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Preventive care and prenatal diagnostics
What can prenatal examinations do?
40 moving weeks: from conception to birth
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.
How does the pregnancy proceed?
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:
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Even if externally still no belly is to be seen, the body of the mother has now completely much to do with it to adjust to the pregnancy. The release of pregnancy hormones leads in some women to pregnancy symptoms such as nausea, great fatigue, constipation or sensitive breasts. Some women suffer more than others. Mood swings are also completely normal in this early phase. In the womb, cell division begins after fertilization. In SSW 4, the embryo develops, which can be seen on ultrasound from SSW 8 at the latest. At the end of the first trimester, all vital organs are developed and your baby is already about 5 cm tall. The heart beats at up to 160 beats per minute and the baby is practicing its first movements.
In the 2nd trimester, the pregnancy symptoms usually subside. Instead, the belly now grows continuously. During this phase of pregnancy, the development of your baby progresses with particularly large steps. The brain and nervous system of the fetus develop from around SSW 13. The organ functions mature: kidneys, intestines and lungs are flushed with amniotic fluid through swallowing and breathing movements. The baby already perceives light and pressure. The baby also already reacts to external sounds. From about the 18th week of pregnancy, you can feel the movements of the embryo. The ultrasound may already be able to determine the sex of the child. In SSW 24, the embryo is about 30 cm tall and weighs around 700 g. The unborn child now reacts to sounds with movements, can laugh, cry, recognize light sources and also feel pain. At the end of the 2nd trimester, it is about 37 cm tall and weighs about 1200 g.
Meanwhile, the belly has become quite round and everything is increasingly burdensome. The weight of a pregnant woman increases steadily in recent weeks - a total of 11 to 18 kilograms, as a rule. The uterus begins to press on the internal organs. This can lead to heartburn, urinary urgency and shortness of breath. Sleeping often only works in the side position because of the growing baby ball. With the completed maturation of the lungs, all organs are ready to function by the 9th month. Due to the increasing lack of space in the abdomen, the baby's outstretched movements become steadily less frequent. Instead, the child assumes the typical fetal position and draws its legs and arms close to the body. Towards the end of pregnancy, the child usually weighs between 2800 and 4200 grams and is on average 48 to 54 centimeters tall. After 40 long weeks, it is ready to see the light of day.
10 times preventive care: How will I be medically accompanied?
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:
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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)
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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.
What can prenatal diagnostics do?
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.
Will my child be healthy?
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.
What are the advantages and disadvantages of prenatal diagnosis?
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.
What prenatal diagnostic services are available?
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.
Who bears the costs for prenatal diagnostics?
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.
The flyer "Prenatal Diagnostics" of the Federal Center for Health Education BZgA provides information about counseling services, examination methods and help.
The brochure "Special Circumstances" is dedicated in detail to the information and questions of expectant parents after an abnormal finding in prenatal diagnostics.
