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Discussion Starter · #1 ·
Hi - In my area, the NHS do not offer a nuchal fold scan (nor a 20 week scan - as dh pointed out no wonder the birth rate in scotland is so low!) - what they offer is an AFP test at around 16 weeks.

Does anyone know if one of these methods is substantially more accurate than the other?

I could pay for a private nuchal fold scan - but its quite a lot of money. On the other hand, it can be done sooner, so we would have more time to think about amnio if that were relevant. But if AFP is just as accurate I might leave it.
BTW I asked my GP about this, and he didn't know the answer! Can't find it on google.

Thanks for any wisdom!
Jola


 

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hi
I'm on my phone so don't have the link to hand but the rcog website has the NICE clinical guideline to routine ante natal care on the guidelines pages. It has a whole section onthe various different down's screening tests and how they differ. The nuchal plus bloods will be better than one blood test at 16 weeks at accurately predicting risk when combined with your age.
i would say the nuchal was money well spent if you want additional time to consider cvs or amnio if necessary ( hopefully not).
best wishes
Betty
 

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Hi,

I had a leaflet when pg with ds1 which gave the accuracies of each. Roughly from memory it's about 60-70% for the triple blood test at 16 weeks, 70-80% for nuchal scan or most accurate assessment to pick up high risk cases is the nuchal fold scan + bloods and I think that's about 80-90% accurate. I'll wrack my brains to see if I can recall where it was from - it was possibly Bupa or BMI.

If you would consider CVS or Amnio if you find yourself in a high risk scenario (hopefully not) then I would most definately go for the nuchal fold scan + bloods.

Good luck

S xxx

 

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Take a look at www.arc-uk.org
The NICE guidelines are just that - guidlines. Each NHS trust has their own 'way of doing things' and scotland is notoriously bad with ante-natal screening.

Before you get too carried away about what screening is best ask yourself the big question - "what would you do if you were given a high risk?"

If you would do nothing then is it worth worrying about? If you would want to know to make a potentially heartbreaking decision or just to prepare yourself for a different life then you may decide that paying £150 (or whatever) for an early nuchal fold scan is the way forward.

None of the screening tests will give you a definate answer, just a risk or likelyhood. The only positive way to confirm is with an invasive test, which obviously have their own risks.

If you are considering screening and don't know which way to turn then Antenatal Results and Choices (website above) can help you find out about your options.

Hope this helps a little

Deb
 

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Hi

Just to re-affirm the above, the NHS triple test is around 60% accurate and the nuchal + bloods is around 90% accurate although as CM says, none are a definitive answer - they just provide a risk factor which you may or may not chose to act upon depending on the results. 

Fluffs xxx
 

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Im glad youve posted this I am really annoyed withthe nhs.
I went to see my gp 2 weeks ago and mentioned/told her that i would require a nuchal fold.
She said she would sort it out.  I finally get a letter from hospital today with 2 appointments
1 scan at 11 weeks = fine  1 x midwife appoint at 13 weeks
but when do i get a nuchal?  i rang the number on the letter, the hospital dont do nuchal tests you have to go to leeds, 
the midwife apnt as it is on week 13 is too late for her to arrange appnt as it has to be done between week 11-13????
the hospital said go see the gp again for her to arrange??
Ive rang gp but shes not in today left message for her to ring me back monday.
In an ideal world I would like to think she has written to leeds to get an appointment, but this is not an ideal world :mad:
I really dont know why our maternity hospital which is state of the art new has no facility for this.
I have researched every aspect of pregnancy as most of us have in our position, but just think if someone didnt know about this nuchal test they wouldnt ask for it and wouldnt have it,.
It makes me cross :mad:
 

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Kitty - Its not a standard test, and the sonographers that perform it have to be trained (expense!) so not all hospitals are able to offer it. There is also a software and equipment element to the scan (more expense). Yes in an ideal world we would all get it, but unfortunately the NHS has to cut its cloth.....
 

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What Im annoyed about is that they did not give me an option eg go elsewhere and pay for it.
I could have quite merrily gone on to my 13 week midwife appnt mentioned it and then it would have been too late for me to arrange as it has to be done in a strict timetable.
All they had to say at first apnt 2 weeks ago is that it is not done in this area , I would have been slightly miffed as why would nt a brand new state of the art hospital have this facility, but would then know the score and arrange myself. So basically a bit of communication is required from our area's health staff.
 

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Discussion Starter · #9 ·
Kitty - yes, I agree - infuriating.
 

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Discussion Starter · #10 ·
Thanks all for your help - I followed up suggestions etc, and it seems that by far the most accurate screening is to do is BOTH a nuchal scan at 11-13 weeks and the blood test at 16 weeks. So am going to do that - despite having to pay privately.

But I resent paying tax which gets spent on subsidising wars and oil and environmentally catastrophic farming methods instead of on the NHS!!!! ^bigbad^
 

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Hi Jola,

If you are having a nuchal scan done (the one with bloods as the same time as the scan) then you don't really need the triple test at 16 weeks (my MW told me that you had the full nuchal/bloods done then you don't need the triple test at 16 weeks). I think that the 16 week blood may be able test for some things that the nuchal scan bloods doesn't but i'm not sure.

The reason for saying this is that you may have a low risk nuchal assessment but then a high risk result from the triple test which may be incorrect but then throw you into allsorts of predicaments. I had nuchal assessments with my 3 children but never the 16 week triple blood test.

Good luck for your nuchal, but make sure you and your dh have fully discussed what you will do in the result of a high risk result. Many don't and end up in a bit of pickle so it's best to make a decision beforehand or at least have spoken in depth about it.

S xxx
 

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Hi

I know what you mean about paying taxes and then not getting anything for it  ^bigbad^  ^bigbad^

We decided against the Nuchal but did have the Triple test done around 14 weeks.  If you are having the Nuchal then you can have the bloods that go with it and therefore not bother with the Triple Test.

We have also paid for a private scan in the meantime but were offered a 20 week scan.

Wishing you all the best

x x x x
 

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Jola

Following up on what Shelley said and in case it he;lps others (souynds like you probably know all this already now)- the 16 week bloods are usually the quadruple test (hCG, AFP, uE3, inhibin A)  or the triple test (hCG, AFP and uE3). Testing the AFP in the 2nd trimester will also screen for risk of spina bifida so that is an extra. The  nuchal plus blood tests at 11-13 weeks includes blood tests for hCG and PAPP-A. If the hospital offers the integrated test (NT plus bloods at 11-13 and 14-16 weeks) then they combine your age, the bloods and nuchal fold screen in to one combined risk so often you wont have the full result until 16 weeks. They will often give you an idea at the nuchal but a full risk will be later.  I had both NHS nuchal plus quadruple test and a private nuchal plus bloods at FMC. My risk went from 1 in the high hundreds in both pregnancies to 1 in 5000 and more after the second lot of bloods.  Obviously you can still be the one but for me the risk in the thousands was very reassuring.

Betty
 

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FWIW, my consultant told me that the most accurate test was the combined bloods at 16 weeks, followed by the combined bloods and full scan at 13 weeks (ie including the heart, nasal bone as well as the nuchal fold), followed by the basic nuchal at 12w plus later bloods at 16w. I chose the full nuchal plus bloods at 13w just to get the result sooner. It cost £150 which was totally worth it, but YMMV.

 
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