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Home For pg ladies or those who were pg >35

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janinegirly

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Hi there,

I hope this isn''t too heavy a topic, but I''m wondering what you thought about prenatal testing and what you opted for? (invasive vs. non invasive). Do you feel the results of one were more reliable than the other or do you have any experiences to share (positive or negative)?

Just trying to educate myself..thanks!
 
I''m a "need to know" kind of person so I had every test that was offered to me and will do them again this time with a minor modification. I started with the nuchal translucency (first trimester screening) at around 11-12 weeks. It''s a no-brainer because you get to have an extra ultrasound! They measure the fluid in the fold of the baby''s neck and do a blood test. It''s the first screening for Down Syndrome and the other trisomies. Then I had the AFP test which is a test that measures the alpha fetoprotein in the mother''s blood. This is yet another screening and it has very poor results based on age--like false "positives" although it''s not really a positive or negative thing. It gives you odds and on my test, I didn''t like the odds for my age so I went ahead with the amniocentesis which I was planning to do anyway. This was the only diagnostic, invasive test and for me, it was completely worth it for peace of mind. Plus, you get to have another ultrasound! The procedure is creepy when you think about it because you are having a needle inserted into your abdomen but it''s over in literally one minute and there really isn''t any pain if it''s done correctly, just minor cramping. I was mentally so freaked out before it and when it was over I couldn''t believe how easy it was! Within 24 hours, I had the results and was able to enjoy the rest of my pregnancy without worrying too much. This time around, I will do just the NT and the amnio, no need for any added stress with the AFP since it''s not even terribly accurate.

I know this topic can get very heated as some people believe that the only reason others have an amnio is because they would terminate if they find out something is wrong with the baby. In many cases, that is true but I also believe that some people just want to know in advance so they can prepare for a child with special needs. Your doctor will discuss all the options with you and it''s completely your choice whether you want to do any or none of the tests. I''m fine with the non-invasive screenings but if you really have to have 99.9% accurate info, you need to do either the CVS or amnio. I chose amnio only because my doctor has done thousands of them and recommended it over CVS, not sure why but she''s the expert so I trusted her. Another positive for diagnostic tests is that if you are going to find out the sex, you will never be wrong with one of these tests!!! Whatever you choose to do will be right for you. Feel free to ask any questions too, I''m happy to help out!
 
Thanks Curly, that''s exactly what I was looking for. And I read somewhere that you said you live in NYC which I do as well!

I agree with your philosophy and would do the screenings if pregnant. Would you do the amio if your NT/screenings and bloodwork came back with very good odds? (meaning are you''re doing it no matter what?). I''ve heard of the CVS which seemed like a good option since it''s an earlier test, but then I hear other things like it''s not reliable and slightly higher rate of m/c.

Anyway, it''s so nice to know you''re a great resource for this information, and btw, CONGRATS on #2!! :)
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janine, yes, I do live in NYC where as you know, it''s much more common to find mothers of "advanced maternal age"!!!

Regarding the testing, my NT results were amazing--like I had the same odds as a 20 year old! But my doctor knew that I was one of "those" people who had to know more, more, more!!!! So she said we would just take it step by step and do each test as necessary. She had warned me that the AFP was unreliable but said we should do it anyway because it''s just one more bit of information before going to the amnio. Honestly, the results weren''t horrible--1/250 chance of Down Syndrome which is seriously pretty good odds! But for me, the nervous nelly, it wasn''t good enough especially since the NT scan had me at something like 1/10,000!!! So there was never any doubt in my mind that I wanted to do the amnio but I just figured I might as well do as many tests as possible along the way. As an old lady, insurance pretty much covers all of this stuff so it''s not like I had to shell big bucks out to do any of this.

I liked the idea of CVS as well because you can do it earlier but you''re right about the miscarriage rates being higher. And I think it doesn''t give as much conclusive information as the amnio because the baby isn''t as developed at that point. As I mentioned, my doctor felt much more comfortable doing the amnio and I trust her so I just went with it!

I can''t remember what hospital you mentioned you were considering. NYU maybe? I''m a devoted fan of Columbia Presbyterian so if you have any interest or need a recommendation for a doctor there, let me know! It''s a great hospital and the staff is amazing.
 
I turned 35 during this pregnancy and didn''t do any of the testing but this is my 3rd pregancy and i have very normal, low risk pregnancies the first 2 times. i did have a false positive with my first AFP test and it freaked me out and just wasn''t worth the stress. I think a big deciding factor really should be what you would do with the results. if you would terminate the pregnancy then I would have it done for sure. if not, then it would up to you if you''d want to know ahead of time if there were problems in order to prepare for them. I figured when I had my 18-20 week ultrasound they can pretty much tell everything and that would be enough time for me to deal with whatever.

I probably wouldn''t do the CVS personally, it''s a little too evasive for me. I would be open to the amnio and if it was my first pregnancy at 35 I would have done it.
 
thanks again curly (and mssalvo)!
I heard that it''s pointless to do the AFP if you do the NT screenings (for reasons you pointed out), unless you isolate the test for spina bifida since the NT screenings do not check for that. When the time comes, I think I''d do the screenings followed by the amio as soon as it''s feasible... if my #''s aren''t excellent. Scary to think about it all though.

Oh and my current ob/gyn works out of St Lukes (I don''t know anything about that hospital), but not sure if I''d stick with her through pg anyway, since I picked her kind of randomly at the time. Maybe I''ll come to you for doc rec''s when the time comes :)
 
My Nuchal Scan numbers were okay in 1st trimester--so I opted out of the amnio (2 babies post-35). In my case, i had statistically more of a chance to miscarry from the amnio than have a baby with a problem, so I did not have the test. I had all the usual ones other than that. I love ultrasounds.
 
Hi Janinegirly
I just had a cvs done at Columbia in NYC and it was so easy. CVS is not riskier than amnio- there is a 1% chance of miscarriage with both CVS and amnio. You can look up the 2006 study on the "what to expect when you''re expecting" website. The main benefit with CVS is it can be done much earlier than amnio. The only advantage amnio has is that it detects spina bifida, but that can also be detected through a blood test. Since my CVS was performed trans-vaginally with a thin tube, it was actually LESS invasive than an amnio which is always done with a needle through the stomach muscle. Most doctors just do the amnio because thay are not trained to do the CVS- you have to go to a specialist. Columbia has one of the top docs in the county for CVS. Hope this helps. Good luck to you!
 
Janine

I had an amnio with my 2nd baby last April (I was going to be 37 at delivery) and things turned out fine. We originally went in with the thinking we''d terminate with a poor prenatal diagnosis, but you never know if you''ll actually make that decision or not. I don''t think I could have done it. Glad I didn''t have to go down that road. However, if we had found out there was a genetic problem, but decided to keep the pregnancy, it would have given us & our families 5 months to make all the neccessary adjustments to be ready. DH would have had to find a new job with no travel, since his has him out of town a lot. We''d have to sell our funky 3 story house & get a single level, disability friendly home, etc. So no, amnio is not a test you have done only if you are planning on terminating, but a test you have done if you are a ''need to know'' kind of person. Frankly, I''d rather KNOW what was coming, especially if it was a diagnosis that I could spend time getting prepared, mentally and emotionally for, instead of being hit with it all with a newborn & all the hormones & sleep deprivation that goes along with that.

There are tons of reasons why women choose amnios, and its all very personal. I wish you a healthy pregnancy.
 
There are tests out there now that were not when I had my third.

I did the AFP and also did an amnio because I was going to be 36 one month after delivery.

I am not sure what I would have done in case of an issue but there was none so I did not cross that bridge,

CVS can be done earlier, at about 11 weeks, so parents can terminate more safely in terms of how pregnant a woman is, should they get a result showing something is wrong and they decide they do not wish to continue the pregnancy. At the time I did my amnio, the woman I went to thought CVS not warranted, as I had no risk factors other than age. She felt I could do the amnio. At that time, she told me that CVS has about a 2% rate of miscarriage while amnio had about 1%. However, she also told me, which made sense, that some people might still miscarry on their own prior to the end of the first trimester so it can be hard to correlate, and that that percentage includes procedures done all over, and that not all clinicians have the same skill level in doing it. Keep in mind this was over 7 years ago, and I am not sure how things have changed. No matter what I would go to a high risk specialist who does a lot of them.

I was terrified of the amnio. Could not sleep the night before and freaked that I would miscarry. It ended up being not as terrible as I convinced myself it would be. Not a barrel of laughs, but not the worst thing. I am just a worrier by nature, so waiting for results and calling for them freaked me out.
Good luck to you!
 
You''ve gotten a lot of great advice thus far. More tests are avalable than when I had mine, and I was younger than the age bracket you are inguiring about. But wanted to say I had an amnio, it went well, not too bad. I had one because as I was pregnant my daughter was very sick and in the Hospital. They were thinking cancer, or perhaps an auto immune disease. I had to have peace of mind, so got the amnio and it came back fine. It did give me a sigh of relief. HTH.
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I got pregnant at 29 and had my baby when I was 30. I had all of the prenatal testing that could be done through blood tests, but I didn''t have amnio or CVS. Several of my friends had one or the other,though, and all of their pregnancies went fine after the tests. I guess every person just has to talk to their dr. to find out what''s right for them.
 
I am 35 and have decided to get the nuchal translucency sonogram done in two weeks, when I am 12 weeks pregnant and the AFP. If the results come back were there might be a risk that the baby has down''s syndrome, spina bifida or some other CS defect, I will get an amnio.

Unfortunately, I work in a NICU and some of the infants I see are so heartbreaking it fills me with so much sadness. I have seen babies die in their mothers arms and I have had babies die in mine.

I think the most heartbreaking thing was an anencephalic baby that was born and died a few hours later, without it''s mother or father at it''s side. The parents knew before the baby was born that it had this condition and chose not to see the baby or have anything to do with it after it was born.


If I find out that something is wrong, I am not sure what I will do, but I feel better knowing than not knowing.
 
Date: 2/26/2008 9:32:05 PM
Author: SquareCut
Hi Janinegirly
I just had a cvs done at Columbia in NYC and it was so easy. CVS is not riskier than amnio- there is a 1% chance of miscarriage with both CVS and amnio. You can look up the 2006 study on the 'what to expect when you're expecting' website. The main benefit with CVS is it can be done much earlier than amnio. The only advantage amnio has is that it detects spina bifida, but that can also be detected through a blood test. Since my CVS was performed trans-vaginally with a thin tube, it was actually LESS invasive than an amnio which is always done with a needle through the stomach muscle. Most doctors just do the amnio because thay are not trained to do the CVS- you have to go to a specialist. Columbia has one of the top docs in the county for CVS. Hope this helps. Good luck to you!
Click to expand...

Sorry to hijack but SquareCut, I'm a Columbia person as well!! I don't know who your doctor is up there but mine doesn't love the CVS for some reason. She definitely does them but she's an amnio "expert" so I guess she is more comfortable with it and she did an amazing job--so much so that when I saw her today at my first appointment, I told her I already know that I want to do the amnio and she said, "was it because you had such a great experience the last time?!" She's somewhat conservative in that she doesn't push it on you but she knows the kind of person that I am so we'll schedule it for 15 weeks. She also said she's not even offering the AFP anymore because of the horrible false results it produces. Anyway, just wanted to high five another Columbia patient! In my opinion, it's the best!!!!

janine, that's not to say that St. Luke's isn't great! I have actually read really good stuff about it, especially their L&D unit. They have jacuzzis in their birthing suites and allow doulas and midwives to be in the room with you. Many hospitals do not allow that. One of my friends is planning to deliver there (drug free!) with a midwife. But if you do decide to switch doctors, I'm more than happy to recommend mine at Columbia. She's great!
 
Date: 2/26/2008 9:32:05 PM
Author: SquareCut
Hi Janinegirly
I just had a cvs done at Columbia in NYC and it was so easy. CVS is not riskier than amnio- there is a 1% chance of miscarriage with both CVS and amnio. You can look up the 2006 study on the 'what to expect when you're expecting' website. The main benefit with CVS is it can be done much earlier than amnio. The only advantage amnio has is that it detects spina bifida, but that can also be detected through a blood test. Since my CVS was performed trans-vaginally with a thin tube, it was actually LESS invasive than an amnio which is always done with a needle through the stomach muscle. Most doctors just do the amnio because thay are not trained to do the CVS- you have to go to a specialist. Columbia has one of the top docs in the county for CVS. Hope this helps. Good luck to you!
Click to expand...
Hi SquareCut, I tried to send you a private note, but not sure if it worked. (if so, sorry if this is repetitive). Thanks so much for sharing your experience. I was wondering if you wouldn't mind letting me know the doctor you used for your CVS at Columbia. I'm also curious how long it takes for results to come back? Thanks and thanks to everyone for the helpful responses!!
 
Hi Janine & Curly!
I used Dr. Wapner and was very pleased with him and his staff. I don't think he does ob gyn - he specializes in doing the cvs. The procedure was done on Thursday and I had the preliminary results back on Monday. Final results can take up to two weeks. It does not test for neural tube defects like spina bifida, but I believe that the afp, while not accurate a test for Down's syndrome, is fairly accurate in testing for Spina bifida. At an advanced age, you're more at risk of Down's than spina bifida. It was such a relief to know early on (before I told everyone that I was pregnant) that everything was fine!
 
I had the blood work (guess it was AFP) which showed a slightly above average chance of Downs. I elected not to have amniocentesis but I did have to go in for a specialized ultrasound (13 years ago it was called a level 3 ultrasound) due to problems with a previous pregnancy. The ultrasound was fine, I did not have a Down''s syndrome baby but my almost eleven pound, picture of health son was diagnosed with autism at age 3. You just never know. I lost a baby the year before and the ultrasound had shown no problems whatsoever. He was almost full term and only lived one week-on life support. Personally, I would never have been willing to do an invasive prenatal test. The baby I lost had very serious problems which would ONLY have shown up on a level 3 ultrasound and these weren''t done routinely.
 
I did the nuchal test, blood screen, and amnio. I don''t know why I did all three, except my doc recommended it. I would have done the amnio though...something in me really wanted to know diagnostically that the baby was OK for some of the chromosomal issues. Our baby wasn''t exactly planned and I had only been off the pill for two weeks (and not been doing anything good like taking prenatals beforehand) so I just felt a bit freaked out.
 
i finally conceived our 4th child after 3 miscarries. our first 3 kids are much older. i had the nuchal scan which was normal, i had him 4 days after i turned 40. then unexpectedly pg again at 41, again had the nuchal, no other tests, healthy baby when i was almost 42. i did have several u/s early with both of these pgs as i had had 4 years of infertility and the three miscarriages. i am a bit of a worry wart and found something to hone in on and worry about with all five of my pgs. and imagine i may be elected to have more testing if early scans showed anything. i would not have terminated though, no matter what. good luck to you.
 
typing as i hold my newborn so forgive my typos. i had two miscarriages at 39- had no trouble getting pregnant at all, just some problems staying that way. so for the third pregnancy i was paranoid about things going wrong. i opted for the quad screen but we chose not to do cvs or an amnio because of the miscarriage risks. we also knew that we wouldn''t terminate the pregnancy based on the results so the risk wasn''t worth it to us. the results of our quad screen were great- chances of down''s were 1 in 3900, trisomy x odds were 1 in 5000. excellent results for my age, and that really put my mind at ease. i now have a healthy, beautiful five-week-old daughter. we don''t plan to have any more children but if we do i''ll do exactly the same thing when it comes to testing.

best of luck to you!
 
I had a long talk with my GP about this last week. First thing he ever says when I walk in is: "So, babies?" so he was really pleased when I said we''d finally decided.
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I will be at least 37 by the time I have a child - if we do. I want to do all the available tests that there are. Partly because FI has a dominant genetic disorder which is would be helpful to know about in advance (they induce you early or do an elective c-section).

My GP said he was unhappy that I wanted to go for amnio - he''s advising that I do all other tests first and then see. He does agree with me that I am not the kind of person who would cope with a child with Downs or severe disabilities, and we have discussed all the ins and outs of that, but I would still be paranoid.

His reason against amnio is the miscarriage risk - I know a lot of women who have had amnio and no problems, is the risk really as high as 1%?

He is a great GP and I really trust his advice, but I''m one of these people who needs to have every bit of info possible.

I am fortunate that I live in the area for the top maternity hospital in London - comes with a lovely view of the Houses of Parliament too - so I am thinking I''d be in safer hands than many other places.

I spoke to my Dad about it (he''s a GP and his brother is a Gynae), and he was all for the amnio - or at the least very early scans.

In Italy they now insist on amnio for all women over 35 - but also apparently offer a thing called biocentisis at 9 weeks, which seems much better to me, especially if there are difficult decisions to make.

Does anyone know more about this?
 
I had babies at 40 and 42. I had amnios both times. No problems, complications or anything. I was glad I did it. It was a huge relief and both times I was beyond thrilled to find out it was a girl. (Although I did try to talk DH into being surprised on the second baby but he wouldn''t).
 
Pandora,

What is biocentesis? I''ve never heard of it. Also, someone else mentioned AFP? What does that test for and how is it done?

I read somewhere that the miscarriage risk associated with amnio is actually a lot less than previously thought - something like 1 in 600 or 400...instead of 1 in 200 as stated before. This was from a large-scale study done recently.

What is the average cost for an amnio?
 
Did some research and seems it is the same as villocentesi - or chorionic villus sampling.

They take a sample of placental tissue and test for chromosomal and genetic disorders.

The big advantage is that you can test at 10 weeks rather than waiting till 16 weeks for amnio. Also the results come in quicker. The risks are about the same as amnio.

The reason they like it in Italy is that if you find out that the foetus has severe genetic or chromosomal abnormalities and you wish to teminate the pregnancy you don''t have the trauma of having to go through labour like you would at the 20 weeks or so that you would be by the time you get the results back from amnio.

Basically, its easier for both parents and medical staff to cope with.

Most of my Italian friends had this and no problems.
 
Date: 3/16/2008 12:31:00 PM
Author: Pandora II
Did some research and seems it is the same as villocentesi - or chorionic villus sampling.


They take a sample of placental tissue and test for chromosomal and genetic disorders.


The big advantage is that you can test at 10 weeks rather than waiting till 16 weeks for amnio. Also the results come in quicker. The risks are about the same as amnio.


The reason they like it in Italy is that if you find out that the foetus has severe genetic or chromosomal abnormalities and you wish to teminate the pregnancy you don''t have the trauma of having to go through labour like you would at the 20 weeks or so that you would be by the time you get the results back from amnio.


Basically, its easier for both parents and medical staff to cope with.


Most of my Italian friends had this and no problems.
Click to expand...

Ahh... I see. Thanks!
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