Checkups and Examinations during pregnancy

You are pregnant and don't know which tests make sense for you and your child?
Nowadays a wide variety of examinations and test are offered to expectant mothers. Some of them are intended to check the health of the mother; others are used to monitor the development of the child.

It is fundamentally both sensible and important to have medical accompaniment during the pregnancy. The introduction of the “Mother & Child Examination Passport” has helped to significantly improve the health of both mothers and children.

But not all of these examinations make good sense and some are even risky. Let no one talk you into something that you don't want do!

Fully recommended Checkups and Examinations:

Ultrasound
The ultrasound examination is non-invasive, painless and safe for both mother and child. With this check the size and weight of the baby will be measured (Fetometry) to see that it is developing properly and is being well looked after.

The Organ Screening later in the pregnancy checks the organs of the child, such as the heart and kidneys and so on, to confirm that they are properly developing. Should this not be the case then some action can be already be planned, such as a life-saving operation for the child immediately after birth.

A Doppler Ultrasound test measures the blood flow in the umbilical cord and the uterine vessels. Where the child is not sufficiently supplied with blood, it is possible that the birth may be initiated early.

Blood tests for the mother
The blood test is safe for both mother and child. In the mother's blood evidence is sought of possible illnesses affecting the mother which are harmful for the child, such as toxoplasmosis, diabetes (diabetes mellitus), etc.
In addition, it can be determined whether the mother is immune against diseases such as rubella and chickenpox as should these diseases occur in a pregnant woman it can be harmful for the development of the child. Therefore, it is important to do something about it in good time.

Examinations which may lead to uncertainty

During the ultrasound they mostly performed the so-called "neck fold measurement" that actually measures the density of the fluid in the back of the neck of the child. If here an unusual value is found there is an increased risk of a specific disability for the child, such as: Trisomy 21 (Down syndrome), Neural cord defects (developmental disorder of the spinal cord), "Open Spine", and others. 

However treat such findings with particular caution as this is only a statistical probability - it is not certain or even likely that the child really has this disability. 

The same is true for the Triple Test which is often automatically made as part of the blood test in the 15th week of pregnancy. Also here deviating values are an indication of an "increased chance" for certain disabilities – but even this is no certain diagnosis!  For multiple child pregnancies the test has no significance.

An example: From 1000 pregnant women who took the triple test around 100 receive the findings of "increased probability of Down syndrome". But actually only one these women is expecting a child with Down syndrome - this is just 1% of those women with an “increased probability” (and only 0.1% of all pregnant women). However the other 99 mothers now live (unnecessarily) with fear of having a handicapped child.

In the Combined Test, the ultrasound measurement of the nuchal translucency (neck transparency) is combined with a blood test. This is performed mostly in the 12th week of pregnancy. For a child with Down syndrome the test shows an increased risk. There are also many other cases in which the test shows an increased risk but the child is completely healthy. Usually, further (high risk) investigations are recommended where the risk is 1:300 or more. 1:300 means that the reality of Down syndrome only affects one of the 300 children and mothers, where the test result is positive.

Where these examinations are performed and you get a positive finding for a "possible disability' in your child, do not let that make you insecure. The probability that your child is actually disabled is still very, very small!

Invasive (risky) methods

"Invasive" means that tissue is taken from the mother or the child and used in the test.
With the Chorionic Villus Sampling a small portion of the placenta is taken either with a long needle, which is inserted under a local anesthetic through the mother's abdominal wall-up into the uterus (while doing this the process is monitored by ultrasound), or through
a tube through the vagina and the cervix. This extracted tissue sample can then be investigated in the laboratory to determine if there
is any genetic damage; for example.
This examination brings with it the risk of bleeding or infection but can also harm the embryo such as by deformation of the arms or legs,
and leads to miscarriage in almost 9% of cases.

A comparison: four school classes with a total of 100 children go to a sporting event where experience has shown that approximately
9 children will die if they attend. Would you let your child go? -The Chorionic Villus Sampling is just as dangerous!

Also with the Amniocentesis, a needle will be pierced through the abdominal wall into the uterus, to remove some amniotic fluid.
The child's cells contained in the fluid are then examined.
The risks are similar to the chorionic villus: bleeding, amniotic fluid loss, infections, injury of the child or even miscarriage (between
2 to 5% of cases - also the older the mother, the higher the risk).

In an Umbilical Cord Puncture (only very rarely needed, for example in Rhesus incompatibility) a sample of the child’s blood is removed from the umbilical cord. The miscarriage risk is between about 2 and 7%.

These invasive tests are not routinely offered but only where the ultrasound or blood tests have already shown an increased risk of a disability for the child. With these tests, a more accurate diagnosis can be made - however no test is 100% accurate yet.

Before you agree to such an examination, consider whether the result would be something useful to you.
Genetic diseases are incurable!
To learn with some certainty during the pregnancy whether your child has a genetic defect leaves in the following possibilities open to you:
• You can accept as it is. In any case you can now prepare yourself as to how best you can support this special child.
• You can decide to release a possibly disabled child for adoption or to hand it over to a foster family.
• You can abort your child (with the risk that you may have killed a healthy child).

For the first two possibilities, it is still not too late after even the birth. Even if abortion is not an option for you then you should ask yourself the question as to if you want to accept the up to 9% chance of a miscarriage just by undergoing the examination.
But even where abortion is a possibility for you this miscarriage risk remains - even if your child is perhaps in any case healthy.

Don’t let yourself be put under pressure. Some doctors seek to secure themselves legally by making all possible kinds of tests. But you do not have to agree to any kind of test, examination or investigation which brings a threat to your health or that of your child that you are carrying.

 

References:

Alfirevic Z, Mujezinovic F, Sundberg K (2009). Amniocentesis and chorionic villus sampling for prenatal diagnosis (Review). The Cochrane Collaboration

Bettelheim D, Kolinek B, Schaller A, Bernaschek G: Zur Komplikationsrate bei invasiven, intrauterinen Eingriffen an einer pränataldiagnostischen Schwerpunktabteilung; Ultraschall in Med 2002; 23(2): 119-122, doi:10.1055/s-2002-25191 PMID: 11961726

Jauniaux, E. & Rodeck, C. (1995). Use, risks and complications of amniocentesis and chorionic villous sampling for prenatal diagnosis in early pregnancy. Early pregnancy: Biology and Medicine, 1, 245 – 252.

Lao, M.R.; Calhoun, B. C.; Bracero, L. A.; Wang, Y.; Seybold, D. J.; Broce, M.; Hatjis, C. G. (2009). "The ability of the quadruple test to predict adverse perinatal outcomes in a high-risk obstetric population". J Med Screen 16 (2): 55–59. doi:10.1258/jms.2009.009017. PMID 19564516
http://de.wikipedia.org/wiki/Triple-Test

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Papantoniou, N. E., Daskalakis, G. J., Tziotis, J. G., Kitmirides, S. J., Mesogitis, S. A. and Antsaklis, A. J. (2001), Risk factors predisposing to fetal loss following a second trimester amniocentesis. BJOG: An International Journal of Obstetrics & Gynaecology, 108: 1053–1056. doi: 10.1111/j.1471-0528.2001.00246.x;   PMID 11702837.

Reynolds TM, Penney MD. The mathematical basis of multivariate risk screening: with special reference to screening for Down's syndrome associated pregnancy. Ann Clin Biochem. 1990 Sep;27 (Pt 5):452-8

Rodeck, C. H., Morsman, J. M., Nicolaides, K. H., McKenzie, C., Gosden, C. M. & Gosden, J. R. (1983). A single-operator technique for first-trimester chorion biopsy. Lancet, 2, 1340 – 1341.

Ward, R. H., Modell, B., Petrou, M., Karagozlu, F. & Douratsos, E. (1983). Method of sampling chorionic villi in first trimester of pregnancy under guidance of real time ultrasound. British medical journal, 286, 1542–1544.

Analysis of the impact of PAPP-A, free β-hCG and nuchal translucency thickness on the advanced first trimester screening. Berktold L, von Kaisenberg CS, Hillemanns P, Vaske B, Schmidt P. Arch Gynecol Obstet. 2013 Mar;287(3):413-20. doi: 10.1007/s00404-012-2585-y. Epub 2012 Oct 19. Erratum in: Arch Gynecol Obstet. 2013 Aug;288(2):467. V Kaisenberg, C [corrected to von Kaisenberg, C S].

https://en.wikipedia.org/wiki/Nuchal_scan