Prevention and prenatal diagnostics

A newborn on the way? Congratulations! One thing is certain: you're in for an exciting time with the start of your pregnancy. 9 months is a long time, with a rollercoaster of emotions, many emotional moments and growing anticipation. Find out here how the expectant mother's body changes and how the unborn child develops.

A pregnancy is divided into 3 major stages. These are called trimesters or third trimesters. 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. During your pregnancy, you are legally entitled to a total of 10 check-ups. You can choose who should carry out the examinations specified in your maternity record: Your midwife or your doctor. You alone decide who you feel more comfortable with. The costs are covered by health insurance in both cases.

Routine check-ups include the following standard examinations:

• Listening to the child's heartbeat
• Measuring the mother's blood pressure
• Determining the weight gain
• Testing the urine for kidney problems and diabetes
• Testing the blood for a possible iron deficiency
• Measuring the size and height of the uterus
• Determining the position of the child
• Check for possible water retention or varicose veins

In addition, swabs, blood tests and other laboratory tests are carried out at the beginning of pregnancy to check for various infectious diseases. Pregnant women are examined free of charge for

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

These examinations are free of charge as part of statutory screening.

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

• 1st examination: 9th to 12th week of pregnancy
• 2nd examination: 19th to 22nd week of pregnancy
• 3rd examination: 29th to 32nd week of pregnancy

If there are any abnormal findings or particular risks, your doctor will probably recommend further ultrasound examinations or special tests.

Voluntary individual health services (IGeL services)

Your doctor may offer you additional individual healthcare services during your 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. As a general rule, you should always trust your gut feeling and not let yourself be driven unnecessarily crazy. If there is a reasonable suspicion of a particular risk during the course of the pregnancy, your doctor will certainly order all medically necessary examinations.

Of course, your doctor or midwife is also available to answer any other health-related questions you may have about your pregnancy.

Prenatal diagnostics refers to examinations and tests that go beyond the "normal" screening examinations. The methods specifically search 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 arranged by the doctor if there are indications of risk factors during the check-ups. The costs are covered by health insurance if there is a medical necessity.

Many couples ask themselves this question and want answers from modern medicine. Various prenatal diagnostic tests can also be carried out on special request. The parents-to-be hope that this will give them additional certainty that everything is in order with their child.

Before you decide to go ahead, however, you should know that Almost all children are born healthy. Very few illnesses and disabilities are congenital, and only a small proportion of these can be detected before birth. Anyone considering prenatal diagnostics should therefore be well informed and consider the possible consequences at an early stage.

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
.
• In particular in the case of genetic predisposition, the tests provide additional certainty.
• Certain anomalies can now be treated before birth.
• Genetic defects such as trisomy 21 cannot be cured. However, parents have the opportunity to prepare for the situation long before the birth, take advantage of counseling services or even consider terminating the pregnancy.
The examinations carried out help to prepare the birth well, for example with a planned caesarean section.

These are the disadvantages:

• The invasive tests increase the risks of bleeding, rupture of the membranes and miscarriage
.
• Tests can give an inconclusive result. Such findings may cause anxiety and unnecessary worry for parents-to-be.
Expectations of diagnostics are often too high. Diagnostics are not 100% reliable.
• Diseases with non-genetic causes often remain undetected
• The finding of a malformation triggers conflicts of conscience, as 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 non-invasive examinations.

In the case of non-invasive tests, the amniotic sac is not penetrated. These include:

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

Invasive tests involve interfering with the child's living space. These methods include:

• Amniocentesis: In the 15th to 16th week of pregnancy, amniotic fluid is taken through the mother's abdominal wall with a needle under ultrasound guidance. The fetal cells in the amniotic fluid are examined for genetic diseases.
• Chorionic villus sampling: This examination is possible from the 9th week of pregnancy. Cells are removed from the placenta via the abdominal wall or vagina using a fine needle and examined for genetic disorders.
Cordocentesis: From the 19th week of pregnancy, blood is taken from the baby's umbilical cord with a needle through the mother's abdominal wall. The laboratory tests provide indications of anomalies and blood disorders.

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If there are signs that something is wrong during the regular check-ups, the costs of further examinations are covered by the health insurance companies.

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

Unless there is any suspicion of abnormalities in the child's development, prenatal diagnostic examinations are carried out at the parents' request. The costs are to be borne by the parents themselves.