OSCENUCHAL TRANSLUCENCY (FIRST TRIMESTER ULTRASOUND SCAN)Shown below is the tarete! antenatal "ltraso"n! s#an o$ the $etal ne#% an! hea! reion o$ a &' wee% estation $oet"s( The )other is a *+,-ear ol! ./01A& with a 2re3io"s #hil! with Down S-n!ro)e(4UESTIONSDescribe the type of ultrasound image and abnormalities seen, this "ltraso"n! i)ae is a n"#hal transl"#en#- (NT) s#an(, it is a saittal 3iew at the le3el o$ the ne#%showin )ar%e!l- 2ro)inent transl"#en#-at the base o$ the ne#%5 i3in a wi!ea22earan#e to the ne#%(What is the cause of this abnormality?Itistho"httorelateto!ilate!l-)2hati# #hannelsan!is#onsi!ere!aeneral)ar%er $orane"2loi!esli%etriso)-1&(Down S-n!ro)e)5triso)-&*5triso)-&6aswellas othernon,ane"2loi!-str"#t"ral!e$e#tsli%e #onenital heart !iseaseFet"ses with e7tra #hro)oso)es ten! to ha3e )ore8"i!atthebaseo$theirne#%s9as2ot %nownasn"#hal$ol!9an!this#an)a%e their ne#%s larer( This 8"i! #an be )eas"re! onasonora)!"rinwee%s&&to&/when the base o$ the ne#% is still trans2arentTi)in is #r"#ial5 be#a"se the n"#hal $ol! be#o)es less trans2arent as $et"s rowsNT )eas"re)ents are not #on#l"si3e5 b"t $or) a "se$"l s#reenin test to 2i#% )others at in#rease! ris% o$ ha3in a #hil! that )a- ha3e a #hro)oso)al !isor!erOutline specifc counselling points you would consider for this patientA 2ast histor- o$ Down S-n!ro)e an! an "ltraso"n! i)ae at &' wee%s in the #"rrent 2renan#- whi#h is #onsistent in in#rease! NT is 2ositi3el- relate! to triso)-( :ith a Down S-n!ro)e #hil! she has an in#rease! ris% o$ Down (&;&'')NT )eas"re)ents are a s#reenin test onl-( NT alone has a low s2e#i