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

Naar aanleiding van de anamnese stelt je verloskundige samen met jou een zorgplan op. Welke onderzoeken raden we je aan om te doen de komende maanden? Maar ook: wat zijn redenen om contact op te nemen met je verloskundige? In het ZORGPLAN lees je er meer over.

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 https://www.pns.nl/en/.

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

If the midwife who conducts the intake appointment is qualified to perform ultrasounds, she will carry out an early ultrasound or a dating scan. Otherwise, a separate appointment will be scheduled for this.

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

What is prenatal screening?
During your pregnancy, you can choose to have tests to check whether there are indications that the baby in your womb has a chromosomal abnormality or a physical abnormality. This is called prenatal screening.

Two types

There are two types of screening:

1. Testing for chromosomal abnormalities: the NIPT (non-invasive prenatal test). This is a blood test.
2. Testing for physical abnormalities: the 13-week scan and the 20-week scan.

Counseling

Would you like to know more about these tests? During the intake we will look together at what you need in order to make the choice that suits you best. You can also ask any questions you may have.

Prepare for the counseling

Read information about the tests before the appointment. You can find more information at www.pns.nl/en/, for example:

• A webpage about the NIPT, the 13-week scan, and the 20-week scan.
• A short video about the NIPT and videos about the 13-week scan and the 20-week scan.
• Questionnaires that can help you with making a choice.

Whether or not to have the tests: that is your choice.
The NIPT, 13-week scan, and 20-week scan are not mandatory. You decide for yourself whether you want to have one or more of these tests and what you do with the results. You can also stop the testing at any point.

A normal NIPT result has a reliability of 99.9%. An abnormal result is slightly less reliable. For example, if the NIPT indicates that the baby has Down syndrome or Edwards syndrome, in 2–4% of cases this result is incorrect. For Patau syndrome, the result is incorrect in as many as 47% of cases. Therefore, a chorionic villus sampling (CVS) or amniocentesis is always offered to confirm such a result. The results of these tests provide a definitive answer as to whether or not the baby has one of these three syndromes.

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 https://www.pns.nl/en/.

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.