This go around, I'm all about as much information as possible, since I do not have the benefit of knowing what may have caused our issues. I will also be turning 35 about 2 weeks after my due date. I inquired with my OB about NIPT and was told I would need to choose between NIPT and an NT scan because they don't do both. I was frustrated because I was willing to pay out of pocket for the NIPT and didn't understand why I couldn't also do the NT scan.My visit this morning was wonderful. She listened to my concerns and anxieties (and I even choked up a little bit, which I wasn't expecting), and made sure I was able to say everything on my mind and ask any questions before she started to explain options to me. She ran me through a variety of scenarios regarding NT, NIPT, CVS, and amnio. She explained to me that the main difference between an NT scan and a standard scan isn't really visible to the patient, and therefore wouldn't necessarily feel different, but that for an NT scan, they use technicians who are specifically trained in measuring the thickness of the fluid buildup on the back of the baby's neck. This is a very precise measurement, and the tech is highly trained and certified to perform it. This measurement, along with some 1st trimester blood work, gives you a range of risk for conditions such as down syndrome and trisomy 18. If you come back with an elevated risk flag from your scan, then you would forego doing 1st trimester blood work and go straight to genetics to get the Harmony test. The reason they do not like to do both tests in conjunction is because it's possible for the NT scan to come back elevated and the Harmony to come back low risk, and they would always default to the Harmony risk level, but then you have two risk factor numbers and unnecessary anxiety for the expectant mother. So, they prefer to skip over the NT scan and go for the more precise Harmony screening for higher risk pregnancies to avoid the unnecessary redundant and possibly conflicting information. In the case of an elevated risk coming from the Harmony test, we would then discuss the options regarding invasive CVS vs. amnio testing, and the risks associated with them (namely a slight increase in miscarriage risk).
She asked me what I would like to do, and I told her I would like to take the most accurate non-invasive screening test possible, but that I did not want to do it at the sacrifice of getting a ~12 week scan and having to wait until 18+ weeks to know whether or not we may have missed something that could have been caught at a 12 week scan. I then explained to her that one of the reasons I was anxious was because I didn't want to go 10 weeks (between my 8 week viability scan and my 18 week anatomy scan) without receiving some confirmation that everything still looks okay, the baby still has a heartbeat, and that my SCH has resolved. I explained to her that while my OB doesn't have me on pelvic rest because of my SCH, I've been mostly doing one anyway out of an abundance of caution and not wanting to increase my risk of spotting or bleeding, and raise my anxiety any further. At that point she asked me if I would be agreeable to a Harmony test in conjunction with a standard, non-NT scan to check for those sorts of things prior to my anatomy scan. I asked if there was anything that could potentially be missed by doing Harmony and a scan but not the NT measurement, and she told me there wasn't, really. We then talked about other genetic factors that could come into play (such as Tay-Sachs, since MH is French Canadian) and tests that could be run to cover those bases. We landed on the plan that I would have the Harmony Test and a standard 12 week ultrasound, with an added genetic screening for Tay-Sachs carrier status. I've already had carrier screening for cystic fibrosis and spinal muscular atrophy. Oh, and she looked into my insurance and said there's no reason she could see why they wouldn't cover the Harmony test, so yay to that!Whew! That was a lot. Overall, I'm feeling really positive after my visit today, and feeling good about our plan moving forward. I feel like she really went above and beyond to make sure I felt good about the plan, and she was really just so wonderful. I'm also finally letting myself get a little bit excited! ETA correction
@pirateduck exactly. I hadn't thought of it either. My friend lives in Nashville and delivered in Boston due to her extraordinary circumstances.