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Some of the anxiety revolves around the whole point of testing, the key question of choices if testing were to prove a problem exists. After working for, in some cases, years and spending sometimes hundreds of thousands of dollars to achieve a pregnancy, how likely is one to terminate it if an anomaly like Down syndrome is discovered?
Following alongside that question is the larger one of human life and existence -- for many, pregnancy termination is seen as morally wrong in most or all cases. Even for women who typically would consider themselves "pro-choice," termination in their own case might not be something they would choose. Some women make the difficult decision to continue with a pregnancy regardless of testing results, even in cases where a condition meaning certain postnatal infant death has been discovered.
Finally, there's the question of relative safety and risk. CVS and amnio carry varying levels of risk of miscarriage. With CVS, the risk is thought to be three to five percent (and a slight increase in risk for resulting limb abnormalities), while amnio is believed to have a lesser chance of anywhere from one in 200 to one in 400. While the AFP and ultrasound are virtually risk-free so far as potentially causing miscarriage, the risk here involves the accuracy of the tests and whether or not women choose to have CVS or amnio based on the results.
Information about the inaccuracy of the no-risk screening tests has been discussed for several years. It's generally agreed that no one screen alone is sufficient to warrant riskier testing. Patients should understand that both ultrasound and AFP testing are screens and not diagnostic in and of themselves.
Low maternal AFP indicates only an increase in risk for Down syndrome. Chances are relatively high for false results with the AFP. The "triple screen" is a test which includes AFP with two additional screens for presumably greater chance of reliability. Also, the AFP screen is used to detect risk for neural defects other than Down syndrome, such as spina bifida.
© Tracy Morris
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