I won another lottery. And of course it's not the good kind.

1 in 100.

That's the number of fetuses that manifest a chorid plexus cyst (or "CPC") at the time of their second trimester ulstrasound. It's a cyst in the baby's brain which may in itself sound alarming but apparently it's not the cyst that's a problem in the least, it's what the cyst is a marker for that is worrysome.

Here's how the conversation went, a full one and a half weeks after my anatomy scan - why they didn't call me sooner I will never understand.

OBG: Everything looked fine, although the tech did detect a choroid plexus cyst. Other than that...

Me: Wait, a what?

OBG: A choroid plexus cyst [she wrote it down on the back of one of her business cards. A gesture of good faith. She wrote it down knowing that I would take that card and type each letter directly into google, it was like she was handing me permission, like she wanted me to know she had nothing to hide, like she had given up and all she could hope was that I would trust her].

Me: What's that? [Starting to realize that she's not freely giving up any information and that this is going to be a game of 20 questions for sure]

OBG: It's an isolated incidentanoma....

Me: [losing my patience] what does that mean?

OBG: Just something the tech felt he should point out, it's like the baby's gender, that's an incidentanoma...

Me: [Not satisfied and making no apologies] Why would he feel he needed to point it out, what is the concern? What is it associated with? [I'm a lawyer, I'm surprised it's taking me this long to ask the right questions, I should be doing better than this but man is she drawing it out].

OBG: It can be associated with birth defects...

Me: [My hear trate is really out of control now, I'm trying not to panic, she wasn't even going to get into all this so where's the damn 'but you don't have to worry about it because...']

OBG: People have tried to associate it with Trisomy 18.

There it was. I've read a few studies since this conversation, CPCs are associated with Trisomy 18. Around 50% of babies with trisomy 18 ("t18") manifest CPCs in their second tri ultrasounds. There is a demonstrated correlation. So 1 in 100 fetuses have a CPC and then somewhere around 3% of babies who have a CPC end up having t18, but the vast majority of those have additional risk factors - abnormal maternal serum screens, advanced maternal age, and/or additional anomolies detected via ultrasound to be specific. Which leaves me with no idea of what my risk factor is now.

OBG: Absent other signs, the risk is extremely low that the baby would have this, and you have no other risk factors.

Me: But I skipped the quad marker screen. What if that could have shown an increased risk...[PS, the quad marker screen had to be done between 15 and 20 weeks - my scan was at 19 weeks exactly. I got the results yesterday at 20w4d]

She responded to this only by saying it is now too late to do that test, that no test is 100% accurate, etc. I am well aware that the window closed a mere five days ago - well after the scan. Why didn't she call me sooner?

Even Dr. Google says the risk of having a t18 baby with a so-called "isolated CPC" (no other risk factors) is extremely low - in some studies 100% of babies for whom this was the only marker turned out to be perfectly healthy. My concern is that I'm not working with a full assessment since I didn't have that second trimester blood screen. To some extent it's like we're hiding our heads in the sand and saying, "well I don't see any other risk factors so no problem here." You won't find other risk factors if you don't go looking for them. I did have the first trimester screening though and the result was an amazing 1/100,000 chance for t18. But that screen is only about 80% accurate at picking out abnormalities, and I clearly have no problem falling into the 1% chance type of ranges.

My OBG tried to reassure me that this was not a cause for concern. She speculated that even if this raises my chances from 1/100,000 to 1/70,000 she would still certainly NOT recommend an amnio since the risk of loss from that procedure is 1/200-300. And when I asked her how often this comes up she said she has this conversation "several times a month" and that anecdotally she had never seen an isolated CPC result in a baby with t18.

But she is not a geneticist. And part of what bothers me about all of this is that I don't know how confident anyone is that I don't have any other risk factors. I think I could live with all of this if I knew I could rule out other risk factors but I'm not all that sure that they scrutinized all the things they should have during the anatomy scan in light of this CPC finding. Did they look at the hands carefully? What's the story on the heart - the most common problems with t18 babies are with the heart. And what about the length of the femur, did they measure that? I do remember the tech spending time showing me the baby's upper lip. At the time I wasn't sure why but after some research I realize he was probably looking for cleft lip.

I wish I could trust the doctor's assessment of the scan, but the nurse mentioned she was 'printing out the results' for the doctor after I was checked in. Had she not bothered to look at the pictures? The other trust issue I have with her stems from her assessment of my pathology report from last year's miscarriage - she told me, point blank that it was "normal." It took me five months and four doses of MTX and a lot of heartache to find out the actual result was "inconclusive." That's a pretty big difference. So forgive me if I can't quite stake my baby's life, my husband's life, our marriage, my family's hopes and dreams etc. on her telling me this is isolated and based on my first trimester screen everything should be fine.

On the other hand, my panic over this is once again just a product of knowing too much. The ultrasounds are too sensitive now, I had one scan too many, I have committed the ultimate sin of googling, etc. If I had never gone in, I wouldn't have worried about this. The baby would have continued to grow, on schedule, and would probably come out just fine. In fact I don't know if I would have the quad marker screen even if I still had a chance (although I am frankly appalled that my OBG let that window go by while she sat on my results). I don't think I can take any more of these soft markers and fickle statistics. I don't think, in my heart of hearts, that anything is wrong with my baby. I think everything is fine and that I've had enough tests that if things were not fine, something would have come up. My chances that the baby is normal seem to go up every day based on the statistic that only 50% of t18 babies even make it to birth.

My OBG strongly advised against an amnio. I called this morning to ask whether I should do another u/s to look specifically for t18 markers and her assistant called back with the message that my OBG "Doesn't think that would be a good idea." What the F does that mean? She has recommended that we do nothing. She said to me "at some point we just have to choose what to worry about." Hinting, I think, that this is not one of the ones to worry about. She also said "I can't tell you he doesn't have it..." while her face read "but he doesn't."

DH has been tremendously sympathetic and supportive but ultimately thinks I should just forget the whole thing. Forget it happened. I think I need to. I don't really think I have a choice. But how can I? How can I now go purchase the nursery set and pick up my friend's hand-me-down exersaucer and have this stuff laying around in my home and go to my baby shower and dream about the baby with my parents and pick a name out and go on like this didn't happen? Like I'm not seriously concerned? Maybe the bottom line is that before the scan there was a small risk that the baby would have a chromosomal defect, and that after the scan, there still is. There is always a risk. Maybe I should get an amnio, but I really don't think that's logical.

At this point I feel like I am going through the motions. Like I am forcing myself to go look for childbirth classes, and like I will act like nothing is wrong, but that the innocents is gone. Like this is the final nail in the coffin of not being able to enjoy my pregnancy. And I hate it. I didn't expect it to be like this.