Thank you all, I was really worried about the "soft markers" they found. After my appointment yesterday my mind is at ease now that she is measuring normal.
I am left now angry and frustrated at the first ultrasound experience I had, she shouldn't have even measured the nuchal fold at 20weeks 2days. I am worried for others who will go through this now, a less empowered person may have not opted for a second opinion and then would have been left with worry that they were higher risk of downs..etc for their whole pregnancy or even gotten an amino and put the baby at risk for no valid reason. I am going to talk with with my doctors about these concerns I feel they should be voiced.
I hope others read this and realize that doctors are only as good as their experience, knowledge and the tools they use, they can be wrong/inaccurate and one should always seek a second opinion. Even the machines that are used are only as good as humans ulitize them i.e. the ultrasound machines. Thank you all again for your concern and I praise God that my girl is measuring normal :-) So RELIEVED!
Your tech was correct in measuring the fold. It is standard practice to measure the fold at our facility, as well as at the tertiary care (high risk) center I used to work at. I still work for the same practice, just in a community hospital now.
The baby can be lying with it's head tilted back, which will naturally cause the baby's fold to appear thicker. However, if we did not measure the fold, we would not being doing our job. We HAVE to document soft markers. They are soft markers. Soft. Not 100%. But there the possibility. As I posted before, I have send patients onward for more testing due to thickened folds, and had them come back normal. And I am relieved. I hate putting the mom through the stress of that , but I would hate to deny a mom the opportunity to know more about the potential for a chromosomal disorder.
I'm glad your baby is ok. But don't go blowing your stack about a tech doing their job to the best of their ability. The tech is to measure the fold in the 2nd trimester, up until 22 wks. Read more below.
Nuchal fold measurement is obtained from the outer edge of the occipital bone to the skin surface in the transaxial plane of the fetal head at the level of the cavum septi pellucidum and cerebellar hemisphere.
Nuchal fold can be spuriously thickened by angling caudally (intersecting the inferior level of the cerebellum and occiput).
This nuchal skin fold increases with advancing gestational age and ranges between 1 and 5 mm in normal fetuses between 14 and 21 weeks gestation.
A nuchal skin fold thickness of ³6 mm is considered abnormal between 14 and 21 weeks.
Excess skin along the back of the neck is well known in babies with Down syndrome (80% of neonates).
There are many studies that have reported the relationship of a thickened nuchal fold with abnormal karyotypes.
Benacerraf and co-workers 1985 (1,2)(nuchal fold ³6mm).
Combined Studies 1987(3)
42% fetuses with Downs syndrome had thickened nuchal fold.
False positive rate = 0.1%
Sensitivity = 42% specificity 99.9%
Kirk an co-workers 1992(4)
Thickened nuchal fold associated with 40% of abnormal karyotypes and 0.4% of normal second trimester fetuses.
Crane and Gray 1991(5)
Identified 75% of fetuses with Downs Syndrome, using the thickened nuchal fold, with a false positive rate of 1.4% and a positive predictive value of 1/13 for the detection of affected fetuses.
Recommend using 5mm thickening between 14-18 weeks and 6mm from 19-24 weeks. Sensitivity = 50%, false positive rate of £3%.
1mm of each other with a 95% probability.
Reproducibility was within 0.5mm 95% of the time in the first trimester(6).