Nuchal Scan X2

I had an appointment on Friday for my first visit with the MFM practice and to get the nuchal fold measured for the bean as part of the ultrascreen test. The MFM practice I go to is one of those group practices where you don't get assigned a primary doctor, but you can request a specific doctor when you make an appointment. I have two doctors there that I like -- the first, who I will call Dr. Jolly, has a good bedside manner and is very patient with all my questions. The second, Dr. Careful, is totally not the usual type of doctor that I like -- he tends to be a patronizing and has no bedside manner. The reason why I love him is that he is incredibly careful and meticulous when he does ultrasounds. This is the doctor that detected that something was going to go wrong with my pregnancy last time, even though the ultrasound, for the most part, really looked fine.

My appointment on Friday was with Dr. Jolly. He went through my questions, although there was one he refused to answer. The funny part was that after all my questions, he complained that I was being a little difficult. I laughed and told him he could go next door and compare notes with my RE -- I know they are friends. I got a list of other OBs he recommended, which was a bit awkward, because I know he is friends with my OB as well. He didn't see any reason that I could not attempt VBAC if I wanted to try. Now, the weird part of the visit is that they were not able to do the nuchal scan because the baby was 1mm too short for the minimum length required to do the test. I was told to come back the following week, so I scheduled an appointment for Monday, since my CVS was scheduled for Tuesday.

The baby was supposedly almost 1cm longer this morning. Unfortunately, the LO was not being cooperative and it took a long time for the technician to be able to get the needed measurements. Once she did, though, the measurements were quite good and the nuchal fold was 1.3mm. Anything under 3mm is okay, so 1.3 is very good. After the scan, I had to see the genetic counselor again to discuss my results and it was another one of those conversations why pregnancy at 40 is never a harbinger for good news.

The Ultrascreen has 3 parts to it - hCG bloodwork, PAPP-A bloodwork, and nuchal fold measurement. My nuchal fold measurement was great and my hCG levels were normal (50th percentile), but my PAPP-A was on the low side (20th percentile). Now, this was still a good number for me, since my PAPP-A had been in the 1st percentile last time and 20th percentile is high enough that it is not predictive of any future placenta problems. However, it is still low enough that it can indicate some increased risk for Downs Syndrome. My risk factor for Downs Syndrome after the test is 1:282 and the cutoff for not being at increased risk is 1:298, so we just barely missed being in the clear. Now, based on age alone, my risk factor for Downs is 1:61, so the positive test results do reduce my risk levels, just not enough -- due to my old geezer reproductive status. The genetic counselor said that at my age the test results really need to be perfect to indicate reduced Downs risks and my results were actually pretty good.

We opted not to do the CVS today. It was going to be a logistical mess for us anyway because we would have needed to take T with us - T in the room with a doctor and a big needle does not sound like my idea of a good time. I am still going to do the amnio. I really wanted to have it done by Dr. Careful, but he is out that week. Dr. Jolly was also unavailable, so I'll be seeing the head of the practice instead.