Counselling on Prenatal Diagnosis

During pregnancy many women and couples are worried about the health of their unborn baby. The following questions may help you to get information on the chances and risks of prenatal tests. If these tests show an abnormality counselling could help you to make your personal decision and develop a perspective. We support you during pregnancy or after an abortion based on prenatal abnormalities.

• What kinds of antenatal examinations can be done? »

  First of all there are regular antenatal examinations which are covered by your health insurance. In addition there are so-called examinations for prenatal diagnosis to detect possible foetal abnormalities. You may seek advice on the different available tests before you make a decision. It is important to know that these tests are not part of the routine antenatal care. You may have to pay for them yourself.

  During the first 7 months you will have regular examinations once a month, and after the 7th month every two weeks. The doctors will take your blood pressure, take your weight, and test a urine sample for blood, sugar and protein. During the first examination you will also be tested for Chlamydia infection.

  Most of the examinations can be done by a gynecologist or a midwife, others - such as ultrasound - only by a gynaecologist.

  During routine antenatal health care there are three ultrasound examinations covered by the health insurance. For medical reasons additional examinations can be done. If you wish to have an ultrasound examination without medical reason or for a nuchal scan you will have to pay a fee.

  A set of blood tests will be done at the beginning of pregnancy (examination of blood group, haemoglobin, rubella antibodies, testing for syphilis and HIV etc.) covered by your health insurance. Later you will be tested for Hepatitis B and blood-group antibodies will be checked. You may be offered further blood tests for which you will be charged.

• Which prenatal examinations are useful? »

  Your gynaecologist may advise you on the possibility of additional antenatal examinations in the beginning of your pregnancy. You should decide yourself which examinations you want to have done. With these tests you can only detect certain abnormalities and diseases and you can’t be guaranteed to deliver a healthy child. With some of the examinations you can only calculate probabilities for certain diseases and further examinations are necessary to get definitive results. Only a few of the diagnosed diseases may be treated during pregnancy or shortly after giving birth. In most of the cases of abnormalities or diseases you may have to deal with the decision of having a late-term abortion.

  The decision whether to have antenatal examinations done involves many difficult questions: How much is appropriate for us to know or not to know? Can we imagine having a disabled child? What would a late-term abortion mean for us? Counselling may help you to reach a decision you can cope with.

• What to do if the examination shows an abnormality? »

  Shock and grief are the predominant emotions in this situation. Nevertheless you have to make a decision whether you want to carry the child to term in this situation. Should you wish so, we are there to help you in reaching a decision, support you throughout the pregnancy, or help you cope with a possible abortion.

• Overview over the most important prenatal examinations »

  Nuchal Fold Scan
  Ultrasound is used to measure the nuchal fold during the 11th-13th week of pregnancy. The thickness of the fold may be a sign for an abnormality. However further examinations are needed to determine whether there really is a foetal abnormality or disease. In most cases of an abnormal nuchal fold the child is healthy. A combination of special blood tests with a nuchal scan allow more accurate risk calculations, but cannot replace further examinations to provide a definitive diagnosis.

  Amniocentesis
  A sample of amniotic fluid is taken with a needle through the abdominal wall and the womb. The foetal cells in the amniotic fluid are tested for chromosomal abnormalities. This procedure can detect chromosomal abnormalities with high reliability. However, you will often not know exactly which disabilities the baby will have. An amniocentesis is usually performed during the 15th week of pregnancy, with the results being available two weeks later. In 0.5% of the cases the examination may lead to a miscarriage.

  Chorionic Villus Sampling
  A sample of tissue from the placenta is taken with a catheter through the vagina and cervix. The sample can be analyzed for chromosomal abnormalities. The procedure is somewhat less reliable than an amniocentesis, but may be performed earlier, during the 10th -12th week of pregnancy, and the results are available after a couple of days. Furthermore, the examination allows for the detection of hereditary metabolism disorders. The risk of miscarriage is similar to that of an amniocentesis.

  Morphology Ultrasound Scan
  During the 20th week of pregnancy ultrasound may be used to detect abnormalities in the development of foetal organs. The procedure is performed by specially trained gynecologists.

  Doppler Ultrasound
  During this procedure a special ultrasound technique is used to examine the blood flow in the child's blood vessels and the umbilical cord in order to determine whether the child gets enough oxygen and nutrients.