Tests and check-ups taken during pregnancy

Hello,

I´m in my 13+ week and I´ve got a few questions:

1) So far I´ve been asked if I want to have a test for Down Syndrome, is there are reason why a Dr would promote this or is this normal procedure, and why does it cost €190?
2) What are the necessary tests later on down the track, and are there any implications for infection etc?
3) Has anyone else here noticed different treatment when your not a German?
4) Are there any pregnant women willing to meet for a chat on a regular basis?

Would love to hear from you!

are you privately insured? If so, the doctors will try and carry out endless amounts of tests and check-ups so they can cash-in on your insurance. Some of them are necessary, some are optional and some down-right unnecessary.

The test for Downs Syndrom is offered as an option depending on your family history and the age of the parents or if a preceding blood test may indicate a potential risk. If you are state insured and it is considered necessary for those reasons it will be covered. However, it is not risk free.

As a foreigner, I didn't notice any particular difference in the way I was treated through two pregnancies here.

We had the downs test due to my wifes age at the time (35 if you must know). We were not required to pay for it, but if you want the results back within 10 days rather than 4 weeks you have pay extra. We obviously paid, sod the cost, eh? Although it is not technicaly 100% risk free, I have never heard of anybody I know personaly know having had complications.

The only complication for us was that although the test may be positive, it can not show the extent of the syndrom nor the amount of physical or mental complications the child will be born with. Which means we spent some hours doing some very serious and intense soul searching as to what to do if you get a positive result.

As for the foriegner bit, I was the Dad so I don't count ;-)

The test is called an amniocentesis...or Fructwasseruntersuchung, in German.
I had it done because it was advised by my doctor due to the fact that I was over 35.
We also went through a long process to decide if we wanted it done or not...the only reason why I had it done is because it was the only test that can tell you 100% whether it's a girl or a boy.
We knew that if our child had Down syndrone we would have still kept him/her...that part was sure.

We did not pay for it...only thing, if you want the results within 24 hours, you pay about 100 euro( could be more now)
If you wait two weeks, it is free...that was the longest two weeks in my life.

as gideon mentions the test does apparently include a certain degree of miscarriage risk, although as DDbug mentions you should be able to do some sort of screening with blood tests and scans to help decide if the test is worthwhile

congratulations btw

why is there risk of miscarriage? any other risks? haven't they come up with a better and less risk-free way to test for this?

i'm guessing too, if it's a necessary test, then public insurance should pay. i know my former gynecologist had that as part of my standard check-up. only when i got to munich did they say this was not so. i paid once for a ultrasound and had to bargain to get a good price!

Your doctor has to legally inform you of your option to test or not for Down Syndrome. It is not automatically done, but there are a couple of tests they can do. At 13 weeks, they can do a non-invasive test which involves taking a blood sample and an ultrasound. Based on these results, they give you a ratio of your chances of having a child with Down Syndrome. The only problem with doing this test is that it can be expensive if your insurance doesn't cover it (if you are privately insured and 35 or over, it will be covered) and it can give false positives, so then you are put in the position of getting an amniocentesis to know 100%. The amniocentesis is the invasive test, with a needle being stuck through the skin into the sac that surrounds the baby to pull out a small sample of amniotic fluid. It can say with 100% certainty if your child has Down Syndrome or a couple of other genetic conditions.


If your first ultrasound/blood test is positive, you can then consider an amniocentesis. That happens from 15-20 week of pregnancy. It does carry significant risk of miscarriage. I don't have the exact statistics, but your doctor should. From what I recall (which could be wrong, it's been nearly a year), about 1 in 1000 pregnancies end in miscarriage after an amniocentesis. May not sound high, but if you are under 35 and have no other significant reason to expect genetic problems, the risk of something being wrong is a lot lower than the risk of something going wrong with the test. Even if you are older, check out the numbers first.


I didn't give birth in Germany, but I was there for 7.5 months of my pregnancy. It's hard to say if I was treated differently, since I can hardly compare it to my experience being a German and being pregnant. I can say I felt I was well-treated.


Can't help you there, but I'm sure there are or will be some out there. Good luck and enjoy your pregnancy!

A lot of these tests that they can now carry out are a complete and utter waste of time and money IMHO, and they serve no other purpose than to cause a lot of unnecessary worry to the parents.

What is the point of paying a lot of money to take a test where the results are not accurate, can cause anxiety, and basically lead to further tests that will cost a lot of money?

If you are not an "aged" first time mother or have a family history of Genetic problems there is no reason to have the Down's Syndrom test, particulalry if you would not consider a termination, bearing in mind the small risk of miscarriage with the Amnioscentesis. Of course you could find out the sex of the baby but if you don't care what colour the nursery needs to be you can save this as a surprise for the birth day!
As far as I can remember (my children range from 20 to 13) there was no real different treatment here compared to the UK at least! I worked as a midwife in UK and arrived in Germany 5 months pregnant with child one. Child two was born in USA and number three back here in Munich. The care I gave and received in all three countries was fairly comparable. There are always going to be differences, even between clinics here and from State to State, aren't there!
Enjoy your pregnancy and don't think about it too hard, women have been doing this for centuries without the modern technology of today. Just go about your usual business and don't let it take over your life, the baby will do that when he/she arrives LOL.

they basically stick a needle into the amniotic fluid, as showem said, kind of disturbs things


as showem mentions, there are non invasive tests, but they can give false positivies


I think its a bit higher but not sure either to be honest.

In addition to amniocentesis, there is another test for Downs Syndrome called chorionic villi sampling -- I forget the exact German translation but its something like chorionbiopsie. This also involves a needle but tests the chorionic villi rather than the amniotic fluid and can be done much earlier -- around 12 weeks. You get a preliminary result the next day and a confirmed result in 2-3 weeks. In the past this test was viewed as slightly riskier than amnio, but my Ob/Gyn assured me that the risk factor is about the same if you go to a good clinic. I had amnio for my first child and cvs for my second, due to "advanced maternal age", and my BKK paid for both.

The website links above says the miscarriage risk is between 1 in 200 and 1 in 400.

As I remember they measure the length of the neck with a scan, and can then tell you if you have a higher or lower risk of Downs.

Never had a baby, and don't plan on having one anytime soon but think about the amnio that way:
would the result of the test in any way influence your decision to have this child? That is, if the test was positive, would you have an abortion?
If not, don't take the risk of the amnio.
Had a conversation about this topic the other week with my neighbors (one of whom just had a baby two months ago) and one who is like 7 months pregnant.

Is it true that here you get internal examinations at every appointment? I was never examined, in Scotland until I was in labour to see how dilated I was. I was told that there is a risk of miscarriage if internals are done during pregnancy.

g24, I seem to recall getting a short internal examination nearly every time. They check that your cervix hasn't softened and take a swab. Isn't it funny how countries are different; I was very surprised not to get any when I came to the UK.

It's called chorionzotten biopsie. Had it done for both pregnancies. Would do it again without question. Go to the prenatal lab at Taxisklinik -- have met with 4 doctors there (not all for CVS), all top-notch with excellent English. Pränatal-Medizin. Frauenklinik vom Roten Kreuz. Taxisstraße 3. 80637 München. Telefon 089 15706-519 www.praenatal-medizin.de

All reputable research I've seen (med websites, not simply parenting ones) indicate risks are equal for CVS and Amnio. If you are just looking to be prepared with information, go with whichever makes you feel more comfortable; if there is a decision you would make based on the results, you may want to make that decsion as early as possible -- CVS allows that. Maternal age & family history seem to be the predominate reasons for having one of these tests -- can't think of too many people I know who have had a test without one of these factors in play.

Best of luck.

In the US they only do a very occasional internal exam. They will check the woman's bits on the first appointment and more towards the end. But the others are just standard "how are you, and let's see what tests we can run to get more money from you" visits...

It's funny, but the wife did not get one single check-up for the middle 3 months of her pregnancy and yet everything is still OK. In fact everything is totally perfect according to the last exam. Amazing that the baby survived really...

Interesting statistic though - termination rates for pregnancies where Downs Syndrom is diagnosed are currently at 80 - 90%... Interesting, but not altogether unexpected. I was talking to a colleague who has a Downs Syndrom child and is very active in this area

Some people would rather have the information to try and prepare themselves (emotionally and practically), even if they wouldn't consider aborting.

Whoa maestro? WG is with Crawlie JR? Oh man congrats dude!

Yeah, I guess, I just don't think it would be worth the risk of losing the baby, whether healthy or not. My personal opinion of course.

Thanks Tahoe for the additional information re cvs -- I went to the same clinic and was also favorably impressed.

Hi,

First of all, an amniocentesis is recommended for women 35 and over having their first child I think. Normally your insurance reimburses you if you fall in that age bracket. If you are not, then you have to take on the costs yourself.
But before you have an amniocentesis, there is also another test which you can have done. It works out the odds of you having a baby with down syndrome. They do an ultrasound and a blood test. You get results within a week.
If you are found to be in the high risk category, then you can take the next step and have an amniocentesis which result is 100% accurate, but it carries some risks of miscarriage.
Have a look at the following link. It explains the different tests.

http://www.babycentre.co.uk/referencedarti.../downssyndrome/

Babycentre.co.uk is a very useful site and answered practically all the questions I had during my pregnancy.

If you do go for amniocentesis be prepared to put to put your feet up for 2 days afterwards. This is required to reduce the risk.

4 1/2 weeks to go... Man, I did not realise that something so small actually needs sooooo much crap. Unbelievable...

Wait until the babe is there. Then you will be saying, "Man, I did not realise that something so small actually craps sooooo much. Unbelievable..."

Kimf, where are you getting the information that an amniocentesis is recommended for any mother over 35? I know that insurance will pay for it, but that's slightly different from recommending it.

Hi!

I'm new to the forum, and still in the UK, but I am 14 weeks preg and my husband has just had his transfer to Germany confirmed, so we will be moving to Munich before the baby is born ... wanted to say hello,as we are at almost the same point in our pregnancies!

On the Downs test - in the UK we are offered a non invasive test for Downs at between 12 and 14 weeks - this is the ultrasound scan plus blood tests... this gives you a percentage risk ( 1 in 12000 in my case!) if it comes back as higher than 1 in 250 you are offered the option of amnio... obviously the non invasive tests carry no risk, I have heard a 1 in 100 risk of miscarriage with amnio, but am not sure if that's correct, it's just second hand information. I have 2 friends who had their first babies at age 37, and neither were advised to have amnio as their non invasive test results showed low risk... Just to let you know how things work here, for comparison!

Would love to hear how antenatal care works in Germany - I have an 18 month old daughter so know the procedure in the UK, but I believe it's all different in Germany - here you really only ever see a community midwife for antenatal care, unless you're labelled "high risk" - my husband (who is German by birth) has a vague idea there are no such things as community midwives in Germany and everything is done through your family doctor or maybe hospital or clinic, but we really have no idea as none of his old friends have children and of course his mum's experience is very out of date! Can anyone let me know how the basics will work for when we move? Who have you seen so far - family doctor first and then a referral to an obstetrician, or how does it work?

Would love to meet up too once we've moved to GErmany - may be several months as my husband will move first and I will stay behind in the UK to (hopefully) sell the house, but I would love to be in touch with another pregnant mum in the Munich area! I am a little concerned about losing my current network of "mum friends" and it would be great to know there are other expats in my position, as my German needs a lot of work at the moment!

Good luck with your pregnancy, hope you're not feeling too sick!

Hilary

Hello all! I'm 7 weeks pregnant, and had my first pre-natal exam yesterday (everything went well).

I have public insurance, and as a result, the doc gave me a list of proceedures that are NOT covered by public healthcare. You have the option to take the tests, but you must pay. Here they are:

NOT COVERED BY PUBLIC HEALTHCARE:

• Gestational Diabetes test in the 25th week: € 25
• Toxoplasmosis test, up to three during pregnancy: ~ € 38 - 61 (per test)
• Chicken Pox, "Zytomegalie, Parvo B Titer" (checking resistance?): € 31 (per test)
• ß-Streptokokken smear as of the 35th week: € 27
• "NT-Nackenfaltemessung" (Down's Test and Heart malformations, see above post) in the 12-14th week: € 130
• Any extra Ultrasounds, with pictures (only 3 ultrasounds are covered by public) : € 25 each (or € 100 for 5)

You ARE covered for 3 ultrasounds, blood work, and other basic services.

"Prenatal Screening Tests
Ask your provider about prenatal screening tests for the baby. For instance, amniocentesis is often recommended for pregnant women 35 or older."
http://www.marchofdimes.com/pnhec/173_812.asp

You can find information on this on many sites about pregnancy.

But what I really wanted to say is that it would only be recommended once you've had a non-invasive first-trimestre screening which showed you were in the high-risk category.
Then, an amniocentesis would be highly recommended. Or if you had a family history of down-syndrome of course.

I am no doctor but I did do a lot of reading during my pregnancy last year.

Ok, that makes more sense, testing if you are high-risk.

Some of these other things will also be covered if your doctor feels you are at risk -- my gestational diabetes test was covered by public insurance as there is diabetes in my family and my doctor felt that put me at a higher risk... also in my experience they will do more ultrasounds if they feel something should be checked...

I agree with Zard, I think many doctors don't charge if they feel there is a good reason to do the test. I am publicly insured but had the Nackenfaltemessung free of charge and lost count of the Ultrasounds that I had but I was an older mum, pregnant with twins.

Although not directly related to the topic, I'll add the following:

In Munich, in addition to Folic acid supplements, pregnant women should also take Iodine supplements ( "Jod" auf Deutsch ). This is on the advice of my doctor, who says that a Jod supplement is important, because it is not added to the tap water here, as is the case in some other countries.

I bought a 60-pack of "Taxofit" of 150 mmg Jod supplements for 3,75 euros at DM.

As per Wikipedia:

Hi!

I am new to the forum, my husband and I just moved to Munich and I am 30 weeks pregnant. I have not yet decided whether to have my baby here or at my old clinic back home (Italy), so I am trying to do some scouting on local structure and support. Unfortunately I do not speak any german. Does anyone know if there are pre-natal courses in english?

As per the amniocentesis, I had mine done back in Milan, it appears as a standard routine for women over 35 but there are other tests (villocentesis, tri-test, etc). Amniocentesisi seemes to be the more reliable in terms of results. There are risks, but statistics are more frightening that they should be. A ggod practitioner might never have had an amniocentesis with complication. It also helps to be extra careful in the next few days.

In Italy it was very expensive, and normally carried out around the 15/16Th week. Resulta are usually out in a couple of weeks.

Maria

Hi YCM,

The topic of prenatal courses in English was already discussed on Toytown, search for Ester Hölzemann in google, or see this post:
Birthing classes in Munich and taught in English
I am starting a course in German next week, but if you need other pregnancy info feel free to contact me personally, I live in the same part of town as you.