For every pregnant woman, whatever their age, it is possible to have combined screening or an ultrasound screening done.
The cost of these tests will be reimbursed by your health insurance if you are 36 years or older at a pregnancy of 18 weeks. If you are not yet 36 years old, your health insurance will not cover these costs and you will have to pay for the tests yourself.
If you are 36 years or older in the 18th week of pregnancy you can choose to have  invasive prenatal testing. That is a Chorionic Villus Sampling (CVS) or an Amniocentesis.  These tests are done to determine if there are any chromosomal abnormalities in the fetus.

Combined screening:
With this test we can see if there is an increased chance of having a child with Down syndrome.

What is Down syndrome:
Down syndrome is caused by a chromosomal abnormality. People with Down syndrome have an extra chromosome number 21, that causes a mental handicap. The child also has a greater chance to have physical problems. The syndrome is incurable.
Finding health problems at an early stage and good teatment increase the chance on better health and a longer life expectancy.

How great is the chance to have a child with Down syndrome:
The chance of having a child with Down syndrome increases with the age of the pregnant woman.

The test:
The combined screening consists of two tests, both of which are safe for the pregnant woman and the unborn child.
Your age and the duration of your pregnancy are combined in 2 tests:

1. Nuchal translucency screening (NT test)
   The NT test uses ultrasound to measure the clear (translucent) space in the tissue at the back of the baby’s neck between the 11th and the 14th weeks of pregnancy.
2. Maternal Blood Screening
   Between the 9th and the 13th week of pregnancy the mother’s blood is tested for 2 proteins –PAPP-a and free B-HCG.

The results:
The results of  the screening of the two proteins and the NT screening, combined with the age of the pregnant woman result in a number. This number indicates if there is a high or low risk. The chance is called increased if it is greater than 1 in 200. An increased chance is different to a great chance! Even with an increased risk the chance that a healthy baby is born is many times greater than the chance to get a child with an abnormality.
For example: With a chance of 1 in 100, 99 women are NOT pregnant of a child with Down syndrome and 1 is. This means that a large part of the women with a abnormal test result will get a child WITHOUT Down syndrome.

An abnormal result – What next?
If the result of the combined screening indicates that there is an increased chance of getting a child with Down syndrome, then a Corionic Villus Sampling or an Amniosyntesis can determine with a 100% certainty if it is definitely a case of Down syndrome in the unborn child.

Corionic Villus Sampling:
In this test some of the chrionic villi(tiny finger-like units that make up the placenta) is removed via the vagina of through the abdominal wall and tested for chromosomal abnormalities. The test can be done from the 11th week of pregnancy on. When doing this test there is a small risk of miscarriage of 0.5-1%. The results will be available after 7-10 days.

Amniosyntesis:
This test is performed by inserting a needle through the abdominal wall into the uterus to remove some amniotic fluid to test for chromosomal abnormalities. The test can be done from the 15th week of pregnancy on. There is a small risk of miscarriage of 0.5%. The results will be available after about 3 weeks.

Whether or not to do the corionic villus sampling or the amniosyntesis is entirely a matter for the pregnant woman and her partner to decide. If there turns out to be an abnormal result this presents the parents-to-be with a very difficult choice: whether or not to continue the pregnancy.

Sometimes the parents-to-be know beforehand dat they want to continue the pregnancy whatever the results. They use the knowledge of the results to prepare for a child that will need extra care.

Whatever you decide, it is very important to be well-informed about prenatal screening and the consequences of the results. During the first check-up we will tell you more about this and of course you can ask any questions you may have.

Ultrasound screening:
An ultrasound scan is usually performed at 18-20 weeks to look at the baby’s anatomy to identify a variety of abnormalities that might affect the remainder of the pregnancy or delivery. We look at the brains, skull, face, vertebrae, heart, stomach, intestines, kidneys, bladder and limbs of the child. It is also to make sure that the amount of amniotic fluid is adequate, to indicate the position of the placenta and to determine the size of the child.
The ultrasound at 20 weeks is performed by passing a wand-like instrument called a transducer back and forth over your abdomen.

Cost:
The cost will be covered by the insurance.