A first trimester screen is a non-invasive test best performed between the 11^th and 13^th week of pregnancy and involves an early fetal organ analysis and a measurement of the fetal neck fold.

The test allows us to identify babies at increased risk for certain genetic syndromes (like Trisomy 13, 18 and 21). In order to do this, we use the ultrasound measurement of the fetal neck fold as well as two special blood values tested in your (maternal) blood.

The results of this test are reported as a statistical risk, in other words, as the chance that a baby would be affected by a certain complication. In the table below, you can see statistical risk based on maternal age alone. 

Maternal Age. Statistical risk of Pregnancy affected by Down's Syndrome

If the first trimester screen (or the baby’s neck fold measurement) is elevated or abnormal, there may be other causes aside from genetic syndromes. These include:    heart malformations, skeletal malformations, enzyme defects, diaphragmatic or umbilical hernias.

If the results of a first trimester screen are abnormally elevated, generally a recommendation for definitive genetic testing (non-invasive prenatal diagnositc testing i.e., Praena test, or amniocentesis) is made.  Furthermore, a high risk fetal anatomy ultrasound (level 2) at 20-24wks may be recommended.  It is possible, that all of these tests are performed and are normal. The pregnancy continues without complications and the baby is baby is healthy.

It is now possible to isolate or find fragments of fetal DNA (genetic material) which have crossed over the placenta into maternal blood. This enables us to estimate the likelihood of certain chromosomal abnormalities in babies just by drawing maternal blood.

This method is called the „DNA blood test“ or NIPT (non-invasive prenatal test). We use the Praena Test. 

This method is able to determine the presence of Trisomy 21 (Down’s Syndrome) with a much higher certainty than fetal ultrasound. It is also able to test for other chromosomal problems such as trisomy 13 and 18, as well as some sex chromosome abnormalities like monosomy X (Turner’s syndrome) or Klinefelter’s (XXY).

We generally recommend the Praena or NIPT test only in combination with an early fetal anatomy scan, since the blood test alone would not identify structural problems of the fetal organs. If certain structural anomalies are seen, we may recommend a diagnostic amniocentesis (amniotic fluid analysis) whereby a small amount of amniotic fluid from around the baby is obtained with a very thin needle. These diagnostic procedures are also performed in our office.

We perform special fetal anatomy ultrasound scans between the 20-21wk of pregnancy, often upon referral from colleagues or wish of patients for a more detailed anatomy scan. These exams are more detailed than the basic fetal anatomy scan which is required by the German pregnancy care guidelines and require not only special high-resolution ultrasound machines but also experienced and trained physicians.

The detailed fetal anatomy scan can require up to 30 minutes. The accuracy is dependent on the position of the baby as well as the thickness of the maternal abdominal wall.

With the help of ultrasound we can examine many fetal organs and their function with increasing sensitivity, including the fetal heart. Unfortunately, this does not mean we are able to detect all organ malformations, fetal diseases or chromosomal abnormalities. 

A Doppler examination of fetal and maternal vessels is performed by ultrasound and is often recommended if there are abnormalities in fetal growth or amniotic fluid during pregnancy. Also, if there are suspected fetal heart or other organ malformations, a Doppler examination is useful.

If pregnant mothers have been diagnosed with high blood pressure, diabetes, kidney disease or preeclampsia a Doppler examination is important to evaluate the function of the placenta and well-being of the baby. Also, in pregnancies affected by Parvovirus, regular Doppler examinations are important.

Although most pregnancies proceed naturally and without complications, we have years of experience in taking care of high risk pregnancies such as those involving twins, diabetes, high blood pressure, etc. Much of the monitoring and care of these pregnancies can take place in our office, and we work closely with hospitals in and around Wiesbaden when further consultation and in-patient care becomes necessary.

Acupuncture during pregnancy has been shown to be a helpful adjunct therapy, for example, for symptoms like nausea, headache and back pain. It can also help reduce the need for an induction of labor and may reduce the length of labor. Acupuncture for these different indications is offered by the midwife working in our team.

If you are interested in the acupuncture therapy, please contact the office or our midwife, Steffi Brockmann, at the following number: 0151-41448046. The appointments take place on Wednesday afternoons between 3 and 5pm. They last 20-30 minutes and cost 25 EU per session.

In November 2018 Dr. Simone Aßfalg, a physician specialized in genetics, joined our team and is offering genetic counseling in our office. Questions such as, „am I at high risk of being diagnosed with breast cancer?“ or „does my family history increase the risk of disease in my unborn child?“ are best answered by her competent and detailed analysis.

If a planned Cesarean delivery is medically necessary, we are able to perform this delivery ourselves in St. Josefs Hospital in Wiesbaden.