Prenatal Examination
During the initial checkup, you will be given information about possible tests that can provide insight about the baby’s health during pregnancy.
These tests are not mandatory and are not all covered by insurance without medical indication. The period ultrasound and the 20-week ultrasound are covered by the insurance company.
Non-Invasive Prenatal Test (NIPT).
In the Netherlands, all pregnant people are given the option of having their unborn child’s health tested. Part of those tests consists of a probability calculation, which determines your individual chance of having a baby with one of the following chromosomal abnormalities.
The test calculates the risk of having a child with a chromosomal abnormality. These include:
- Down syndrome - in which there is an extra chromosome 21 (trisomy)
- Edwards syndrome - in which there is an extra chromosome 18
- Patau syndrome - in which there is an extra chromosome 13
The Non-Invasive Prenatal Test (NIPT) is a blood test performed on the pregnant woman. In the blood, it looks for DNA from the placenta. This almost always matches the baby's DNA. By examining this, it determines whether the baby is suspected of having chromosomal abnormalities. The NIPT is safe for the pregnancy and therefore poses no risk of miscarriage.
When: NIPT can be used from the 10thweek of pregnancy.
Probability
The NIPT is also a probability calculation but is very accurate. When the result is not found to be abnormal it is almost always correct. Less than 1 in 1,000 pregnant women are nevertheless pregnant with a child with a chromosomal abnormality.
If the baby is suspected of having a chromosomal abnormality, the chance of this result being correct varies by syndrome. If the baby is suspected of having Down syndrome, the chance of this being correct is 90%, for Edwards syndrome it is 90% and for Patau syndrome it is 50%. Amniocentesis or chorionic villus testing will have to provide certainty in this case.
Side findings
NIPT focuses primarily on three chromosomal abnormalities: Down syndrome (trisomy 21), Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13). However, NIPT can also detect other conditions. These may be in the child, in the placenta and very rarely in the pregnant woman herself. We call these side findings. You choose whether to have the side findings tested as well.
There are different types of side findings: from very serious to less serious conditions. Out of every 1,000 pregnant women who choose NIPT, about 4 women are told there is a side finding. To know for sure what kind of secondary finding is involved, follow-up testing is needed, usually an amniocentesis or chorionic villus test.
The cost
As of April 1, 2023, the Trident2 study under which NIPT has fallen for five years has ended. That means there is currently no more cost associated with NIPT.
So who pays for the NIPT?
The counseling session you have with us to decide whether or not to have the NIPT is covered by the insurance company.
The NIPT itself is paid for by the government.
If it turns out that follow-up testing is necessary, such as chorionic villus testing or amniocentesis, this is then again covered by the insurance company.
For more information about the NIPT, visit www.pns.nl
13 Week Echo (ETSEO).
September 2021, the 13-week ultrasound was introduced in the Netherlands. The 13-week ultrasound (also called “first trimester screening (ETSEO)” is very similar to the 20-week ultrasound. This is because in both ultrasounds, the ultrasound technician looks to see if the baby has any physical abnormalities. During the first consultation with us, we will conduct a counseling session, in which we explain this ultrasound and what you can expect. At the moment you decide you want this ultrasound, it can be performed at 12+3 weeks pregnant and 14+3 weeks pregnant. The ultrasound will not take place at our practice, but at an ultrasound center. The ultrasound itself takes about 30 minutes. The results are told immediately by the ultrasound technician.
In 95 out of 100 women, no physical abnormality is found. No follow-up examination is then necessary. After this, it is still possible to go for the 20-week ultrasound.
In 5 out of 100 women, something is seen that could be a possible defect. It is not always immediately clear whether there is indeed an abnormality, how serious it is and what effect it will have on your baby. In that case, it is possible to have follow-up testing.
The 13-week ultrasound is currently only available if you participate in the scientific study IMITAS. This study investigates what the advantages and disadvantages of the 13-week ultrasound are.
However, this ultrasound is covered by health insurance.
For more information: www.pns.nl
20 Week Echo (TTSEO)
The 20-week ultrasound is officially called a structural ultrasound examination (SEO). This examination is a medical ultrasound and not a “pretecho.
The structural ultrasound examination (SEO) preferably takes place at a gestational age between 19 and 21 weeks. This is why it is also called the 20-week ultrasound.
During this examination, an ultrasound technician looks at all of the baby’s visible organs and structures, the baby’s growth and the amount of amniotic fluid. Major abnormalities may become visible here. If abnormalities are visible on the ultrasound, you will be referred for further testing. It is important to know that a good result from the SEO does not fully guarantee that the baby is completely healthy.
Fortunately, very few abnormalities are found in the group of healthy pregnant women.
Not required
Ultrasound testing during pregnancy is definitely not mandatory. Many parents do opt for ultrasound testing during pregnancy, but not everyone wants further testing at 20 weeks.
Reimbursement
This ultrasound is covered by all insurance companies.
Where?
For the ultrasound, you make your own appointment.
Chorionic villus test or
amniocentesis
This applies to the pregnant person in whom the combination test and/or NIPT indicated an increased risk of having a child with a chromosomal abnormality.
In the placenta test, the gynecologist removes a small piece of placental tissue through the vagina or through the abdominal wall. This is examined for chromosomal abnormalities.
- How long does the procedure take? 15 to 20 minutes.
- When can I have the test done? From the eleventh week of pregnancy.
- Who performs this examination? The gynecologist.
- Risk of miscarriage? There is a small risk of miscarriage due to the chorionic villus test; this risk is 0.5%.
- When will the results be known? After about 5 to 10 days.
If an abnormality is found
In case of an abnormal result - a chromosomal abnormality is then shown - you can opt for a termination of pregnancy. Until the 14th week of pregnancy this can be done with a suction curettage, after the 14th week you will be given vaginal tablets in the hospital to make the body reject the pregnancy.
In amniocentesis, a small amount of amniotic fluid is taken through the abdominal wall. The cells in this amniotic fluid are examined for chromosomal abnormalities.
- How long does the procedure take? 15 to 20 minutes.
- When can I have the test done? From the 16th week
- Who performs this examination? The gynecologist.
- Risk of miscarriage? Amniocentesis carries a miscarriage risk of 0.3%.
- When will the results be known? The result of a rapid test, for chromosomal abnormalities and gender is known after 3 to 5 working days, depending on the day of collection. You will receive a result by phone 3 to 7 working days after the test.
However, this test does not examine all chromosomes. Therefore, you will receive the final result of amniocentesis after 3 weeks, after examination of all chromosomes.
If an abnormality is found
If amniocentesis reveals a chromosomal abnormality and you choose to have the pregnancy terminated, the pregnancy is already too advanced to have it terminated by curettage and delivery will have to be initiated with medication.