Preventive care and prenatal diagnostics

Youngsters on the way? Congratulations! One thing is certain: with the start of pregnancy, you are facing an exciting time. 9 months is a long time, associated with a roller coaster of emotions, many emotional moments and growing anticipation. How the body of the expectant mother changes and how the unborn child develops, you will learn here.

A pregnancy is divided into 3 major stages. This is called the third or trimester of pregnancy. The most important milestones in the course of pregnancy can be described as follows:

To give your baby a healthy start in life, you will receive the best possible medical support even before the birth. In the course of pregnancy, you have a legal right to a total of 10 preventive examinations. You have the choice of who should carry out the examinations specified in the maternity passport: Your midwife or your doctor. You alone decide with whom you feel better cared for. In both cases, the costs are covered by health insurance.

The main focus of preventive examinations is the health of mother and child. Provided there is no high-risk pregnancy, a routine maternal check-up takes place once a month after the initial examination. From the 32nd week of pregnancy onwards, this will be every two weeks. You will receive your maternity passport after the initial examination. You should always carry it with you from now on.

The routine screening appointments include the following standard examinations:

• Listening to the child's heart sounds
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• Measuring the mother's blood pressure
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• Detecting weight gain
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• Examining urine for kidney problems and diabetes
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• Exam the blood for possible iron deficiency
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• Measuring the size and height of the uterus
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• Determining the position of the baby
• Checking for possible water retention or varicose veins
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In addition, various infectious diseases are clarified with smears, blood tests and other laboratory tests at the beginning of pregnancy. Free of charge, pregnant women are examined for

• Rubella immunity
• Chlamydia
• Hepatitis B and syphilis
• HIV

These examinations are free of charge as part of statutory preventive care.

In addition, 3 ultrasound examinations are scheduled during pregnancy to monitor the growth and development of the child. These examinations can only be performed in a gynecological practice.

• 1st examination: 9th to 12th week of pregnancy
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• 2nd examination: 19th to 22nd week of pregnancy
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• 3rd examination: 29th to 32nd week of pregnancy
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If there are abnormal findings or special risks, the doctor will probably recommend further ultrasound examinations or special tests.

Voluntary individual health services (IGeL services)

It is possible that your doctor will offer you additional individual health services during pregnancy. You can take advantage of these if they make you feel better. However, you will have to pay for them yourself if these examinations are not absolutely necessary from a medical point of view. Basically, you should always trust your gut feeling and not let yourself go crazy unnecessarily. If, in the course of the pregnancy, there is a well-founded suspicion of a particular risk, your doctor will certainly order all medically necessary examinations.

Of course, your doctor or midwife will also be available to help you with any other health-related questions you may have about pregnancy.

Priatal diagnostics refers to examinations and tests that go beyond the "normal" preventive examinations. The methods specifically look for indications of possible malformations or hereditary diseases in the unborn child even before birth. In this way, certain diseases can be ruled out or confirmed in early pregnancy.

Such special examinations are initiated by the physician if the preventive examinations reveal indications of risk factors. The costs are covered by health insurance if there is a medical need for them.

Many couples ask themselves this question and wish for answers from modern medicine. Various prenatal diagnostics tests can also be performed upon special request. The parents-to-be hope that this will give them the additional certainty that everything is fine with their child.

Before you decide to do this, however, you should know: Almost all children are born healthy. Very few diseases and disabilities are congenital, and only a small proportion of these can be detected before birth. Anyone considering prenatal diagnostics should therefore inform themselves well and also consider possible consequences at an early stage.

For couples considering prenatal diagnostics, it is therefore important to inform themselves thoroughly about the individual procedures. They should also consider possible consequences before deciding for or against prenatal diagnostics.

These are the advantages:

• Genetic defects such as trisomy 21 (Down syndrome), trisomy 18 (organ malformations), spina bifida (open back), or Turner syndrome can be detected.
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• In particular, in the case of genetic predisposition, the examinations give additional security.
• Certain anomalies can be treated today even before birth.
• Genetic defects such as trisomy 21 are not curable. However, parents have the opportunity to adjust to the situation long before the birth, to take advantage of counseling services or even to consider abortion.
• The examinations performed help to prepare the birth well, for example, by a planned cesarean section.

These are the disadvantages:

• Invasive testing increases the risks of bleeding, rupture of the membranes, and miscarriage.
• Tests may yield an inconclusive result. Such findings may trigger anxiety and unnecessary worry in expectant parents.
• Expectations of diagnostics are often too high. Diagnostics do not provide 100 percent reliability.
• Diseases of non-genetic causes often remain undetected.
• The finding of malformation triggers conflicts of conscience, since a conscious decision must be made for or against a disabled child.

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In prenatal diagnostics, a distinction is made between invasive and noninvasive examinations.

Noninvasive tests do not involve penetrating the amniotic sac. These include:

• Ultrasound examinations such as the nuchal fold measurement:
• Examination in the 11th to 14th week of gestation provides a risk assessment for possible trisomy 21.
• Fine or organ ultrasound:
• Sonography reveals changes in organs.
• Examination of the mother's blood:
• Laboratory tests indicate trisomy 21, 18, or 13.
• First trimester screening:
• This is a combination of blood tests and nuchal fold measurement.

Invasive testing involves interfering with the child's habitat. These methods include:

• Amniocentesis: amniotic fluid is collected through the mother's abdominal wall with a needle under ultrasound guidance during the 15th to 16th week of pregnancy. The fetal cells in the amniotic fluid are examined for genetic diseases.
• Chorion villus biopsy: This examination is already possible from the 9th SSW. Through the abdominal wall or the vagina, cells are taken from the placenta with a fine needle and examined for genetic disorders
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• Umbal cord puncture: From the 19th SSW, blood is taken from the baby's umbilical cord with a needle through the mother's abdominal wall. Laboratory tests provide evidence of abnormalities and blood disorders.

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If, in the course of the regular preventive examinations, there are signs that something is wrong, the costs of further examinations are covered by the health insurance funds.

If the expectant mother is over 35 years old, health insurance will cover the cost of an amniocentesis or chorionic villus sampling.

Otherwise, unless there is a suspicion of abnormality in the development of the child, prenatal diagnostic examinations are performed at the request of the parents. The costs for this are to be borne by the parents themselves.