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CVS or Amniocentesis
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CVS or Amniocentesis

Hi ladies. Here's my story. I'm 38, and am about 10wk pregnant with twins. I had my first visit with my perinatologist today.  He asked me to think about whether I wanted to have a CVS or an amnio.  He told me he won't make recommendation to me whether to have either one but only present data to me.  But if I do decide take one of them to detect the chromosomal abnormalty, he would suggest me to have CVS.  His reason is if one of the fetus is found to be abnormal, the chance of bringing the remaing one to full term after stopping the bad one is higher than after amnio.  It is because CVS is done in the first trimester (11 to 13 wk), while amnio is in the second trimester (16 to 17 wks).  The clinic he is going to send me over for CVS is the only clinic in my area which is specialized in CVS.  their complication rate is 1 in 300 according to him.  He said the risk of both is the same.  But I do decide to do amnio, it will be done in his office, whose risk rate is also 1:300 according to him.  On my way back home, I thought I wanted the CVS.  But until I went online and googled it. It sounds like it is more risky than amnio plus it is not as accurate.  Does anyone have any experience or knowledge with either that can give me some insight?

Another thing that I am confused about is he asked me to schedule an NT scan in 3 weeks.  Now I am just reaching 10wk.  3 weeks later, I will be 13 weeks.  If I do NT in that week and if the result comes out not desireable, I would miss the window of doing CVS anyways.  Isn't it the case?  I would if the doctor miscalculated the dates.  Could anyone help me to look into this?  I plan to call in tomorrow to discuss with the doctor if he was indeed mistaken.

Thanks for any words!
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10 Comments Post a Comment
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377493_tn?1356505749
I don't know a lot about CVS, but I do know that the risk for complications is slightly higher then it is with amnio.  The NT scan has to be done around 13 weeks for accuracy, so you are right, it would make you lose the window of opportunity for CVS.  I personally opted for amnio after my first trimester screen as the results of that non invasive test were what I was basing my decision of whether or not to have amnio on.  I am only carrying a singleton, I do know with twins you have to have 2 tests to test the fluid in both sacs.  I am not sure how that changes the risk of complications.  That is the best info I can give you, I hope it helps a little bit.  I wish you well.
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951946_tn?1263568983
My experience with the timing of these things is that I really had to DRIVE the timing myself based on what I wanted. Sadly, I have found that providers are a bit careless about the timing of these tests. I don't know why, but it just seems like they don't THINK of the obvious-- like, if you get your NT scan at 13 weeks, depending on when you do the accompanying bloodwork, you may not be able to get in right away for CVS.

The bottom line is *I* drove it. Rather than taking my provider's recommendation, I called the fetal monitoring clinic *directly* and asked them what I should do, based on the fact that I would want CVS if my risk came back high. They then advised me to schedule the NT scan at 12 weeks, and do the bloodwork a week earlier so I could get the bloodwork + u/s results all at the same time. They said that if I came up high risk for any problems, they would then make sure to get me in for CVS if I wanted, before the 13w2d cutoff.

For the bloodwork, I then had to call my provider's office, ask for the lab slip to be written up for my 1st trimester screen, and made a special trip by their office to pick up the slip, then straight to the lab. I didn't wait for my next scheduled prenatal visit. When I went to the lab, I also made sure to let the technician know that I would need the results within a week. She said that because the State of California has taken over this particular process, they are really backlogged and it could be 2+ weeks before I got my results back. I explained that that would be too late for me to have diagnostic testing if I needed it. She was REALLY nice and said that she would put it on "rush" somehow. I guess I got lucky with that lab tech.

The timing on all of this is really tight so I highly recommend you take it into your own hands. :)
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921340_tn?1271595794
Thank you very much!  I think I am leaning towards amnio now.  I understand I will need to be poked twice and the complication rate is increased.  But giving my age, I can't just say I will avoid this test...

Maybe I should wait for the NT scan result to come out anyways.  So NT has to be done around 13w?  So my doctor is right?

Thanks a lot!
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921340_tn?1271595794
Wow, admire you!  I guess when it comes to anything important about ourselves, we can't july rely on the experts, we have to monitor closely or sit on the driver seat.

Now, I need to find out the window for NT scan.  If there is a chance, I will leave my decision until after the NT scan result comes out.  My doctor said the NT scan will be done in the hospital, together with blood work.

So how was your CVS experience?  Would yo mind sharing with me?  Best wishes on your remaining pregnancy!
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Avatar_f_tn
Hi there:

I was just reading your questions.  I had a set of twins 10 yrs ago and I had to have the amino done b/c my 1st trimester test came back high and I was really scared that something was wrong so I went ahead and had it done.  They do have to give you the needle twice and what they do is they put a dye in one of the sacs so that when they do the other sac they will know if they have the right baby or not.  They use an u/s machine as well to see where they have to put the needles in and all.  It was uncomfortable.  They do numb the area but u feel a lot of pressure as the needle goes in.  You have to stay of your feet for 3 days or so and I mean you can't do a thing.  I was a nervous wreak waiting for those results but the babies were just fine and I found out that I was having a boy/girl twins.  Surprisingly I am pregnant again with twins and I am in my 9wk.  My husband does not want me to have the amino done this time b/c it was too stressful for me.  We are going to a Maternal, Fetal Medicine doctor in a few weeks and they are going to do an u/s to check the back of the babies heads for any abnormalities.  At that point we will have to figure out what to do.  I didn't have the 1st trimester testing done either b/c it came out high last time so we didn't bother with it yet.  I hope that this helps you.  Keep me posted and good luck to you.
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377493_tn?1356505749
I had a good experience with the amnio.  They didn't use anything to numb me at all though, but still, it was about the same level of pain as getting freezing at the dentist. And I really really hate needles!  

Here is how I based my decision.....the odds for a loss with amnio are statistically 1:200.  If my odds for DS had been greater then that, I would have skipped it altogether.  However, in my case, my odds came back 1:13 so we decided to go ahead.  I went to the info session offered ahead of time, and I asked a lot of questions.  I wanted to know what the odds of complications were for the clinic I was going to, how experienced the perinatologist was that was performing the procedure and what his rate of complications were.  It turned out to be 1:1600 (or something like that).  If at any point or time they had not completely answered my questions, been vague or I had not been satisfied, I would have not gone through with the procedure or gone elsewhere.

It is important to know why you want the information.  For some, if they know they would not terminate the pregnancy regardless, they choose not to have the procedure.  For me, I knew I was keeping this baby no matter what, but I would have stressed and worried the whole time.  Even if the amnio had come back positive, it would have been fine, because for me the not knowing is the worst possible thing.  

If I had to do it over again, I would make the same decision, however it is easy for me to say that as I had no complications or problems at all.  I stayed on bed rest for the 72 hours and all was just fine.  My results were good, my baby is fine and I have been able to enjoy the rest of my pregnancy.

I would never ever advise anyone to have or not have this procedure.  There is an element of risk associated with it, and you are the one that has to be comfortable with that.  The decision is yours and your partners alone, and it is highly personal.  

Whatever you decide, I wish you well.  
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921340_tn?1271595794
Thanks a lot for sharing your experience with me!  Yeah, I am going to do the first trimester test first an see what I should do next.  Given my age, I guess I shouldn't avoid the diagnostic test, either CVS or amnio.

I am so worried about the complication resulted from these tests.  But actually I have not heard of a single case of the complication.  I guess I don't need to be too paranoid ...

Good luck on your pregnancy!  You must have the gene in your family.  You know how to make 2 babies at a time.  :-)
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921340_tn?1271595794
Thanks a lot for your story and your advice!  I don't think I want to keep the baby if he/she has chromosomal abnormalties.  So it makes the test vitally important to us.  So I will be prepared but I will wait till the result of the first trimester screening test comes out.

It seems most people are going for amnio.  I probably should choose amnio over CVS as well...

Enjoy the rest of your pregnancy!  Take care!
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1008869_tn?1283964857
My experience:  I was ready to do both until I was faced with a bad NT Scan number (1:8 for Downs). After debating for some time, and was suggested by my OB to do the CVS ASAP or wait until 16-18 weeks to do Amnio, I came to the relization it would not matter if the baby had DS so why risk a m/c from CVS.

However, I will do the Amnio just to "know". So yes, it is a personal decision, and if you would decide not to keep a baby with absnormailities, I would suggest the CVS.
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951946_tn?1263568983
To answer your question, I was lucky in that my 1st trimester screen came back 1:1600 for Downs and that was a low enough risk that I decided to forego CVS. I have a friend who has had it twice, and said that the vaginal route was much less painful for her than the abdominal route, but neither is too bad. Which route they take depends on where the placenta is.
I should be getting my 2nd trimester bloodwork results back any day now, and based on what the numbers now are, I will decide about amnio.
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