The combined test is used in early pregnancy to find out whether there is an increased chance that your child has Down’s syndrome. The test involves no risk for you or your child.
This test consists of a combination of two tests: 1. a blood test given to you in the period between weeks 9 and 14 of your pregnancy; 2. a measurement of the skin fold in your child’s neck. This is conducted by means of an ultrasound scan, in the period between weeks 11 and 14 of your pregnancy. Do keep in mind that the result is a probability not a certainty.
Whether or not you decide to take this test can be a difficult decision. There are a lot of factors weighing in on this decision: your thoughts and ideas concerning the pregnancy, your lifestyle, your thoughts about possible birth defects and the termination of the pregnancy when this option arises.
This screening is not insured by your basic health insurance. The costs of these tests are about 165 euros. When taking this test and the results indicate increased chances of possible birth defects you are entitled to a follow-up screening or prenatal diagnostic tests (see further below).
When you are twenty weeks pregnant you are entitled to an Anomaly Scan on a regular basis to watch the development of your child's organs. This screening is a reasonably reliable tool when screening for possible physical defects. This ultrasound also checks the child's growth, the placenta and the amount of amniotic fluid. Even though this screening allows the midwife to see a lot, this ultrasound screening does not guarantee a healthy child as some afflictions are undetectable by ultrasound. Even when an affliction or defect has been detected through ultrasound, the severity will only be known once the child is born. The screening takes up about 30 minutes at the Verloskundige Echopraktijk . You are insured for this screening. Whenever medically necessary or because of a high risk pregnancy we will refer you to a gynaecologist for a more advanced ultrasound screening (GUO).
NIPT – Non Invasive Prenatal Testing
As of April 1st 2014 pregnant women with high risk pregnancies can opt for the integrated screening but also choose the NIPT, the Non Invasive Prenatal Test. This test takes the mother's blood and tests it for foetal chromosomes. These foetal chromosomes are run through a chromosome screening. This screening will not be insured unless you have a (medically) known high risk pregnancy. It is not possible to have this test done without a medical reason or when privately paid for. The NIPT can be administered every Monday at the LUMC at any phase/time during the pregnancy. The results come back within two weeks and are 99% reliable.
To test for chromosome abnormalities, neural tube defects and metabolic diseases a needle will be penetrating the abdominal wall to gather amniotic fluid from the womb. This test takes place after the 15th week and the results will be known after three weeks. This test has a 100% accuracy. This test does increase the possibility of a miscarriage by 0,3%.
Chorionic Villus Sampling (CVS) (vlokkentest)
Another way to test for chromosome abnormalities is through a chorionic villus sampling. This test screens the tissue of the placenta. 11 to 14 weeks into the pregnancy you can test the placenta tissue through a cell research to look for chromosome abnormalities. If the test results are inconclusive it will be run again or followed up by an amniocentesis. The results will be known within two weeks. This test can increase the possibility of miscarriage by 0,5%.