<s>[INST] Hi doctor, Currently, I am 14 weeks pregnant with my second baby. I am attaching my NT and double marker report for your reference. I have a 5-year-old son and no abortion in the past. I have conceived naturally both times. My doctor has asked me to do either NIPT or CVS and I am not sure if I really need to do any. She has asked me to take Ecospirin 150 immediately if not doing CVS else start after CVS. I have some queries. Do I really need to go for either NIPT or CVS? Or I can forgo these tests? Should I take Ecospirin 150 as my previous pregnancy did not have any complications and at present also I am in good condition with no health issues (also I don't drink and smoke)? Are there any issues with my beta HCG and Papp-a value? Do you see any other concerns in my report? Please reply. [/INST] Hi. I have seen the report. (attachment removed to protect patient identity).  Now every laboratory has its own calculation methods to come to a risk ratio after the test. b-HCG and PAPP-A levels are also different at different times of pregnancy and also has some effects of weight and age on it. This is a genetic screening test. And we do this test to find out what is the risk of this pregnancy having a congenital abnormal baby. (Specifically Down’s, Edward, Turner, and Patau syndromes). This risk ratio has cut off values. Means trisomy 21 (Down’s) has a risk ratio of 1:365 in your case and cut off is 1:250. Now with this report, we are calculating the risk of having a baby with Down’s syndrome is 1 in 365 pregnancy with your age and with the test and ultrasound reports you have. We are calculating the risk and the report is always low risk or high risk. There is never no risk. Practically also after doing all available tests we never can rule out all the possible abnormalities in the baby. CVS (chorionic villus sampling) and sometimes amniocentesis are 100% if they found baby DNA in the procedure to rule out that the baby does not have trisomy 21 or other major chromosomal anomalies. That does not mean all genetic abnormalities are ruled out. Both of these procedures also have some risk of abortion during or after. And that is why we advise these test in high-risk double marker. NIPT (non-invasive prenatal testing) is also a screening test like double marker but the test is less risky as compared to CVS and amniocentesis but at the same time more costly. And test sensitivity to rule out trisomy 21 and other is 99.99%. After all these details you must be confused. Now other trisomies are definitely low risk but in case of trisomy 21, your report is 1:365 and which is somewhat near cut off 1:250. Ideally I advise further testing of CVS and amniocentesis if the value is below cut off value. But 1:365 is also near the cut off value. So it is a debatable issue. 1:365 means that out of 365 pregnancy 364 will be normal and 1 pregnancy will have trisomy 21. Secondly, you can start Ecosprin tablets. We usually start it in some high-risk patients. If you have pregnancy after 30 years then you come under high-risk group. So you should start it. In CVS there is chance of bleeding inside and that is why your gynecologist does not ask to start it if you are going for CVS. And every pregnancy is different. And we cannot say that if previous pregnancy did not have any problem nor the baby has any problem then this pregnancy will not have anything wrong. Yes, we can say that if previous pregnancy was normal then there is somewhat more chance that this pregnancy will also normal. Go through all details two or three times to understand it properly and then ask anything if you have more questions. I hope this helps. I am not able to open NT scan report. Yes, but the second report is saying that NT is 1.93 and nasal bone is seen. Mostly these two sonography markers are also used to calculate the risk in double marker apart from b- HCG (beta-human chorionic gonadotropin) and PAPP-A (pregnancy associated plasma protein-A). Both NT (nuchal translucency) and NB (nasal bone) are normal. </s>