Should I have CVS or Amnio? I am 35 but don't want either?

Question

I live in Greece and my gynie says that I must have one or the other, I asked him if I could just have the test where they measure the baby's neck (don't know what it's called, it was invented by the Greek Doctor) and he advised me against it. He has also said it's better to have one of the other two tests so an abortion can be arranged if there is something wrong, I was horrified to hear this, is it the same in th UK? I'm British and very wary of the advice that I'm being given here.

There are no facilities where I live for children with difficulties, I do not have the option of moving back to the Uk as my husband lives here. It seems to me that the way of thinking here is if there is something wrong with the baby, abort it! I don't agree with this and I am very worried. I have never seen a downs child or a child with any serious disability here, the locals look upon them as oddities when they see tourists with physical or mental problems. they are very behind the times here, but I don't have a choice whether to live here or not.

Answer 1

How many weeks pregnant are you?

All the prenatal tests that you refer to are done at slightly different times in the pregnancy.

The test where they measure the baby's neck is called the Nuchal Translucency test or the Nuchal Fold test. It is done by ultrasound - sometimes simply called an "NT Ultrasound". This is done at no earlier than 11 and no later than 13 weeks, and it is a screening test - it is a test that determines a RISK factor, it doesn't actually diagnose either way that your baby definitely does or does not have a problem.

The NT test measures the fluid that accumulates at the back of the neck of the fetus. If a baby has a chromosomal problem then the amount of fluid tends to be increased. Depending on the measurement that is taken, a risk factor can be calculated. The NT test most usually picks up an increased risk of disorders such as Down Syndrome about 80-85% of the time. It is worth noting however that not every baby with a high NT measurement has DS, and not every baby with DS necessarily has the high NT measurement.

CVS (chorionic villus sampling) and Amniocentesis are far more invasive prenatal tests that will actually diagnose chromosomal disorders. These tests both carry a small risk of miscarriage.

CVS is normally performed between 10 and 12 weeks, and is offered to women who are over 35 years at the time of delivery, or where there is a family history of inherited disorders, or where they have already had a baby with a chromosomal disorder, or where an ultrasound screening test has shown an increased risk of a possible abnormality. Results are normally available anywhere from just a few days up to two weeks, depending on the lab.

CVS is about 99.95% effective in dignosing many specific chromosomal disorders like Down Syndrome, cystic fibrosis, and tay-sachs. It does not however test for spina bifida or other neural tube defects. About 95% of women who have a CVS test will find out that their baby does not have any detectable chromosomal disorders.

CVS carries approximately a 1% risk of miscarriage, however, this is an OVERALL risk factor, and it is worth noting that each individual who performs these tests will have their own miscarriage rate - some highly skilled health care providers have very, very low risk factors - some even below the statistics for spontanous miscarriage. It is also worth noting that this figure usually includes all pateinets, even those who are carrying babies that do have disorders that may spontaneously miscarry anyway - it cannot be known for sure whether the miscarriage was caused by the CVS test or whether it would have happened anyway.

Amniocentesis is normally performed later in the pregnancy - at about the 14 - 20 week mark. Before this time, there may not be enough amniotic fluid to sample. This test is offered for the same reasons as CVS. Test results may take 2-3 weeks to come through.

As well as the chromosomal disorders detected by CVS, amnio can also test for a whole range of other disorders and also infections - this will be discussed with the patient beforehand. Fetal blood sampling is also available with amnio, taken from the umbilical cord, not the actual baby.

The overall miscarriage rates quoted for amniocentesis can be anywhere from 0.25% to 2%, depending where you are in the world, however, as with CVS, it really is very much up to the skill of the doctor who performs the procedure. Each will have their own miscarriage rate, and also as with CVS, these statistic normally include resulting pregnancies where disorders are detected, and it cannot be known for sure whether the miscarriage was caused by the amnio test or whether it would have happened anyway.

A doctor saying a patient MUST have either one of CVS or amnio is borderline unethical, in my opinion. By all means offer these procedures, but no health care provider should ever insist on one. CVS and amnio, because they are so invasive, are usually recommended after proper genetic counselling and/or other prenatal screening tests like the NT ultrasound in combination with tests like the AFP blood test have detected an elevated RISK of a problem. I have never heard of a doctor refusing basic pre-test screening and going straight into the test, unless there is a confirmed history of serious chormosomal disorders (or even where the patient or her partner actually have a chomosomal disorder), or an early ultrasound has detected something very unusual.

In addition, recommending these tests with the automatic assumption that the patient will abort the baby if a problem is discovered is also way out of line.

Some patients refuse all prenatal testing based on the premise that they will have the baby no matter what anyway, so it is pointless.

Some patients still have prenatal testing, however still intend to continue with the pregnancy either way, and simply use the information to prepare themselves and their family for any special needs they may have for the delivery of the baby (such as having a paediatric surgeon on hand) or to prepare for bringing a sick or special needs child home, get in touch with support groups etc.

And some patients indeed so use the information to make a decision whether or not to have a theraputic temination, depending on that nature and severity of the problem detected.

Is there another doctor you can possibly see, or a clinic that could give you any other advice? Have you seen a genetic counsellor at all? You are totally justified in being wary of the advice you are being given, if the only risk factor you actually have here is your age, being 35.

Answer 2

Genetic testing is routinely offered to all women 35 and over in most countries.Recently the AMA recommended that all women ,regardless of age have some form of genetic testing done.Both carry risk with CVS having a slightly higher risk than amnio.I've had amnio's done since I've had a child with DownSyndrome and never had any problems with it.If the results wouldn't matter to you either way,then don't do the testing.Remember, not everyone is prepared to raise a child with a serious defect,so that is why they are offered the option to terminate.I am pregnant at 39 and am opting for amnio since I have had a child with a genetic problem,but that is a personal decision.If you haven't had a triple screening done yet,,don't!The tests are frequently wrong ,especially in older women.Nuchal testing is done here in the US but I'm not sure how accurate that is,but I would request it anyways especially if invasive testing is not for you.If you do decide to do the testing,it's not terrible painful ,you just need to rest a day or two afterwards.Good Luck and a healthy happy nine months to you.:)

Answer 3

In the UK, they would normally do a nuchal scan (measuring the neck fold) they then do a calculation that factors into account that measurement and your age to give a risk factor. If that risk factor is low, then you don't need to have further testing. If the risk factor is high (1 in 250 or less) then you can consider other tests. That applies to women of all ages, it's just that your age will nudge up the risk factor. But if the nuchal fold is still very small then probably no need for further testing.
If you don't want anmio or CVS then you don't have to have it. Your risk only really starts to go up at 35 and you are not at a very high risk at 35. If you were 40 the risk would be much higher. Being 35 gives you a very similar risk to if you were 34.
There are risks to your pregnancy with having an amnio and those risks are higher than your risk of having a baby with Downs.

Answer 4

Im 36 and 29 weeks pregnant with my first. I refused all the aminio tests point blank. NO ONE can make u have an abortion if there is something wrong, and at 35 there only a slightly higher risk that something might be, its not like u are 45 years old!! If u don't want the tests then don't have them, they cannot force u, it is your body, no matter where u live. My midwife gave me the choice of yes or no and that was that - no pressure, no hassle and never mentioned again. im in the UK. U DO NOT HAVE TO HAVE THEM. Good luck honey, don't do anyhting u don't want to do.

Answer 5

Hi! I had my first baby at 39 and my doctor said he wouldn't risk me losing it by doing the amnio. I would have had the baby regardless so what you do really depends on what you would do if you knew something was wrong. If you would keep it anyway then I wouldn't worry about any test, if you would have an abortion then you should take whichever test you feel more comfortable with. However, I was told by the doctor that with todays technology they can pick up abnormalities in babies during a routine ultrasound. It's really up to you and what you want to do if the baby isn't normal.
Take lots of folic acid as this helps prevents spina bifida especially if it's early on in your pregnancy. Good luck!

Answer 6

Why does he want to do these tests? are they worried about the baby? I would decline, if there is something wrong with baby would you keep it anyway? I personally would and so the test would only make me worry and there is a risk of miscarriage from these tests. Go with your gut, if you do not want them then do not have them. Also seek a second opinion. Call back to the UK and as an OBGYN there as a telephone consult...they may bot be able to give you absolutes but they could direct you in options that help you make a decision. Good Luck, Mum of 3

Answer 7

you sound really upset, I'm sorry for you. You do not need to have either test unless there have been problems in your family regarding child birth in the past. 35 is not old nowadays to have a baby and in Britain these tests are not compulsary until you are older. I have two friends, one 37 and one 39 who have recently had healthy babies. Neither of them had either test. Can you get a second opinion from another gynie? Good luck hunny, I wish you all the best

Answer 8

dose it matter to you if the baby has down syndrome or another problem? will you love it anyway or if you found out there was a problem would you abort?
if you are going to keep the baby no matter what then don't get the test done but if it matters then get the amino done it's a bit safer but the cvs tells more.
He can not force you to take the tests!
so it's up to you also there is a small risk(less then 1%) that the cvs or amino will cause a miscarriage so you need to keep this in mind also.

Answer 9

when a woman is over a certain age those tests are offered in the uk but you dont have to have them i think the amnio one carries a risk of miscarriage as well
i was offered but didnt take it im grateful for the chance to have a baby regardless

Answer 10

must be a tough decision for you hun

but just because your 35 doesnt mean there will be anything wrong with the baby,theres tons even older have perfectly healthy babies hun

its your right so id go with what you think is best

and "IF" anything is wrong with baby,so what if others look
its your baby and your going to love it no matter what right?


good luck hun