Prenatal examinations

During pregnancy, there are various types of tests for possible birth defects in the baby. This is called prenatal screening, where it is checked whether there is a risk of chromosomal and/or anatomical abnormalities in your child. For this you can opt for the NIPT around 11 weeks of pregnancy and/or and any ultrasounds around 13 and/or 20 weeks of your pregnancy.

In addition, there are also other studies that mainly look at the health of the mother to ensure that both the mother and the baby are in good health during pregnancy and delivery. This includes, for example, your blood pressure, sugar and/or iron levels in the blood.

Prenatal screening means that you can have your baby screened for certain abnormalities before birth. There are two types of screening available:

1. 'Screening for Down, Edward and Patau syndrome', these are chromosomal disorders.
2. 'Structural ultrasound examination' or the 13 and/or 20 week ultrasound.

You will first have a conversation about this subject, which is called counseling. I will hereby inform you about the disorders, screening methods, options and possible follow-up steps. It is important that you make the choice yourself, I will not give you advice in this, but I will give you all the necessary information and support so that you can make a choice yourself.

For more information about prenatal screening, visit www.pns.nl

Down, Edward and Patau syndrome It is important to know that this is a screening method, which means that it is checked for indications of Down, Edward or Patau syndrome. It is not yet a diagnosis. If a clue is found, further testing can be done by means of chorionic villus sampling or amniocentesis, this is called prenatal diagnosis. A chorionic villus sampling and amniocentesis are part of an invasive examination, in which there is a physical risk of miscarriage.

We use the NIPT test for screening for Down, Edward and Patau syndrome.

The NIPT (Non-Invasive Prenatal Test) The NIPT test is a blood test in which blood is taken from the mother. So there is no risk to the baby. At the NIPT you will receive a result in which there is or is NOT evidence of Down, Edward or Patau syndrome. You can have the NIPT test performed from 11 weeks of pregnancy and the result will take approximately 2 weeks. The NIPT does not look at the sex of your child.

If the NIPT results are abnormal, there are strong indications that the unborn child has Down, Edward or Patau syndrome. However, with an abnormal result, it is possible that the child does not have one of these syndromes. This is because NIPT looks at the hereditary material (DNA) of the placenta. This DNA is almost always the same as that of the child, but very occasionally not. Therefore, in the event of an abnormal result, to obtain certainty, further testing is required to confirm the NIPT result.

If indications are found in the baby for Down, Edward or Patau syndrome, you have the option of having an interview for prenatal diagnosis at a specialized hospital. In the The Hague region, this is the Erasmus Medical Center in Rotterdam.

The NIPT is currently not reimbursed unless you have a medical indication. Your midwife will discuss this with you if there is a medical indication. Otherwise, the NIPT costs 175 euros. From April 1, 2023, the NIPT will also fall under the prenatal screening of the RIVM and the costs of this will be cancelled. If you are eligible for follow-up examination, for example in the event of an abnormal result, this will be reimbursed. For more information, visit www.pns.nl.

The First Trimester Structural Ultrasound Exam This ultrasound is also called the 13 week ultrasound. The purpose of this ultrasound is to investigate at an early stage whether the unborn child has any physical abnormalities. Serious abnormalities — such as an open skull or large defect in the abdominal wall — may be detected early in pregnancy.

The 13 week ultrasound can be performed from 12+3 weeks to 14+3 weeks of pregnancy. The difference with the 20 week ultrasound is that the 13 week ultrasound takes place earlier in the pregnancy. Although the child is smaller and less developed around 13 weeks than around 20 weeks, some (serious) abnormalities can be seen. These abnormalities may not be compatible with life. If the sonographer suspects an abnormality, the pregnant woman can have a follow-up examination early in the pregnancy. She also has more time – compared to the 20-week ultrasound – to determine what to do with the results. At the 20 week ultrasound, many structures (such as the heart) are further developed. This allows the sonographer to examine the child in more detail.

The Second Trimester Structural Ultrasound Exam When you are about 20 weeks pregnant you can opt for a structural ultrasound examination, or the 20 week ultrasound. The purpose of this ultrasound is to detect physical abnormalities such as an open back, heart defects, abnormalities in the brain, etc. In addition, growth, the placenta and amniotic fluid are also checked.

Not all birth defects are visible on a structural ultrasound. It is therefore possible that an abnormality is still detected after birth. During the 20-week ultrasound it is possible to ask for the gender of your baby, provided it is clearly visible on the ultrasound.

In addition, there are also studies that monitor the health of the mother and baby. The examinations listed below are the standard examinations that fall under normal obstetric care. During each check I will discuss with you which investigations would apply to you, why they are carried out and whether there are any alternatives. These examinations are not mandatory, so if you do not feel comfortable with something, you can indicate this. Then we look together at what else is possible.

Possible one-off investigations are:

Blood test for 12 weeks of pregnancy The blood test is usually taken before the 10th week of your pregnancy. This looks for abnormalities that could harm the health of you or your baby. Think of blood group, Rhesus factor, irregular antibodies, iron deficiency, glucose (sugar) and infectious diseases such as HIV, Hepatitis B and Lues. We can also look at your vitamins D and B12.

vitality ultrasound An ultrasound can be made around 8 weeks of pregnancy to see if your baby's heart is already beating. It is also checked whether the baby is in the right place in the womb (so it is not an ectopic pregnancy) and whether it is possibly twins. This ultrasound is not reimbursed, unless there is a medical indication.

term echo A term ultrasound can be made around 12 weeks. This allows the due date to be reliably determined. The due date is important to know in order to determine whether your baby is growing well during pregnancy and whether you will give birth too early (before 37 weeks) or just overdue (after 42 weeks). This ultrasound is reimbursed for everyone.

Glucose Research If there are indications that you may be developing gestational diabetes, we can test for this by means of the glucose test. Gestational diabetes is a temporary type of diabetes that goes away immediately after childbirth. During pregnancy, the body temporarily responds less well to insulin, the hormone that regulates blood sugar. During a normal pregnancy, the body makes extra insulin to maintain blood sugar levels. But that doesn't happen (enough) with gestational diabetes. As a result, too much sugar remains in the blood. This can cause health problems for you and your baby. To test whether you have pregnancy sugar, a test can be taken in which blood is taken before and after drinking a sugar drink. If you do not want this, but would like to know whether you have gestational diabetes, you can also have a sugar daily curve pricked, but this test is less reliable. If this applies to you, we will discuss it in detail during an inspection.

Blood test for Rhesus D and c carrier status If the first blood test before 12 weeks of pregnancy shows that you are Rhesus D negative or C negative, you may have antibodies against the baby's blood if it has a different blood group. That is why a follow-up test is done at 27 weeks for antibodies and the blood group of your baby. If it turns out that you have a different blood group or antibodies have been found, you will receive a Rhesus D injection at 30 weeks. The injection makes the chance very small that you will form antibodies yourself that can make the baby sick. The baby will not notice the injection and will not be at any risk. You will be given another injection after the birth. This injection does not exist for Rhesus c, but the blood is closely monitored to check the possible build-up of antibodies.

Blood test for iron deficiency With every pregnant woman, your iron level goes down during pregnancy. Between 28 and 31 weeks, this iron level is at its lowest point. That is why we can check your iron level with a blood test. A sufficient iron level ensures that you will go into labor fit and have reserves in case you lose some blood. If your iron level is too low, we can treat this with nutrition and possibly iron supplementation, depending on your situation.

In addition, there are also recurring studies:

Measuring bloodpressure We measure your blood pressure during every check-up. This is done to detect blood pressure related diseases that can harm the health of you and your baby. This is done with a band around your arm that is inflated tightly. Then I listen to your blood pressure with a stethoscope in your elbow.

Listening to your baby's heart sounds (from 12 weeks of pregnancy) With this I listen with a doptone whether there are no audible abnormalities in the heart rhythm of your child. The doptone is a device that emits ultra-sound waves with which we can listen to the heart through the abdomen. This is possible from about 12 weeks of pregnancy, because otherwise your baby is still too low behind the pubic bone.

Growth of your uterus and baby (from 12 weeks of pregnancy) From 12 weeks of pregnancy I can monitor whether your baby is growing well. I do this by feeling with my hands on your stomach to the height of the uterus. By keeping an eye on your child's own growth curve, it becomes clear whether he is maintaining his own growth well. If it turns out that he is growing too fast or too slow, we can have a growth ultrasound made. From about 26 weeks I will also feel the position of the baby to see whether he is lying with his head up (breech) or down (head lying).