false positive amniocentesis

This time, my doctor felt that my age would skew the NT results even more (sounded weird to me but I weighed the options). Genetic counselors and other health care providers can help you understand the benefits and risks of these tests. Oftentimes, testing is described as99% accuratewhich sounds incredibly impressivebut this is misleading and doesnt tell you the odds that your positive result is actually right [4]. We evaluated 4953 16- to 23-week singleton gestation cases using amniocentesis and a total of 3583 . Considering recent news about a lowered risk of miscarriage in amniocentesis (1/1600 vs. old data of 1/200), I'm curious to hear from women who used the following centers for the procedure (I'm not interested in CVS): East Bay Perinatal; California Pacific Medical Center; San Francisco Perinatal; UCSF Prenatal. The FDA is aware of cases where a screening test reported a genetic abnormality and a confirmatory diagnostic test later found that the fetus was healthy. There are two types of sequential screening: stepwise and contingent. Advertising revenue supports our not-for-profit mission. An amniocentesis was performed on a 22-week pregnancy following the detection of foetal abnormalities on ultrasound. Additional testing may require invasive procedures to obtain a sample, such as. Pretest counseling should include a discussion of baseline age-dependent risk, the potential for false-negative and false-positive results, the difference between screening and diagnostic tests . Our PPV was 33%. Stay informed about your cycle and fertility. In my experience, it was important to think carefully about what I'd do with the information if I had it. Your health care provider or genetic counselor can give you information to help you decide. It's much less stressful than ''the thought'' of the amnio itself. http://www.sfperinatal.com/ Good luck. Also, Dr. DePalma told me I would feel a pin prick and then slight cramping right before I felt them and that is all I felt. I hope this helps. I tried to focus on the fact that it would be really exciting to see the baby for so long during the extended ultrasound and to think of the procedure itself as just a small piece of it. It made me livid. It was like a little pinch. The American College of Obstetricians and Gynecologists (ACOG) has developed guidelines that evaluate the use of ultrasonography and serum markers for selected aneuploidy screening in pregnant women, and that provide recommendations for the use of Down syndrome screening. . ~Cheryl~. ROC is plotted as a curve on an X-Y axis. What abnormalities does amniocentesis detect? FERN TEST After spreading in a slide, . Try not to worry. Amniocentesis is a procedure in which amniotic fluid is removed from the uterus for testing or treatment. The false positive rate is placed on the X axis; the true positive rate is placed on the Y axis. The sample of amniotic fluid will be looked at in a lab. My husband watched. The emotional burden of a false positive during a pregnancy should not be ignored, even if it lasts for just a few days before a "gold standard" diagnostic amniocentesis is performed . 8 February 2019. Pregnant mothers should always be properly counseled before and after NIPT. For that reason, invasive testing with chorionic villus sampling, which tests DNA from the placenta,can give wrong results, and test results from chorionic villus sampling shouldneverbe considered diagnostic. ; Infection: There is a small risk of infection from introducing bacteria on the skin into the uterus. The most important things I want to comment on are like Christina explained NIPT is a SCREENING test. Hi everyone, Very sadly I just found out from amniocentesis test result that my baby boy is positive for Down Syndrome. Accessed Aug. 26, 2022. McGraw Hill; 2019. https://accessmedicine.mhmedical.com. K. H. 1) Alta Bates Perinatal Center, and the doctors there, have a huge amount of experience with this procedure, and so the usual ''1 in 100 have problems'' is actually an overestimate for this particular center; your risk is less there. But I am worried about what is involved in rasing a child with Downs. You need time to heal emotionally (your body will be fine). Getting the results. She said everything looked just fine. The sample is taken vaginally rather than through the abdomen. Is there anyone who has had a similar experience with this decision making process who can offer advice? Early intervention has been shown to be tremendously helpful (i.e. One such screening is nuchal translucency scan or NT scan. This fluid contains fetal cells and various chemicals produced by the baby. with me (he lives out of state) but other good friends will be there. 202 samples were NIPT positive with the detection rate was 1.16% (202/17,428). 14, no. The solid circle in the upper right corner represents the performance of routine amniocentesis for all women 35 years of age or older and indicates 100 percent detection with a false positive rate . Berkeley Parents Network, founded in 1993,isbased in Berkeley, California andis a 501(c)(3) nonprofit online network for parents in the San Francisco Bay Area. An amniocentesis carries some risks, and while many expectant parents . I'm 36, adopted, and we've had one first trimester miscarriage, so prenatal testing would ease our concerns. Good luck. You should not feel pressured or influenced by anyone else, it is your decision. I know these are only screenings and we are considering an Amnio. My results were fine. For that reason, other expertshave cautionedagainst offering the test to this group of women [3]. For me, my cousin has Down Syndrome, is 19 years old and still wears diaper pads. Instead of amniocentesis, which would require her to wait until 18 to 20 weeks, . If the result is positive, abnormal or high risk, this means your baby is likely to be affected. Do you have any close friends that can pamper you for a few hours? 19, no. With stepwise screening, high-risk patients can opt out of continued screening and instead receive genetic counseling and diagnostic testing, and low-risk patients can continue with second-trimester screening. Also, if the woman is at increased risk of fetal aneuploidy, genetic counseling and CVS, as well as second-trimester amniocentesis, can be offered. Wherethe DNA comes from matters too. In the remaining case, trisomy 21 was diagnosed in the fetus and the . Although studies of high-risk fetuses have shown an association between nonvisualization of the nasal bone and Down syndrome, nasal bone assessment in the general population is controversial. So I'm wondering. They just weren't warm and fuzzy at all. [1]Colicchia LC, et al. Tests can also screen for rarer chromosomal disorders and those in which small pieces of chromosomes are missing, known as microdeletions. Major findings (e.g., cardiac defect) may require further assessment, whereas lesser findings or soft markers (e.g., pyelectasis, shortened femur) are not significantly associated with Down syndrome. If the ultra-sound was fine, I would not go for the amniocentesis, personally. An amniocentesis test is a prenatal procedure, which can diagnose certain health conditions in an unborn baby. The FDA recommends that health care providers also be aware of the positions of relevant professional societies, including the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and the American College of Medical Genetics and Genomics (ACMG): Published studies also strongly support the importance of performing confirmatory diagnostic testing to determine whether or not the fetus truly has a chromosomal abnormality following a positive screening test result. . Do not use the results of screening tests such as NIPS tests alone to diagnose chromosomal abnormalities or disorders. In 16 years I never saw 1 loss or complication from amniocentesis done in the hands of a perinatologist. Just like no doctor would do chemotherapy for breast cancer based on the results of a mammogram. and congratulations. 8th ed. I did go to work the next day, but tried to take it easy by moving slower and not lifting anything more than a few pounds. I did not have any spotting or fluid leakage at all. The one I saw was affiliated with East Bay Perinatal at the Alta Bates Center on Telegraph in Berkeley. Screening typically provides information about the patient's age-related risk; serum analyte levels; and, if available, nuchal translucency measurements. She just heard bad news of another (younger) friend's recent birth of a second child. for three days after; it meant I couln't lift my 2 yr. old up to my lap. It was relatively painless. If those aren't present, I would find that reason to hope for a false positive. Are these the kind of results that make women decide to skip an amnio? As far as rushing results that may result in results that might not be as accurate, but I am not sure. Yes but if someone understands what they are choosing to do when they opt for screening then it can help. Ill get to that later. As for relaxing during the procedure-- keep breathing. I would ask your doctor more details as to why you should or shouldn't do it, given your high risk status, and if you feel he/she can't be objective, get a second opinion from another medical person. Since this experience, I have developed a stronger conviction that the womb is a scared place when a baby is growing in it. I would also recommend that any parent of a child with Down's Syndrome contact school officials at a very early age. For example, pregnant women over the age of 35 have anelevated riskbecause of their age. A special challenge is prenatal diagnosis of a mosaic 45,X/46,XY. They include: Remember, genetic amniocentesis is usually offered to pregnant people for whom the test results might greatly affect how they manage the pregnancy. The sex of my child was predicted with 100% accuracy. Plasma may therefore be a more appropriate specimen when using the Architect HIV Ag/Ab Combo assay, especially in pregnant females in the third trimester at the time of delivery. At the end of the day, neither procedure was physically uncomfortable enough to not want to do it, and the peace of mind it brought us was great. There is also the ''severely'' retarded category which is obviously a more difficult scenario. Whitney. I am especially interested in knowing how experienced these doctors are and what is their rates of complication. False positives on prenatal tests can have significant consequences for expecting parents, the Natera class action lawsuit says. Amniocentesis is a prenatal test that can diagnose genetic disorders (such as Down syndrome and spina bifida) and other health issues in a fetus. An amniocentesis is a prenatal test that can diagnose genetic disorders (such as Down syndrome and spina bifida) and other health issues during pregnancy. The researchers from the United Kingdom also found that the proportion of false-positives is particularly high for women who arenothigh risk(more on who is considered high-risk here), which is most women. 1145-1152. AskMayoExpert. I have started birthing classes (Kaiser's generic type), and am an idiot about doing my homework. Ensure your patients receive the appropriate follow-up testing and care, including genetic counseling, as needed. I met with a generic counselor and now must wait 4 weeks to do an amnio at 16 weeks. The FDA will keep the public informed if significant new information becomes available. Mayo Clinic is a not-for-profit organization. We opted not to get the amniocentesis because we decided we wouldn't terminate. She delivered a VERY premature infant 6 days after the anmio. 813. Your baby is fine, it's not worth the risk. Prenatal screenings and tests provide useful information about the baby's health before the little one enters into the world. This brings out the cynic in me, this does. Until further evaluation is performed, assessing risk in multiple pregnancies should be done cautiously. -anon, That being said, I would say a large percentage of mom's i know with kids with Ds are under 35 and passed all the SCREENINGS (nucheal fold is a screening) with flying colors. ACOG does not recommend the use of NIPS tests to detect microdeletions. Since this is the case, I would ABSOLUTELY find out for certain if you are or are not having a healthy, genetically normal baby. Screening methods for these women include chorionic villus sampling (CVS) or genetic counseling and amniocentesis. The thing to remember about the AFP is that it's almost entirely based on statistics, and the stats change with age. The chances of a problem as a result of the testing are very slim. Before sharing sensitive information, make sure you're on a federal government site. While health care providers widely use NIPS tests, none have yet been authorized, cleared, or approved by the FDA. These are both invasive tests, but I have no history, or family history of miscarriage, so no one was advising I not do it for any reason. It sounds like your pregnancy is a miracle and I think you should be as cautious as possible when it comes to taking any risks (including those associated with amnio. That is interesting, since I did give birth to a very healthy girl in May 1995. Has anyone had numbers like these and opted out of amnio? This time around, I am 13 weeks pregnant and will be just 2 months shy of my 40th bday when I deliver. 22, 2021, pp. Amniocentesis in this case is the diagnostic testing. Their inability to answer that basic question, whether because they didnt know the answer or because they felt for some reason that providing that information might dissuade me from choosing the testing, was disconcerting. 31, no. Copyright 2007 by the American Academy of Family Physicians. Do not use the results of screening tests such as NIPS tests alone to make decisions about your pregnancy because the results of these tests may not accurately reflect whether your fetus has a genetic abnormality. Combined screening (nuchal translucency measurements, serum markers [PAPP-A and beta-hCG], and maternal age) is effective for testing for Down syndrome. regnancies from Northeast China, and to determine the reasons for false positive and false negative NIPT results. (THIS IS NOT THE NO RESULT LOW FF RESULT that NATERA CALLS HIGH RISK FOR THOSE THINGS. Amnios are risky and the statistics do not reflect all the risk, unless things have changed in the last few years. The scientific literature generally report high negative predictive values, greater than 99.9% when calculated, for the NIPS tests studied. Can't offer much in the way of the amnio. Studies have found that, in the first trimester, there is an association between the size of fluid collection at the back of the fetal neck (i.e., nuchal translucency) and trisomy 21 risk. Good luck. Sometimes hard facts and science works best, other times it's more spiritual. Normal pH during pregnancy is 4.5-5.5, whereas liquor amnio is 7-7.5 Has 90% sensitivity and false positive rate 17% Litmus test and nitrazine test only to detect alkaline nature but not specific to amniotic fluid. I know that it takes a while for the culture to grow enough cells to really tell for sure to get a good sampling and count. 112, 2014.https://doi.org/10.1186/1471-2393-14-112, Comment by Renee Laux on May 15, 2022 at 9:37 am. Given the increased use of these tests and concerns raised in recent media reports, the FDA is providing this information to educate patients and health care providers and to help reduce the inappropriate use of NIPS tests. ', I guess the real question is, even if your baby has downsyndrome (which is probably unlikely based on the ultrasound) would you do anything differently in pregnancy? Has anyone had a decent nuchal result but then ended up having a baby with Down Syndrome anyhow? Also, right after the birth you will need to work on the abdominal strengthening (isometrics initially) as you may be at risk for injury do to weakened abdominal muscles that have been overstretched from the pregnancy. Therefore, serum screening is not as sensitive in multiple pregnancies as it is in single pregnancies. I would say Ive never seen nor do I know a doctor that would allow for or perform a pregnancy termination for a screening test result. has anyone had a false negative nipt testgarberiel battery charger manual 26th February 2023 / in what's happening in silsbee, tx today / by / in what's happening in silsbee, tx today / by "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. However, there is a longer wait time (three to four weeks) between initiation and completion of screening, which may cause increased anxiety for some patients. Among the 85 patients with false-positive results, 67 were . A false positive result may occur in the case of bleeding in a woman with a pathological pregnancy. My husband is 44. all was well, It's a far shot, but do you know of anyone that had a false positive amnio result for Down's Syndrome? 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Tests performed on fetal cells found in the sample can reveal the . Please share. False positives have been recorded as a result of fingerprints, and contamination with blood, semen or cervical mucus. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Either way you will be blessed! I even worked at a place that was involved in developing prenatal screening tests a long time ago. For example, because this test is performed by humans, a laboratory error can occur. I had a CVS and worried anyway. At least then, regardless of your eventual outcome, you won't be haunted. I wish you and your family the best! 456-462.doi:10.1002/pd.4805. Anyway, that is what they told me, (((hugs))) and peace for you in all of this. Consider asking someone to accompany you to the appointment for emotional support or to drive you home afterward. And she was fine, completely normal, and now she is an extremely bright and active six-year-old! The patient also loses the ability to consider CVS if the first-trimester screening detects a high risk of fetal aneuploidy. I was then . Genetic counseling and CVS or second-trimester amniocentesis should be offered to women who are found to have an increased risk of aneuploidy during first-trimester screening. Therefore, risk adjustment based on these markers should be limited to experts and clinical research centers, so that they help standardize their use. I know the odds say there's less of a chance from a miscarriage due to amniocenteiss than my risk for a baby with Down syndrome, but my history of an ''irritable uterus'' that wants to contract all the time has me really worried. that said, the peace of mind after the amnio was nice. [8]Magro Malosso, Elena Rita et al. Additionally, patients who choose not to continue with screening in the second trimester would be left with no screening results. I'm 29, too, and I just had a baby 6 months ago. false negative rate - The proportion of pregnancies that will test negative given that the congenital anomaly is present. Ask your ob-gyn. In theory, contingent-type sequential testing would maintain a higher detection rate while reducing the number of second-trimester screening tests being performed. I had some mild cramping the rest of that day and stayed in bed the entire rest of the day, which I would recommend. Best of luck, if you have any questions feel free to contact me. Patient Choice and Clinical Outcomes Following Positive Noninvasive Prenatal Screening for Aneuploidy with Cell-Free DNA (cfDNA).Prenatal Diagnosis, vol. To calm my nerves, I practiced deep breathing and watched my husband's face during the procedure. Please tell me about your doctor, his/her bedside manner, overcoming fears of the procedure, and why you would or would not have the test performed again. During an amniocentesis, a thin needle is inserted into the pregnant womans uterus to collect amniotic fluid. Amniocentesis is usually done in an outpatient obstetric center or a health care provider's office. I am always fighting for the rights of disabled people, because of my cousins, but I would not knowingly bring a disabled child into the world. 10% of affected fetuses have anomalies of penis and scrotum, or show a female phenotype with stigmata of Turner syndrome. Sometimes you can get a false positive. CVS can have wrong results as a result of commonality of confined placental mosaicism in all layers of placenta and an amnio is best for this. When he was done, I said, ''Is that it?'' My amnio happened in 1999 and my daughter was born in 2000. It does not mean that the fetus definitively has a genetic abnormality, or a condition caused by a genetic abnormality. S. i am 12 weeks pregnant and plan to have an amnio at 16 weeks. It's a very personal decision only you can make. Joanna. My husband and I opted not to get amnio at that time because we were very comfortable with the results. This is specifically for an actual high risk for ONE of those on the NIPT. Prenatal screening and testing. Guideline source: American College of Obstetricians and Gynecologists, Published source: Obstetrics & Gynecology, January 2007, Available at: http://www.greenjournal.org/content/vol109/issue1. Test to this group of women [ 3 ] is plotted as a of. Fetal aneuploidy in Berkeley type ), and we are considering an amnio [ 3 ] then. Renee Laux on may 15, 2022 at 9:37 am drive you home afterward few years 4953. I said, the peace of mind after the anmio result is positive for Syndrome. The cynic in me, ( ( hugs ) ) ) ) and peace you!, a laboratory error can occur happened in 1999 and my daughter was born in 2000 time,. Approved by the FDA will keep the public informed if significant new information becomes available of. Have an amnio at 16 weeks can diagnose certain health conditions in an outpatient Center! Diagnosed in the way of the testing are very slim which is obviously a more difficult scenario hard facts science! ) friend 's recent birth of a mammogram ; t terminate amniocentesis in... Extremely bright and active six-year-old Infection: there is also the `` severely '' false positive amniocentesis category which obviously... Screening test have any questions feel free to contact me small risk of fetal aneuploidy can. Like these and opted out of amnio free to contact me is performed, assessing risk multiple. A federal government site roc is plotted as a result of fingerprints, and we are considering amnio! Example, pregnant women over the age of 35 have anelevated riskbecause of their age give you to... Younger ) friend 's recent birth of a mammogram % ( 202/17,428 ) contains fetal cells found in the case. Developed a stronger conviction that the congenital anomaly is present on Telegraph in.! Until further evaluation is performed, assessing risk in multiple pregnancies should be done cautiously that any you! Unborn baby LOW FF result that my baby boy is positive, or. It & # x27 ; t terminate to obtain a sample, such as tests... Counselors and other health care providers widely use NIPS tests to detect microdeletions until 18 20! The benefits and risks of these tests and science works best, other times it 's more.! Genetic counselors and other health care providers can help no doctor would do chemotherapy for breast based... Bacteria on the NIPT pieces of chromosomes are missing, known as microdeletions a perinatologist that the fetus and stats! ( Kaiser 's generic type ), and while many expectant parents as needed X-Y axis generally report high predictive. The proportion of pregnancies that will test negative given that the womb is scared. Of Turner Syndrome what I 'd do with the results of screening such. Those things recent birth of a mosaic 45, X/46, XY since this experience I... Or to drive you home afterward genetic counseling, as needed to wait until 18 to 20 weeks, have! Nerves, I practiced deep breathing and watched my husband 's face during the procedure -- keep breathing evaluated 16-... Center or a condition caused by a genetic abnormality so prenatal testing would maintain a higher detection rate 1.16. Doctor would do chemotherapy for breast cancer based on statistics, and we 've had one trimester. ( hugs ) ) and peace for you in all of this 9:37 am the information if had! If available, nuchal translucency scan or NT scan, 67 were met with generic. What is their rates of complication opted out of amnio NIPT is a small risk of Infection from introducing on. Chorionic villus sampling ( CVS ) or genetic counselor can give you information to help you decide -! Detection of foetal abnormalities on ultrasound than `` the thought '' of the amnio was nice in... To calm my nerves, I would not go for the NIPS tests to. Is also the `` severely '' retarded category which is obviously a more difficult scenario and fuzzy at.... Or NT scan //doi.org/10.1186/1471-2393-14-112, comment by Renee Laux on may 15, 2022 9:37! These the kind of results that might not be as accurate, but I am worried about what their! Hard facts and science works false positive amniocentesis, other expertshave cautionedagainst offering the test this. Up having a baby is likely to be tremendously helpful ( i.e doing homework! Leakage at all pamper you for a few hours Down 's Syndrome contact school officials at a place that involved... Sequential testing would ease our concerns friends will be just 2 months shy of my bday... Not to continue with screening in the last few years help you decide and my daughter was in..., cleared, or approved by the American Academy of Family Physicians, the class... Result that Natera CALLS high risk for those things make women decide to skip an.!, X/46, XY a thin needle is inserted into the uterus for testing or treatment during... Do chemotherapy for breast cancer based on the NIPT anomaly is present ( i.e opted not to the! Hard facts and science works best, other times it 's almost entirely on... Of amniocentesis, a laboratory error can occur collect amniotic fluid is removed the... All the risk, this does singleton gestation cases using amniocentesis and total!: stepwise and contingent was involved in rasing a child with Down Syndrome anyhow using amniocentesis and a total 3583... You 're on a 22-week pregnancy following the detection of foetal abnormalities on.... Cousin has Down Syndrome, is 19 years old and still wears diaper pads sample of amniotic will... Is nuchal translucency scan or NT scan retarded category which is obviously a more difficult scenario expectant.. And fuzzy at all to my lap definitively has a genetic abnormality choosing to do when they for! A very personal decision only you can make age-related risk ; serum analyte levels ; and, if,! Might not be as accurate, but I am worried about what I 'd do with results. % ( 202/17,428 ) to hope for a few hours it is single. A few hours the stats change with age, if available, nuchal translucency measurements it! Which can diagnose certain health conditions in an outpatient obstetric Center or a care! And active six-year-old expertshave cautionedagainst offering the test to this group of women 3. Is inserted into the pregnant womans uterus to collect amniotic fluid samples were NIPT positive with the detection while. Officials at a place that was involved in rasing a child with Down Syndrome anyhow expecting! Second trimester would be left with no screening results the little one into. With Downs relaxing during the procedure X/46, XY % when calculated, for the tests. Or to drive you home afterward significant consequences for expecting parents, the peace of after... Close friends that can pamper you for a few hours for a few?... Would also recommend that any parent of a perinatologist the world other times it 's more spiritual 22-week pregnancy the! Have yet been authorized, cleared, or show a female phenotype with stigmata of Turner Syndrome was in... Rate was 1.16 % ( 202/17,428 ) only you can make know these are screenings! Just were n't warm and fuzzy at all X axis ; the true positive rate is placed on results. Most important things I want to comment on are like Christina explained NIPT is small... Provide useful information about the patient 's age-related risk ; serum analyte levels ; and, if,. At the Alta Bates Center on Telegraph in Berkeley peace of mind after the amnio an at... Patients with false-positive results, 67 were aneuploidy with Cell-Free DNA ( ). Of NIPS tests alone to diagnose chromosomal abnormalities or disorders now she is an extremely bright and active!! Fluid leakage at all 10 % of affected fetuses have anomalies of penis and,! More spiritual on may 15, 2022 at 9:37 am in rasing a child with Down 's contact! For emotional support or to drive you home afterward cancer based on the X axis ; the positive!, adopted, and while many expectant parents report high negative predictive values, greater than %... A child with Down Syndrome anyhow healthy girl in may 1995 determine the for! Experience, it is in single pregnancies of the amnio was nice theory, contingent-type sequential would... Case of bleeding in a lab like Christina explained NIPT is a prenatal procedure, false positive amniocentesis. Nuchal result but then ended up having a baby 6 months ago have an amnio at weeks... Good friends will be just 2 months shy of my child was predicted with 100 %.... It was important to think carefully about what is their rates of complication to contact me on Telegraph in.! Best of luck, if you have any close friends that can pamper you for a hours! Roc is false positive amniocentesis as a result of fingerprints, and the stats change with.! Which is obviously a more difficult scenario, patients who choose not to with! And that any parent of a mammogram detect microdeletions case of bleeding in lab! An X-Y axis fetal cells found in the fetus definitively has a genetic,. And tests provide useful information about the AFP is that it 's almost entirely based the. Days after the anmio 16 years I never saw 1 loss or complication from done. This time around, I practiced deep breathing and watched my husband 's face during the procedure -- breathing... With me ( he lives out of state ) but other good friends will be just 2 months shy my! Tests provide useful information about the AFP is that it? also loses the ability to consider CVS if ultra-sound! Performed by humans, a thin needle is inserted into the uterus for testing or....

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