20-week ultrasound

Every woman has the opportunity to have an extensive ultrasound around week 20 of the pregnancy. It is a complete check for physical abnormalities with the baby. The size of the baby is also measured.
If you choose to do this test, the ultrasound will be reimbursed by the basic package of the health insurance company. 

The idea behind this ultrasound is that it gives the parents a choice. If a (serious) defect is found, the pregnancy may be terminated until week 24 of the pregnancy. With certain defects it may be beneficial to know that the child has need of a particular treatment or care. The disadvantage of this ultrasounds is that frequently something abnormal is found that, in retrospect, was not an indication of a defect. Or that something abnormal is found that doctors cannot give any information on because they cannot determine what precisely has been found so nothing can be clarified. Such an outcome can cause (mostly temporarily) stress and doubt to the parents. This can “ruin” the remainder of the pregnancy which can be very stressful. Especially if it turns out be nothing to worry about. 

To choose: 

The goal of the NIPT is to detect chromosomal abnormalities. Such deviations cannot be cured. For example, if a child is diagnosed with Down’s syndrome, the parents to be must make a choice. They can accept the fact that they will have a child with this disorder or they can choose to terminate the pregnancy. The question that parents to be must ask themselves is what they would do with the result of a test. How important do they feel it is to have a choice? Or, how important do they feel it is to not have to make that choice? 

All pregnant women have the choice to be tested or not. On the RIVM (Rijksinstituut voor Volksgezondheid en Milieu) website there is a decision support ‘bewust kiezen’ (choose consciously) to help.

From the previous one can gather that there are different sides to prenatal screening. The balance of pros and cons will be different for each person. A lot of pregnant women want to hear that all is and will be well with their child. It is important to realize that the health of a child can never be guaranteed even if all screening has been done.
Furthermore it is important to consider how the likelihood of having a child with chromosomal abnormalities really is. When thinking about deviations it is easy to forget that the vast majority of children are born completely healthy. The limit for a test result is with a chance of 1 in 200. You can roughly state that for women that are younger than 36 years the chance will be below that 1 in 200; less than a half percent. When reaching 36 years of age that chance is about 1 in 200 and increases with age to about 1 in 100 when one reaches 40 years of age; about 1 percent.

Questions a pregnant woman can ask herself and her partner (if she has one) are:

– How do I feel about a child with a chromosomal abnormality in my family?

– What do I  think about the risk of having a miscarriage when she would choose to do chorionic villus sampling or a amniotic fluid test.

– Would I terminate the pregnancy if I found out my baby had a defect?

– What do I feel constitutes an increased chance and what chance is acceptable to me? 

That the answers to those questions are different for everyone is obvious. That is the reason it is not possible to give advice in these matters. Each pregnant woman must, together with her partner, make decisions in these matters because she must live with those decisions and the consequences of them.  

If there are defects or diseases to be found in your family or if you have a defect or a disease yourself and you think your child can get this too please try to inform yourself about this (preferably before a pregnancy) as soon as possible. You can call us for information or you can call the ERFO telephone number of the VSOP (Joined parents and patients organizations for hereditary or congenital defects) at 035 6034040.

Age of the mother at the time of the test        Chance of having a child with Down’s syndrome

20-25 years of age                                                11 to 13 out of 10,000

26-30 years of age                                                14 to 19 out of 10,000

31-35 years of age                                                20 to 45 out of 10,000

36-40 years of age                                                60 to 155 out of 10,000

41-45 years of age                                                200 to 615 out of 10,000

Additional information:

decision support: choose consciously
NIPT: 2 studies

Echo Amsterdam: laboratory for NIPT
heredity (Dutch)
Further testing: chorionic villus sampling, amniotic fluid test, NIPT 
hoeverder.info: If an abnormality is found you will find independent information here about whether or not to continue with a wanted pregnancy