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Wednesday, October 13, 2004

Pain in the Nuchal Fold

I'm feeling a little shocked and bothered. I knew something was fishy when I was sent for a second ultrasound. I was told that you only get the one ultrasound unless there is a "problem". So when I was told not to worry about being scheduled for a second and then a third, I went ahead and worried. All I knew was that the requisition had the words "Reassess nuchal fold" on the second last ultrasound appointment. I asked the doctor "what's a nuchal fold?" and she told me that she didn't know! I am thinking now that she knows exactly what it is, but didn't want me to panic. She can justify her response to me now by saying that they didn't know the proper measurement of the nuchal fold, so I can't really call her a liar. Much to my doctors dismay, DaddyR and I regularly consult Dr. Google. Dr. Google told us that the nuchal fold is the fold of skin at the back of a fetus' neck. And that there is a correlation between the thickness of the fold and the chances of having a Down Syndrome baby. The first two ultrasounds listed the fold as "thicker than normal" but did not give an actual measurement. The third ultrasound was scheduled a week after the second one, so I didn't even get to go back to my doctor and ask "WTF?" before I was off to the Royal Alex hospital for yet another ultrasound. After the pictures were taken, DaddyR and I were told that we were going to be having a consultation with the doctor and led into a hospital interrogation room. The first doctor came in while DaddyR was out plugging the parking meter. He looked like Stephen Harper meets Charlie Brown and his face really unnerved me. He asked if I knew why I was there and whether I knew why they measure the nuchal fold. When I had positive answers to both, it seemed to catch him off guard. Thankfully DaddyR came back soon. Then this guy left to go get the other doctor, so DaddyR and I got to sit in a brightly lit interrogation room seriously worrying about what was coming next. We were told about the Downs connection, knew that 3 ultrasounds had been done, and that some other doctor needed to sit down and discuss options with us. Options? This is a baby, not a new car..I was freaked right out. Turned out to be not as bad as I thought. The other doctor was much better spoken and didn't put the fear of god into you with just the look on his freaky-assed Charlie Brown-Stephen Harper face. The good doctor explained that nuchal folds greater then 6mm are cause for worry and usually further assessment. Our baby's fold was measured once at 5.3mm and again at 5.8mm which he likened to having a 6'3" man stand in a crowd of men of average height. It may look out of the ordinary, but it still within the 'normal' realm and cannot be considered an abnormality. He explained that there are other 'markers' on ultrasounds for determining whether someone is at a higher risk, but none of these are diagnostic. Our baby shows none of the other Down's markers (thank Buddha) such as short femur length or lack of a nasal bone. The only way to know for sure would be to either give birth or have an amniocentesis done. There is another blood test, CVS, that is used for these purposes, but it has to be done earlier in pregnancy and I am past the cutoff date.
Anyway, the doctor at the hospital advised us that this "thicker than normal, but not abnormal" nuchal fold should not be a huge cause of concern for us based on my age, the lack of known history of chromosomal defects in our families, and the lack of any other markers. The chances of having a miscarriage due to the amnio test (1 in 200) is greater than our chances of having a Down Syndrome baby (can't recall the revised stat).
I'm getting more and more dumb in my old age though...The chance of having a baby with some kind of chromosomal defect increase with the womans age. 35 seems to be the magic age for making the jump to being a high-risk. Yet they say that 80-85% of Down's babies are born to women under 35.


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4:47 AM  

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