Intellectualization and increased nuchal translucency

I tend to use intellectualization as a coping mechanism during stressful periods. I admit that having potentially devastating news delivered to me about my unborn daughter was one of the hardest moments of my life, and the four days waiting for results were equally as excruciating. I felt for the second time in my life what it was like to receive bad news from a physician (the first time I was 10 and was informed that I would have to undergo surgery after stepping on a nail). Whether due to increased maturity, education, fatherly instinct, or a combination of any of the above, it was harder to hear bad news delivered about my daughter. Important events have a way of remaining etched vividly in memory regardless of the passage of time. It was a huge blow to hear the obstetrician say that there was a high likelihood of a poor outcome from our pregnancy, feel my wife clutch my arm while listening to her sobs, being forced to be the support even though I wanted to clutch onto someone else for support. There was no one else to clutch of course. I would be ultimately responsible along with my wife for any adverse outcome of our pregnancy. I fully realize that intellectualization didn't lead me to acceptance of the possibility of a poor outcome from our pregnancy, but it sure helped me pass the time. Only prayer and sincere discussions with my wife really helped me to accept whatever the outcome might be.

It was during this time that I realized the futility of quoting statistics for comfort. I wonder how many times I've spoken with patients about a test or condition and quoted a statistical measure from some study or textbook in an effort to quell their fears and concerns. When it's you or a member of your family who's at risk of having a condition, the statistics only matter for the intellectualizers (and only as a temporizing measure for this subset of the population). It doesn't matter if the risk of having a condition is 5% or 50%. The fact that a medical professional has a reason to believe a test is necessary is anxiety-provoking and often leads the patient to believe that the pre-test probability must be much higher than the normal population. What really matters in the end is the result of the test, and what really counts in the time test results are pending is support from family and friends.

For those who are interested in nuchal translucency and the implications of an abnormal screening ultrasound followed by a normal chromosomal analysis, here are some references I found to be helpful.

If you don't have access to the journals, post a comment with an email and I'll be happy to email a .pdf

Yoshida S, Miura K, Yamasaki K, Miura S, Shimada T, Tanigawa T, Yoshida A, Nakayama D, Masuzaki H. Does increased nuchal translucency indicate a fetal abnormality? A retrospective study to clarify the clinical significance of nuchal translucency in Japan. J Hum Genet. 2008;53(8):688-93. Epub 2008 May 24.

Souka AP, Von Kaisenberg CS, Hyett JA, Sonek JD, Nicolaides KH. Increased nuchal translucency with normal karyotype. Am J Obstet Gynecol. 2005 Apr;192(4):1005-21.

Souka AP, Krampl E, Bakalis S, Heath V, Nicolaides KH. Outcome of pregnancy in chromosomally normal fetuses with increased nuchal translucency in the first trimester. Ultrasound Obstet Gynecol. 2001 Jul;18(1):9-17.

Souka AP, Snijders RJ, Novakov A, Soares W, Nicolaides KH. Defects and syndromes in chromosomally normal fetuses with increased nuchal translucency thickness at 10-14 weeks of gestation. Ultrasound Obstet Gynecol. 1998 Jun;11(6):391-400.