Amnio advice

[Anonymous]

I've posted before on related matters and gotten great feedback; even though this is ultimately a personal call, I'd really be interested in how other people view this dilemma. I'm 39, pregnant with #2, just got my NT results back with really good news - the odds for Downs were in the 1/1700 range and for the trisomies the odds were around 1/3100. Not what I was expecting given my age, and I take it that this is probably as good as I could get at this advanced point in life. So my dilemma is what to do next. I had an amnio with #1 and was fully prepared to go ahead again... except these odds and the nagging queries of my doctor are giving my pause. My doctor hasn't told me what to do, but encouraged me to think about whether any additional risk is worth it. I had a m/c last year, and I can't help but wonder if the minute risk is worth it. The overall prospects for a post-amnio m/c are 1/400, better for my experienced specialist, but still it's not zero. I'm normally all about having definitive info, and I was really looking forward to knowing the gender soon as opposed to 20w, but I'm still on the fence. Any thoughts??

Note that other than this I'm not really a hyperneurotic preggo. I've carried my 40lb 4yo down the street, I eat soft cheese and deli meat, have 1 cup of coffee daily, and will probably even drink a glass of wine on rare occasions if/when I make it past the nausea phase. So it's not like I'm hyperprotective in any other part of my life.

[Anonymous]

The overall risk varies from dr to dr, but the 1:400 or 1:200 stat is the overall risk back when they were done without real-time sonography. Your dr (or whoever in the practice does amnios -- some OBs don't) should be willing to give you her or his stats. I had amnios with all three of mine, but the dr doing them had done thousands and never had a m/c. Certainty was worth it to me with those numbers, but I'm not sure it would have been if the #s had been worse.

[Anonymous]

I recently had one at 40 with my odds at DS at 1 in 10,000--which I am told is waaaaaaay off the charts good. But..I just needed all the info in front of me and would have obsessed. I do think you have great odds in your favor but you have to weigh whether you will obsess the rest of your pregnancy if you don't go ahead and also what you would do with the info. Good luck!

[Anonymous]

I was 40 with great nuchal results and nevertheless felt some pressure from doctor to have the amnio. I respected her a great deal and she ultimately performed the procedure herself. All I can say is that I was honestly amazed at how relieved I was when the amnio results came back. I was carrying weight of worry of which I was not consciously aware. I truly began to bond with my db following the receipt of the amnio results. Best of luck to you whatever you decide.

[Anonymous]

Not sure if this helps, but no one's risk is zero based on the NT test and other screening tests, but your results are about as close to zero as you can get. 1 divided by 1700 equals .0005 -- that's super low.

Personally, I got bad results on the NT test and still didn't have the amnio, and DD does not have Downs or anything else genetically wrong with her. I was too worried about the miscarriage risk.

[Anonymous]

PP got me thinking. Given your odds, I'd have the amnio.

Here's why:
odds for Downs: 1/1700 = 0.0006
odds for one of the other major trisomies: 1/3100 = 0.0003
odds for another chrom abnormality not detected by NT: 1/5000 = 0.0002 (ok, I just made that up, but you need to put something here)

So summing up gives total risk of bad thing if NO amnio = 0.0011 or about 0.1 percent. Very nice number.

The relevant comparison is that 0.1 percent against the risk of a bad thing if you HAVE the amnio.

You suggest that the risk is 1/400. My 1 minute Google research found a recent and seemingly reputable study that gives the risk as more like 1/1600 = 0.06 percent (http://www.sciencedaily.com/releases/2006/11/061101151238.htm). [another link referred to a summary of this study in JAMA].

So let's split the difference and say that the risk is 1/1000 or 0.1 percent, which is about the same as the risk from not having the amnio (admittedly including my invented numbers).

So risk-wise, it's a wash, and given the peace of mind I'd get from the amnio, I'd go in that direction.

Good luck whatever you choose.

[Anonymous]

As I see it it's far more risky to have the amnio (2% I think my dr. said) than your risk otherwise according to the nuchal. You can't add the risk percentages from various diseases tp get a total risk number like pp suggested. That is not the way probabiity works. If it were no one would be alive.

[Anonymous]

Interesting question & responses. My DH & I debated back & forth for a long time with our first on whether to get the amnio even though I had good nuchal results (I was 35). With number 2, (now 37) we are seriously considering the amnio regardless of nuchal results. Several PPs mentioned their docs had very low miscarriage rates with amnio and/or were very, very experienced with the proceedure. Anyone willing to share names? I would love to find someone in whom I have great confidence. TIA!

[Anonymous]

Let me start off by admitting that I am pretty neurotic - alas, I would definitely have the amnio. It is pretty safe procedure and many OB's automatically do it with any woman after 35 as standard practice.

[Anonymous]

consider doing a CVS -- you can do it much sooner than amnio, and if done by one of washington's reputable specialists (dr. karson or dr. pinckert) the risk is no more than amnio which is minimal. but the bottom line is are you comfortable with a screen test versus the diagnostic? if yes, then don't do it; if no then do it. the NT is a screen only but appears to be in the 80% accurate range, maybe that's enough for you?

[Anonymous]

Well I went to a great maternal fetal expert. His question before the amnio was what are you going to do with this information. So I think it depends on why you want to get the amnio and how it will change your pregnancy. Regardless, the risk of loss with amnio is very little if done by someone who has experience. We had amnios with twins and I felt very comfortable and he gave me all his stats. this was done despite my bleeding throughout first trimester and uterine irritability. He was very very good at explaining everything.

[Anonymous]

I would go for the amnio. I didn't have the NT test and went straight for CVS. I'm 40 and wanted definitive results. It was such an incredible relief to get the results back. During my 20-week ultrasound they found cysts on my baby's brain that are not too uncommon. They said that they might have been concerned that it was a chromosomal problem had I not already had the CVS.

[Anonymous]

Depends on what you'll do with the information.
I am older too, had good NT results, etc, and the doctor recommended against an amnio for that reason. I had already decided regardless that I wouldn't be doing an amnio just because if it came back with "bad news" I wouldn't be able to terminate the pregnancy and I would just obsess and worry that anything else I did during the pregnancy would make things "worse" somehow. It was quite interesting considering I'm staunchly pro-choice until, apparently, it's about my kid.

[Anonymous]

I think it comes down to whether you will be nervous the entire pregnancy if you don't get the amnio. I'm in my late 30's and had great results with my NT. For me - that was good enough and erased any worries I had. I didn't want to have the amnio anyway - more worried about even a very slight chance of miscarriage than I was about the chance of Downs after the NT results came back in. The NT results were enough to quench my worries. You have great results too - but will you worry about it for the next 5-6 months?

[Anonymous]

Anonymous wrote:Not sure if this helps, but no one's risk is zero based on the NT test and other screening tests, but your results are about as close to zero as you can get. 1 divided by 1700 equals .0005 -- that's super low.

Personally, I got bad results on the NT test and still didn't have the amnio, and DD does not have Downs or anything else genetically wrong with her. I was too worried about the miscarriage risk.

I also had a bad NT-went on to have a CVS though. I've heard stories of bad NT-but having healthy babies. I went on to have a healthy baby boy-but was a wreck after the NT.