for that test because there is no one close by that does it.

Overall, DH and I totally get the vibe this is a pro-life office. That's fine. We've been happy with them through our last two pregnancies. They can totally be that way. DH and I stand together on any actions taken based on test outcomes.

However, I don't want to be swayed or led astray by my ob office because of their views. Are CVS's really that rare? Is the NT scan pretty uncommon? I will be going back in 2 weeks for a dating U/S because I don't agree with the due date given to me based on my LMP.

TIA!

[rin]

I was offered (and had) NT scans with both my pregnancies; one was with a large teaching hospital and one was at a small, somewhat crunchy OB/midwife practice. I did not get the impression that they were rare at all. I don't know about CVS.

I would be very concerned by a practice that was encouraging me to forgo the non-invasive NT scan (which has no known risks) but to instead go with an invasive amnio, which runs a risk of miscarriage.

[Pilotbaby]

There is a new test out that I have heard replaces the Amnio in most cases as it is much safer. I'm sorry I don't know what its called (maybe someone else does). It is done earlier, I think around 8 weeks or so and does not carry the risk of the amnio. I would go ahead and ask for the referral for the other two and make the hour drive if its important to you to know those results. I would imagine its still pretty common to get them if you are AMA. Good luck to you!

[Piglet]

Pro-life or not (no clue why that would even factor in here as the amnio has a small risk of m/c and the NT does not), the NT is a non-invasive way to ascertain the probability of Trisomy issues. I will also be 36 when #4 makes its appearance and amnio was never suggested for me, even though my Dr. did make note of my "advanced maternal age" (with a wink). They just recommend everyone here, no matter the age, gets a NT scan and then based on those findings they will either push for further testing (amnio) or not.

[petesgirl]

I wasn't offered either one with DS and so far with DD (I'm 27weeks). If you are concerned I would probably do the NT scan. I know amnio testing is very invasive and I think CVS is also. Those I would only do if there were legitimate concern that outweighed the risks.

[mommylamb]

I was 36 when I had DS2. I was offered a NT Scan, which we did. Actually, the NT Scan was presented as just par for the prenatal care course so to speak. I am surprised that this is considered rare. No one talked to me about an amnio or CVS, though I imagine if our NT Scan results had come back questionable, they would have. I would push for the NT Scan IIWY.

[scrooks]

We have had recurrent loss and other issues (plus I was 37 when he came in July) but an amnio was not at all pushed with ds2. It was mentioned but we did the NT scan, the maternity21 test, the second trimester blood testing and I had a couple of extra ultrasounds. Had any of those (non-invasive) test results been off we would have discussed an amnio...

We had nt testing done with dd almost 7 years ago.... It was uncommon and new then.... Now it's a very common test!

[specialp]

NT is very common but doesn't give you a definite answer of yes or no, just your probability. I do think CVS is a lot less common than amnio, but I did not think it was unheard of at all. It was taken off the table for me due to various risk factors, but I did not get the impression it was not done. If I recall, a poster here had one.

[LKMang]

I will also be 36 when my DS is born and I was given the option of having the maternit21 test done. Really easy, just a blood test and ultrasound. It is about 99% accurate when determining chromosomal issues. They made it sound like if this test came back ok, then I wouldn't need to have an amnio. Test can be done as early as 10 weeks, I think. Only issue is that insurance doesn't usually cover it, but the company can offer it to most people for a $250 copay. It was worth it to us, especially because there is no risk to the baby. So we had this in place of NT and everything came back good, so no need for an amnio.

[theriviera]

There is a new test out that I have heard replaces the Amnio in most cases as it is much safer. I'm sorry I don't know what its called (maybe someone else does). It is done earlier, I think around 8 weeks or so and does not carry the risk of the amnio. I would go ahead and ask for the referral for the other two and make the hour drive if its important to you to know those results. I would imagine its still pretty common to get them if you are AMA. Good luck to you!

It's called the Maternity21 test. They can detect the fetal dna in the mother's blood and they are able to test for many (but not all) chromosomal disorders that way. I had it done at 10 weeks and had the results a week later. I still had the NT scan as a back up and will have the 2nd trimester scan in 2 weeks.

[BunnyBee]

There are a few tests like the Maternity21. Harmony, Pan something... My OB recommended these but the woman who handles insurance at the office called to warn me to get pre-cert from my insurance because all of the major insurers in our state are now bucking paying for these tests. I spent over an hour being passed around the phone circles for insurance to find that they will not pre-cert and will not tell you whether the test is covered. The only lab they contract with does one that is $2800 and more expensive than the rest which are $600-$750, so it goes to a review board where you have to sign over your medical records to determine whether the test is medically necessary. The stupidity made my head hurt. Anyway, I decided to skip that test! The scan and regular blood test are standard of care for AMA patients at my OB (large, respected practice in a major city) and at the OBs my friends have used. Amnio is not and has not been for a while I don't think as a first line screening for AMA patients. If something came back wonky on the first trimester screen, then it's my understanding the insurance would cover the DNA blood test (virtually risk free for mom and baby). I would get a second opinion.

Edited: the perinatal ultrasound expert doc who does the NT scan here is who would do amnios, not the regular OB ultrasound tech. I'm surprised the office has access to someone qualified to do (risky) amnios and not a (non-invasive) scan.

[AnnieW625]

When I was pregnant with DD1 I had never heard of either test, just the 17-20 anatomy u/s, and then she later had a 32 week scan because I had had placenta previa for most of my pregnancy so they needed to see if it had cleared. Once I had DD1 I had met a mom friend who was in her early 30s when she had her DS1 (born in 2005) and she told me she had a CVS test done.

With baby 2 I was 31 yrs. old when I got pregnant and I was not given the option for any prenatal scans at all. I did have a wand u/s at 7 weeks and the RN who did the exam said "oh your baby is really hard to see right now, but that is normal" (tri-18 babies grow at a slow rate from the get go, and many have heart issues or small hearts which causes many of the issues including stillborn). I had the anatomy scan at 17 weeks, an echocardiogram at 20 weeks, an amnio at 21 weeks and lost baby 2 a few weeks later at 24 weeks.

With DD2 I was 32 when I got pregnant and I was given the option to have the NT test, but had they not offered me that I would have demanded a CVS test. My OB with DD2 said that they had just started giving the NT test at their office recently (so sometime between January, 2009 and July, 2009), but he didn't think they would be doing it all that long at that time. I did tell him I was eternally greatful for that test though. The same RN who did the wand 7 week u/s did the NT test for DD2. She didn't remember me, but I remembered her and I asked her if things were okay and she said she couldn't confirm 100%, but they looked good (the measurement they really want is the neck measurement).

If you want an NT scan and your insurance will cover you to go elsewhere then I would do it. If you get a hint that something is wrong IMHO (and based on my real life experience) it is a lot easier to know at 11-13 weeks vs. 20 weeks. The NT is painless and for me it was done in less than a 1/2 hr. .

Best wishes

[BDKmom]

I was 34 when I had DS, and 37 when DD was born and I was offered and received NT scans with each. With DS, it was done at my OB's office, with DD, they sent me to a maternal/fetal specialist, I think because of AMA. My OB's office just said it was because the specialist had a more sensitive/higher quality ultrasound machine. I'm not sure if this was the case with DS, but with DD I had the sequential screening, which involved blood work along with the scan. In both cases, the NT scan/work up was presented to me as standard, but my choice. Amino was mentioned as an option with DD due to AMA, but I chose to have the less invasive scan and bloodwork. I live in a large suburb of a major metropolitan area.

It is very odd to me that your physician would encourage something as invasive and risky as an amino and seemingly blow off the option of the NT scan. I would at least question them more on their reasoning.

Good luck with whatever you decide and best wishes for a healthy pregnancy.

[georgiegirl]

NT is standard for most pregnancies and definitely for AMA. I had DS2 in August and I'm 39. I had the matefnti21 test done at the same time as the NT scan. Both had good results and OB said amino wasn't necessary. Level II u/s at. 20 weeks looked good too. No one even mentioned an amino.

[candaceb]

The advantage of CVS over amnio is that it can be done much earlier - usually 10-12 weeks vs. 16 weeks for an amnio. The advantage comes into play if you would consider terminating a pregnancy if problems were found. If you wouldn't terminate, there is probably no reason to do it. At 36 with no other risk factors, I wouldn't do it.

I had CVS with my first pregnancy (that ended in a 25 week loss) because of suspected problems. I had multiple amnios for lung maturity (DS kept flunking) at 36-38 weeks in my second pregnancy. Procedure wise, they are about the same (all of mine were abdominal - some CVS procedures are done vaginally).

My info is not current though since it has been 3+ years since I was pregnant and I'm not planning on getting pregnant again so I haven't stayed up with the research.

[tabegle]

Thanks for all the feedback and info!

[flashy09]

I had the Panorama test done at 9 weeks. Non invasive and extremely accurate. Basically the same thing as the Harmony and MaterniTY21 blood tests. My results and gender of the baby were back by 11 weeks.

[marymoo86]

It's called the Maternity21 test. They can detect the fetal dna in the mother's blood and they are able to test for many (but not all) chromosomal disorders that way. I had it done at 10 weeks and had the results a week later. I still had the NT scan as a back up and will have the 2nd trimester scan in 2 weeks.

This for me as well and you can get the gender details too!

[kmkaull]

I had the Panorama test done at 9 weeks. Non invasive and extremely accurate. Basically the same thing as the Harmony and MaterniTY21 blood tests. My results and gender of the baby were back by 11 weeks.

I had the Verifi test done at 11 weeks. All of these tests are essentially the same, just different companies. It was covered by insurance. We did not do the NT test or amnio.