Living in a Disabled World

Dear Mrs Wood (note normal typing error I am not a MRS!!)

The summary of your examination from 25 July 2008 is as follows:

Indication:

Fetal Anomaly: nuchal oedema

History:

Maternal age: 39 years.

EDD by ultrasound: 26 January 2009.

Gestational age: 13 weeks + 4 days

Early Pregnancy Assessment:

Transabdominal US with Aloka 5500.  Ultrasound view: good.

Fetal heart action present.

Crown-rump length (CRL) 72.0 mm (average)

Fetal anatomy: skull/brain appears normal, heart appears normal, spine appears normal, abdomen appears normal, stomach visible, bladder visible, hands both visible, feet both visible, Generalised oedema / cystic hygroma.

Placenta: posterior high, structure normal. Amniotic fluid; normal. Cord: 3 vessels.

Summary of ultrasound findings: generalised oedema.

Seen today following her routine datings scan which diagnosed an increased NT.

She has 3 children, all of whom are fit and well.  There is no history of note.

On scan there is generalised oedema.  I could see no structural anomalies.

I have indicated the high liklihood of an underlying chromosome problem such as Downs or Turners syndrome.  I have also explained that the fetus could die in the next few weeks.  On the basis of the severity of the findings I have offered termination of pregnancy

We have taken blood Parvovirus and CMV - she will ring for the results of these next week.  I have offered CVS today but she would prefer to postpone invasive testing in case there is spontaneous fetal demise over the next few weeks and also because she would not terminate the pregnancy for Down or Turners.

I have offered a follow-up appointment in 2 weeks but they are away on holiday so have arranged review with one of my colleagues.

I have also indeicated that a normal chromosome result does not exclude all genetic or structural problems and we would need to check the fetal anatomy very carefully.

Timothy Overton, Consultant in Fetal Medicine

(Parvovirus and CMV came back as I was immune to both)