Ultrasound scans in pregnancy
Many pregnant women and their partners look forward to ultrasound scans. But getting that all-important first picture of your child is, of course, not the reason why pregnant women in Germany are offered ultrasound scans. Instead, the aim is to make sure that the pregnancy is progressing normally and the child is developing well.
In Germany, pregnant women with statutory health insurance are usually offered three standard ultrasound scans at no extra cost. They are sometimes also referred to as screening examinations.
The main purpose of these three standard ultrasound scans is to determine whether the pregnancy and the child's development are progressing normally. Generally speaking, 96 to 98 out of 100 pregnant women give birth to a healthy child. But the ultrasound sometimes detects abnormalities that lead to further examinations – and maybe some difficult decisions as well.
Doctors are required to discuss the advantages and disadvantages of ultrasounds before carrying them out. Germany's Federal Joint Committee (G-BA) has published a detailed information booklet as a guide. Every pregnant woman has the right not to have one or all of the ultrasound scans without giving a reason. Deciding not to have a scan doesn’t affect your insurance coverage.
It’s best to talk with your doctor before the scan to discuss whether you want to see the ultrasound images and which results you want to know. If you don’t want to know the sex of your child or other things they might see, it’s important to make that clear beforehand.
Which ultrasound scans are offered during pregnancy?
In Germany, women with statutory insurance who are not considered to have a high-risk pregnancy are offered three standard ultrasound scans. These scans provide basic information about the progression of the pregnancy and the child's development.
During the scan, the gynecologist checks the location of the placenta and the amount of amniotic fluid. The child's size is measured and plotted on a graph in your maternity records. The results of the scan can help to prepare for the birth of the child.
If an ultrasound scan finds abnormalities or delivers unclear results, further examinations can be carried out to clarify them.
9th to 12th week of pregnancy: 1st ultrasound scan
The first ultrasound serves mainly to confirm that you are pregnant. The doctor checks to see if the fertilized egg cell has lodged in the womb and developed into an embryo or fetus. The term embryo is used in the early stages of pregnancy, the term fetus after the 10th week.
The length of the baby and the diameter of the embryo’s head can already be measured during the first ultrasound. The results help to estimate how far pregnant you are and when the baby is expected. The doctor also listens for a heartbeat and checks for a multiple pregnancy.
19th to 22nd week of pregnancy: 2nd ultrasound scan
Pregnant women have two choices for the second ultrasound:
- Standard ultrasound examination
- Extensive ultrasound examination
During the basic ultrasound scan, the child's head, belly and thigh bone are measured. The position of the placenta in the womb is also determined. If the placenta is too low, special measures might have to be taken during the rest of the pregnancy and childbirth.
The extensive ultrasound examines the following body parts more closely:
- Head: Are the head and the cerebral ventricles (brain cavities) the right shape? Is the cerebellum visible?
- Neck and back: Have they developed normally?
- Chest: Are the heart and ribcage in proportion? Is the heart visible on the left-hand side? Is the heart beating rhythmically? Can the four chambers of the heart be identified?
- Torso: Is the front abdominal wall closed? Are the stomach and bladder visible?
The extensive ultrasound may only be performed by gynecologists with a special qualification.
29th to 32nd week of pregnancy: 3rd ultrasound scan
During the third ultrasound scan, the baby's head, belly and thigh bone are measured again. The baby's position and heartbeat are also checked.
What is not included in standard ultrasound?
If there are particular medical reasons, statutory health insurance will also cover additional ultrasound scans. Standard ultrasound does not include an ultrasound scan of the organs by specialist gynecologists. That can be a good idea if a pregnancy is considered higher risk or if other scans produced unclear results.
You can ask to have this kind of scan without a medical recommendation. In that case it counts as an individual health care service (in German: Individuelle Gesundheitsleistung, or IGeL for short), which you have to pay for yourself. All other ultrasound scans for which there is no specific medical reason also have to be paid for out of pocket.
Scans that look specially for signs of congenital abnormalities are subject to the German Genetic Diagnostics Act. One example is the nuchal translucency scan that uses ultrasound to look for signs of Down syndrome. Before carrying out these kinds of scans, doctors are required to provide special information and genetic advice. This not only means clarifying medical questions, but also any psychological and social concerns that may be relevant to the scan and the results.
Abnormalities of a genetic nature can also be detected during a standard ultrasound scan. Special support is then also offered.
How reliable are the results of a standard ultrasound scan?
Standard ultrasound scans can detect some developmental disorders in children straight away, while they can only find less conclusive signs of some other health problems or anomalies. There are some problems and developmental disorders than cannot be identified at all by ultrasound.
As with all examinations, ultrasound scans can produce false results. Two types of errors are possible:
- The ultrasound finds signs of developmental disorders even though the child is developing normally.
- The ultrasound results are normal even though the unborn child does have health problems or anomalies.
It is not possible to say exactly how often ultrasound scans in Germany deliver false results. The frequency of errors depends on factors such as how much amniotic fluid is in the amniotic sac, the child's position and how thick the mother’s abdominal wall is. The quality of the ultrasound device and the operator's expertise can also influence the result. According to international statistics, about 1 out of 100 pregnant women can expect to receive a false result.
Can an ultrasound scan be harmful?
The sounds waves used in standard ultrasound scans are not known to be harmful to either mother or child. But ultrasound can be harmful if it finds unclear results or abnormalities. This can make people feel anxious and worried and may also mean that more examinations are needed. These additional examinations can be intensive and sometimes have serious effects that are difficult for the parents-to-be to cope with.
But the ultrasound scan can also give the impression that the unborn child is developing normally even though it does have health problems. The expectant parents falsely assume that their child is healthy. It can then be quite a shock if their child is born fully unexpectedly with serious health problems or anomalies.
Furthermore, not all scan results are clear and not all problems that are identified during an ultrasound examination can be treated. This can be unsettling, difficult to deal with and call for tough decisions to be made. If there are signs that the unborn child might be physically or mentally disabled, the question of whether to abort or continue the pregnancy might arise. This can lead to inner conflict. Some women say later that they wouldn't have had the scan if they had thought about the potential consequences beforehand.
Is it possible to opt out of having an ultrasound scan?
Every woman has the right to opt out of having any of the ultrasound scans. Perhaps you only want to know if your child is developing at a normal rate, but not if there are any anomalies. Or you decide against ultrasound scans completely because you do not want to be confronted with the associated uncertainties and potentially difficult decisions. Deciding to continue your pregnancy in any case, regardless of how your child is developing, can also be a reason not to have ultrasound scans.
But opting out of ultrasound scans or not wanting particular information can have disadvantages. It could mean that abnormalities in the unborn child remain undetected and untreated, even though treatment may have been possible in the womb. Possible risks for the mother, like the placenta being too low, may go unnoticed. Some scan results can also provide reasons for going to a specialist clinic or practice for the remainder of the pregnancy and for childbirth.
Where can I find more information?
Maternity support centers are on hand to help you with any questions you might have about pregnancy and giving birth. Your right to support also includes pregnancy-related check-ups. This support is usually free of charge.
Many other advice centers can provide help with questions about pregnancy and childbirth. You can find their locations and more information (in German) on the website run by Germany’s Federal Centre for Health Education (BZgA) at www.familienplanung.de/schwangerschaft.
Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Information, consent and medical counselling on ultrasound screening in pregnancy: Final report; Commission P08-01. August 16, 2012 (IQWiG reports; Volume 139).
Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Ultrasound screening in pregnancy - test quality with regard to the detection rates of foetal abnormalities: Final report; Commission S05-03. April 21, 2008 (IQWiG reports; Volume 31).
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