PLEAZE USE THE VIDEO TRANSCRIPT BELOW TO ANSWER BORH QUESTIONS PLEASE.

In the video for this chapter, we join an older couple during an ultrasound examination being administered to the expectant mother. Because of the mothers age, she runs a higher risk of giving birth to a child with some kind of abnormality. While the doctor is performing the ultrasound, he explains that additional, more definitive information can be obtained by performing an amniocentesis, but it is a much riskier procedure. As you watch the video, think about any women you have known who have had an ultrasound or amniocentesis performed, or perhaps your own experience. Consider the inherent risks compared to the potential benefits, as well as the personal implications of taking action to end a pregnancy based on information gained from having one of these procedures performed.

1.Briefly describe the basic process of an ultrasound examination. List the goals of an ultrasound exam that are mentioned in the video, its potential benefits, and its limitations

2. Briefly describe the basic process of an amniocentesis. What are the risks and potential benefits associated with this procedure?

Video Transcript:

>> During a routine prenatal visit, ultrasound is used to estimate fetal age, determine the position and growth of the baby and the health of the placenta. The ultrasound uses sound waves to produce an image of the unborn child for analysis. In high risk pregnancies the ultrasound is used to check for fetal abnormalities. Women approaching or beyond the age of 35 have a higher risk of having a baby with Down Syndrome and other chromosomal abnormalities. Here Dr. Cowen [assumed spelling] performs a detailed ultrasound to help rule out birth defects. While the ultrasound cannot diagnose chromosomal or other abnormalities, it is a useful screen for estimating risk and the need for additional diagnostic tests such as amniocentesis.

>> Down Syndrome is the most common chromosomal problem in live born babies. Ok that's why you hear so much about it. Probably 50% of all the chromosomal abnormalities of babies that are born alive has Down Syndrome. The risk of a woman having a baby with Down Syndrome who is 35 years old at the time of delivery is 1 in 270 pregnancies. The risk of having a baby with any chromosomal abnormality is about twice that risk, since Down Syndrome makes up about half.

>> Ok

>> That means that there's more than a 99% chance that you will not have a baby with a chromosomal abnormality just based on your age alone. Now there's only one way to know for sure whether or not a baby has Down Syndrome or a chromosomal abnormality prior to the birth of the baby and that's to undergo an amniocentesis. In an amniocentesis they take out some fluid from around the baby and analyze it to look at the chromosomes. Now this is great in that you find out yes or no

>> Ok

>> but the downside of amniocentesis is a 1 in 200 risk of losing the pregnancy. So before one engages in an amniocentesis one has to really make sure that you really want to know this piece of information and that most of the time that you would do something about this piece of information before risking the pregnancy per say.

>> Ok but if you tell us that the ultrasound looks normal the risk of the amniocentesis is twice the risk of the

>> You are exactly right. If the ultrasound is norma, the risk of you loosing the pregnancy because of what I do with that amniocentesis is twice as high as the risk of you having a baby with Down Syndrome. Now let's look at a few things and take a little tour of the baby. The baby is in the breech presentation, which means that the head is up here and the spine leads down here. So the bum is down. Ok now 95% of the time the baby is gonna turn around by the time you reach full term. So the first thing that we look at is we look at the position of the baby. The second thing is we look at the placenta. This is the placenta right here sort of a meaty looking thing in the front of your uterus and it looks excellent. This is the organ that feeds the baby nutrients and oxygen and it looks terrific. Next thing that we look at is we go down the baby starting at the baby's head. This is the skull and you see that bones are white and we're gonna look at the brain. This sort of hot dog looking thing right here is called the cerebellum. This is a very, very important structure because when the cerebellum is normal the chance that the baby has Spina Bifida is very very small and for people of Irish decent Spina Bifida is much more common for the Irish and the English than it is in the United States. We're gonna look at the babies spine can you see the spine in that shot coming down. It's a lovely spine. You can see this object beating right here, that's the babies heart.

[ pause in speaking ]

This is the thigh bone.

>> Actually you can see a little bowl joint at the top of [inaudible]. It's amazing isn't it?

>> So we make measurements of the limb length and if the femur length, the thigh bone length is short that is associated with Down Syndrome. This is a nice looking baby no two ways...