Ultrasound scans in 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 record booklet (“Mutterpass”). The results of the scan can help to be better prepared 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.

The main purpose of the first ultrasound scan is to confirm that you are pregnant. The doctor checks to see if the fertilized egg cell has become attached to 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 growing baby and the diameter of their 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 whether there is more than one baby.

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? Have the four chambers of the heart developed?
• Torso: Is the front abdominal wall closed? Are the stomach and bladder visible?

The extensive ultrasound can only be done by gynecologists with a special qualification.

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.

If there are particular medical reasons, statutory health insurers will also cover other ultrasound scans – for instance, a scan of the baby’s organs that is done by gynecologists with special training. That may be recommended if a pregnancy is considered to be higher risk or if other examinations have led to unclear results.

Scans that look especially for signs of genetic disorders are subject to the German Genetic Diagnostics Act. One example is the nuchal translucency scan, which uses ultrasound to look for signs of Down syndrome. Before carrying out these kinds of scans, doctors have to inform you thoroughly and give you genetic counseling. This not only means clarifying medical questions, but also any psychological and social issues that may be relevant to the scan and the results.

Signs of genetic abnormalities can also be detected during a standard ultrasound scan. Special support is offered then, too.

Some developmental disorders can be diagnosed based on standard ultrasound scans alone. When it comes to other medical conditions and defects, these scans can find possible signs of a problem, but further testing is needed to confirm the diagnosis. And some problems and developmental disorders can’t be detected at all by ultrasound.

As with all diagnostic examinations, ultrasound scans can lead to 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 actually have health problems or defects.

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 in the womb, and how thick the mother’s abdominal wall is. The quality of the ultrasound device and the operator's expertise can also influence the results. According to international statistics, about 1 out of 100 pregnant women can expect to receive a false result.

The sounds waves used in standard ultrasound scans are not known to be harmful to either mother or child. But an ultrasound can be harmful if it leads to unclear results or abnormalities. This can make people feel anxious and worried, and may also mean that more examinations are needed. Additional examinations sometimes involve a lot of time or effort, and may have far-reaching consequences 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 there are actually problems. The expectant parents falsely assume that their child is healthy. It can then be quite a shock if their child is born with serious health problems or defects.

What’s more, 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 lead to tough decisions. If there are signs that the unborn child might be physically or mentally disabled, the parents-to-be may have to decide whether to abort or continue the pregnancy. This can be a very hard decision to make. Some women say later that they wouldn't have had the scan if they had thought about the potential consequences beforehand.

Every woman has the right to opt out of having any of the ultrasound scans offered in pregnancy. Perhaps you only want to know if your child is developing at a normal rate, but not if there are any defects. Or you might decide not to have any ultrasound scans at all because you don’t want to face the related uncertainties and potentially difficult decisions. Some women don’t have any ultrasound scans because they know they would continue their pregnancy in any case, regardless of how their child is developing.

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. Potential risks for the mother, like the placenta being too low, may go unnoticed. Sometimes scans discover medical problems that would be best dealt with in a specialist clinic or practice for the rest of the pregnancy and for the birth.

Women in Germany can go to pregnancy advice centers (Schwangerschaftsberatungsstellen) for help with any questions they might have about pregnancy, screening and giving birth. These centers also provide information and advice about pregnancy-related conflicts and abortion. The support is usually free of charge.

The German Federal Centre for Health Education (BZgA) has a search function for local pregnancy advice centers in Germany.