Episode 3: intake, first ultrasounds & prenatal tests

In short

• During the intake with your midwife, she will create a tailored care plan with you for the coming months.
• For an accurate due date, it's important that the dating ultrasound takes place between 9 and 12 weeks of pregnancy.
• You make a choice before 12 weeks of pregnancy whether you want to be tested to determine if the baby has an extra chromosome 13, 18, or 21 (Down syndrome).

Intake with your midwife

During the intake, the midwife takes 45-60 minutes to ensure you have a good start to your pregnancy. The intake consists of several parts:

Anamnesis

The midwife asks you and your partner many questions about your medical history. This includes your general health, whether you have been pregnant before, and whether there are any congenital abnormalities or diseases in the family that could affect your pregnancy. For an overview of the questions asked, please refer to the questionnaire sent to you after registration.

Care plan

Based on the anamnesis, your midwife will create a care plan with you. This plan includes recommended examinations for the coming months. Additionally, it outlines reasons to contact your midwife outside of regular Centering Pregnancy sessions.

Counseling

If you wish, we will discuss prenatal testing with you and support you in making a choice. The conversation focuses on your choice. We will discuss the potential consequences of a particular result, such as whether you would consider terminating the pregnancy if your baby is not healthy. Do you want to know everything you can know? Finding the answers to these questions will hopefully guide you to make an informed choice. Read more about prenatal testing at www.pns.nl.

Tests

The midwife measures your blood pressure, calculates your BMI, and examines your abdomen. If you are less than 12 weeks pregnant, the heartbeat will not be listened to for medical reasons.

Logistics

The midwife provides you with information and referrals for blood tests, arranging maternity care, and any prenatal tests that may be necessary.

Ultrasounds

Indien de verloskundige die de intake doet een echo bevoegdheid heeft, dan zal zij een vroege echo of termijnecho maken.

Blood test

During or after the intake, blood is drawn. In the Netherlands, it is standard practice to test all pregnant women for their blood type, Rhesus D factor, Rhesus C factor, syphilis (lues), HIV, and Hepatitis B. Additionally, we assess your iron levels. Depending on your work conditions, dietary habits, or medical history, further tests may be recommended.

Term ultrasound and your due date

If you have registered at amstermam, you will be offered a free "early ultrasound" between 8 and 10 weeks of pregnancy. This ultrasound checks for a heartbeat, confirms the embryo is in the uterus, and identifies the possibility of a multiple pregnancy. Women who have had a previous miscarriage or experience vaginal bleeding will always receive this ultrasound.

Between 9 and 12 weeks, the pregnancy term can be measured most reliably. During the term ultrasound, the length of the embryo from crown to rump is measured. Using this length, we can determine the exact due date. All embryos grow at the same rate up to 14 weeks. However, knowing the exact due date doesn't predict when you will go into labor. Typically, normal term for delivery is between 37 to 42 weeks. The due date is set at 40 weeks, so it's normal to deliver from 3 weeks before to 2 weeks after your due date.

Prenatal screening

You are pregnant, and of course, you hope that your baby is healthy. Fortunately, most children are born healthy, and with a healthy lifestyle, you can give your child a good start. Occasionally, there are congenital abnormalities that we can detect during pregnancy. For this purpose, the NIPT (non-invasive prenatal test) is used. A small amount of blood is taken from the arm for this test. There is no risk of miscarriage associated with it. It is important that you are well-informed about the possible outcomes if you choose to undergo this test. Whatever decision you make, you may face difficult choices regarding whether or not to terminate the pregnancy. There is decision support available to help you make an informed choice. Learn more about prenatal testing at www.pns.nl.

If there are certain abnormalities within your (your) family, and it's unclear whether these are hereditary or not, you may be referred to the clinical genetics department. The clinical geneticist will investigate the role of hereditary factors in the development of a congenital abnormality in your case.

NIPT

Since April 1, 2017, you have the option to choose a NIPT: a blood test that indicates whether your unborn child has an increased risk of Down syndrome, Patau syndrome, or Edwards syndrome. The NIPT poses no risks to you or the baby and is not covered by your insurance. From 10 weeks of pregnancy, blood can be drawn from you for the NIPT. This blood is examined at one of the academic centers for the presence of an extra chromosome (trisomy) 13, 18, or 21, which are the causes of these syndromes. The NIPT detects the same conditions as the previously used combined test, but provides a much more reliable result.

A good test result has a reliability of 99.9%. A poor result has slightly less reliability. For example, if the NIPT indicates that the baby has Down syndrome or Edwards syndrome, this result is incorrect in 2-4% of cases. For Patau syndrome, it's incorrect in 47% of cases. Therefore, to confirm such a result, a chorionic villus sampling (CVS) or amniocentesis is always offered. The results of these tests provide certainty whether one of the three syndromes is present or not.

13 weeks ultrasound

As part of the screening, between 12 weeks and 3 days and 14 weeks and 3 days of pregnancy, you can undergo the 13-week ultrasound. During this ultrasound, we examine whether your child has any physical abnormalities. We also assess the amount of amniotic fluid and the growth of your child.

20 weeks ultrasound

Later in pregnancy, you can choose to have a 20-week ultrasound where we again examine the baby from head to toe. Read more about this in 'I am almost halfway'. episode 4 of the 9-monthplan.

For all these examinations, read more about them on www.pns.nl.

and more...

For partners

• During the intake, there are also questions about your health and that of your family, so it's helpful if you can come along. A lot of information will also be provided that will benefit you in the coming months: two heads are better than one.
• The online information session Meeting amstermam is for couples and not just for pregnant women 😉

Read tips

• Read here everything you need to know about the prenatal screening / NIPT.
• Zwanger! of RIVM
• ‘De Grote Geboortegids’ written by a midwife and a gynecologist together.

To do

• It's wise to arrange maternity care early in your pregnancy, ideally before 20 weeks. If you prefer an independent contractor (ZZP'er), it's recommended to register before 8 weeks of pregnancy.
• Do you want to use childcare services? Make sure to sign up on time! (for example, after the early ultrasound).
• Making decisions about prenatal screening: whether to opt for NIPT, the 13-week ultrasound, and/or the 20-week ultrasound.