Ultrasound / examination

Every pregnant woman is offered four ultrasounds during her pregnancy. Some of these we perform ourselves at the Noordeinde location of our practice. For prenatal screenings we’ll refer you to Bovenmaas Prenataal or de Star


Vitality ultrasound

All pregnant woman will be offered an early ultrasound around 8 weeks of pregnancy.  During this ultrasound we’ll determine if there is movement in the heart, if there are one or more babies, and if the pregnancy is located inside the uterus or not. In most cases this early ultrasound needs to be take vaginally, for which your bladder should be empty. 


Term-ultrasound

A term-ultrasound is also called a fist trimester- or 12 week- ultrasound. It will be taken between 10 and 13 weeks of pregnancy. 

With this ultrasound we determine;

•    The length of the pregnancy and the due date
•    If the pregnancy is viable, in other words, if the heart is moving. 
•    How many babies there are
•    During this ultrasound there is only a limited possibility to detect possible birth defects. For more information please look here.

For this ultrasound your bladder doesn’t need to be full. Mostly it can be performed through the abdomen, if this is not possible the ultrasound will be done vaginally.
 

Prenatal screening

Prenatal screening that is performed in the Netherlands focuses on:

•    Chromosomal defects e.g. Down’s-, Edwards- and pataus syndrome)
•    Physical defects (e.g. spina bifida, heart defects or cleft lip)

Combination test
The screening for chromosomal defects is done using the combination test. This test gives an accurate, individual estimation of the chances for Down’s-, Edwards-  and Pataus syndrome for your baby. The test is performed around 12 weeks of pregnancy. In some cases the test discovers other chromosomal or serious physical defects. During this prenatal screening there is NO RISK of miscarriage caused by the test. On the other hand, because this test is still an estimation (albeit an accurate one), it cannot determine for 100% certainty that your baby will not have Down’s, Edwards or Pataus syndrome. 
Brochure screening for Down's syndrome

NIPT

Starting April 1th you have the opportunity to investigate (screen for) the risk of your child having Down syndrome, Edwards' syndrome or Patau's syndrome. During your first visit, your obstetrician or gynaecologist will ask you if you want to know more about the screening. If you want, you will be informed about the screening during an information session. You can prepare for this session by reading the information on the website:

onderzoekvanmijnongeborenkind.nl/

meerovernipt.nl/nieuw

Or download the brochure available in several languages:

informormation brochure RIVM about the screening for Down syndrome, Edwards' syndrome and Patau syndrome

The NIPT tests the blood of the pregnant woman. The blood is drawn and tested. The laboratory tests the DNA in the blood for chromosomal abnormalities, allowing the determination of whether the child has Down syndrome, Edwards' syndrome or Patau's syndrome. The blood of the pregnant woman contains placenta DNA and DNA from the mother. The placenta DNA is almost always the same as the DNA of the child. The NIPT can be performed from the 11th week of the pregnancy

 

Structural Echoscopic research (SEO)
The screening for physical defects is done during the 20 week ultrasound. This ultrasound is also called the structural echoscopic research or SEO. It is performed between 18 and 22 weeks of pregnancy. During this ultrasound the different organ systems of your baby are examined to see if there are any serious birth defects. Although many defects can be detected this way, it’s not possible to exclude all defects after this examination. The SEO focuses on defects to the brain, spinal column and the primary organs. Based on the result of this ultrasound an additional examination might be necessary.
Brochure the anomaly scan
 

Why prenatal screening?
All woman have a 3 to 4% chance of having a baby with a birth defect. That is why all woman have the right to choose prenatal screening. You can always decide not to participate!

If the combination test shows an elevated chance of the baby having a chromosomal defect, an additional examination is offered to be able to diagnose the defect. The additional examination consists of:

  • NIPT. Since 2014 woman who have an elevated chance of a baby with a birth defect are eligible for the Non Invasive Prenatal Test (NIPT). Some of the unborn baby’s DNA of placenta is present in the mother’s blood. The NIPT uses this DNA to detect any chromosomal defects. The NIPT has NO RISK of miscarriage. When the NIPT test is negative (meaning a good result) there is no additional examination necessary. When the NIPT shows a change of chromosomal defects, this needs to be examined further using an amniocentesis (taking some amniotic fluid from inside your uterus) or chorionic villous sampling (taking some tissue from the placenta). 
  • Amniocentesis or chorionic villous sampling. These tests can exclude a chromosomal defect, but do offer a small chance of miscarriage. For a chorionic villous sampling the chance of miscarriage is 0,5%, for an amniocentesis it’s 0,3%. 

When the SEO shows irregularities, an additional examination called an Advanced ultrasound research (GUO) is offered. During a GUO some physical defects can be spotted but it is not possible to exclude any defect. The GUO has NO RISK of miscarriage.

Help with choosing yes or no prenatal screening ; decision aid , on the site of prenatal screening.

Reimbursement and access for prenatal screening Down syndrome altered starting januari 1st 2015

All pregnant women that choose prenatal screening for down syndrome (combination test) will pay for this themselves starting januari 1st. This is now also true for pregnant women over 36 years of age. Only in certain cases complementary health insurance will cover the costs.  Further examinations after screening are reimbursed by the basic health insurance, but can be charged to the ‘eigen risico’ (uninsured starting costs). Reimbursement for screening changes over time, for more and up-to-date  information you can refer to  www.rivm.nl/downscreening.

More information on the abovementioned tests can be found at www.bovenmaasprenataal.com


Growth ultrasound

All pregnant women need to have a growth ultrasound between 32-34 weeks of pregnancy. We determine the growth and position of the baby and do an estimation of the amount of amniotic fluid. 
 

Additional ultrasound

Sometimes there is a reason to do an additional ultrasound during your pregnancy. This can happen when we doubt the growth or position of your baby, or if a previous pregnancy calls for extra monitoring. When this is the case we will discuss it with you during your appointment. 

The vitality ultrasound, term-ultrasound, 20 week ultrasound and growth ultrasound are covered by your health insurance. The combination test is not covered by your insurance unless there is a medical indication to have it.


Additional blood testing

Based on your medical history, previous pregnancies of your weight we might want to do a so called sugar test. This test is performed between 24 and 28 weeks of pregnancy and  is used to detect gestational diabetes. If this test is necessary for you, we’ll inform you during your appointment.

Research and privacy

Bloodwork & Praeventis
The data of all pregnant women in the Netherlands who have bloodwork done are being registered. The Department for Public Health and Environment (RIVM) records these records in a databank called Praeventis. This is done to guarantee the quality of the bloodwork and to monitor the overall process.

Click here to read more about the registration of your data by RIVM.

Prenatal screening & Peridos
The data concerning prenatal screening of all pregnant women who are under the care of a midwife or similar health care provider, and the outcome of the pregnancy are registered in a national databank called Peridos. Even when you have decided not to have any prenatal screening done this will be registered. Furthermore Peridos contains information on all healthcare providers and healthcare facilities in the Netherlands.
Al healthcare providers in the Netherlands that are involved in prenatal screening use peridos. But only those that play an active part in the prenatal screening process can access your personal data. The system has been secured to guarantee your privacy.
In the Netherlands there are 8 regional centers. These centers have access to the Peridos data. This helps them to safeguard the quality of your care. For more information about this please consult: www.peridos.nl

If you object to the use of your personal data you need to explicitly mention this to your midwife.

In obstetrics it is very important to be well informed so you can make your decisions carefully and so you know when it’s time to take action. During your appointments we will take the time to discuss all important matters with you, but we also recommend you read up on several of these subjects yourself.
Click the “pamphlets” button to find our own pamphlets online as well as some third party pamphlets we recommend you read.
Click on “links” to have an overview of all our partners and to find additional information. Enjoy browsing!

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