Grand Rounds 4.44 at GruntDoc!
Tuesday, July 22, 2008
Kenneth F. Trofatter, Jr., MD, PhD
Admittedly, it is a long post, but it tells a story. I may be wrong, but I get the sense that the decisions being made by a couple of the featured readers are based on incomplete information and/or biased presentation of the same. (And, for our physician readers, I am not ruling out the possibility that certain patients hear what they want to hear!). That frustrates me because there is no one more vulnerable to that than pregnant women and their families.
It is sometimes hard to present the advantages/disadvantages and risks/benefits of the screening tests that are available during pregnancy without keeping our own feelings out of the equation, but an honest effort must be made to do so. That is especially true when the outcome of such a screening test might lead to an invasive diagnostic study such as an amniocentesis that could put the pregnancy at risk, albeit the risk is small. I am careful to tell patients that, they alone can make a decision with which they are most comfortable - a decision I cannot and will not make for them. In fact, I go so far as to tell them that I don't care what decision they make and that I don't care what they do with the information they may get from the procedure! But, to make that decision, they deserve to have balanced information with some responsibility on the part of the provider that they actually understand the information they are given. In the end, all we can promise is that if their choice is to proceed with an amniocentesis, we will do the best we can to make it, technically, the safest procedure possible.
Labels: amniocentesis, first trimester screening
4 Comments:
At Wed Jul 23, 05:26:00 AM 2008,
Anonymous said…
Thank you for your sentiments. My maternal-fetal medicine doctor pushed me to have the amnio, even after I firmly declined. He even went so far as to make my normal nuchal translucency measurement sound abnormal just because it was above the mean to try and sway me. I would never consent to have the prenatal screening done again because the whole experience caused undue fear and guilt to be a pervasive part of my pregnancy. I encourage families to determine before any screening is done whether they would be willing to have the invasive testing done. If not, don't do the screening at all.
At Wed Jul 23, 01:47:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous July 23: I am sorry you went through that. It does NOT have to be that way. As providers, we need to have more faith in patients to make the decisions that are right for them - our role is to take the time to provide balanced information, answer questions, and then step back from the decision. Thanks for writing. Dr T
At Mon Aug 18, 12:48:00 PM 2008,
Anonymous said…
Dr. T, I am 11 weeks 1 day today. This morning I went for my nuchal and was told due to the 2.4 measurement they were concerned. I'm 35 with my first child and very confused. They seen the nasal bone and other things which they said was great. They suggested either a CVS which would have to be performed next week due to the window of time or a amniocentesis at 16 weeks. I am confused needing you advice?
At Thu Aug 21, 11:34:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Aug 18: Personally, I would recommend waiting until you get the final risk assessment back before deciding about the CVS. An NT of 2.4 mm alone is NOT an indication for invasive diagnostic testing. Best wishes and let us know what happens! Dr T
Post a Comment
<< Home