Prenatal check-ups
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The pregnancy test was positive, and now you have an appointment with your gynecologist. The upcoming prenatal check-ups during pregnancy are often accompanied by many questions for women: What exactly is being examined? Can I go to my midwife instead of the doctor? And who actually pays for these examinations? In this article, you will find answers to the most important questions and an overview of what happens during each examination.
What preventive examinations are available?
Gesetzliche Vorsorge:
Every pregnant woman is entitled to medical examinations and medical advice, with the costs covered by statutory health insurance. In Germany, all recommended prenatal examinations are outlined by the Joint Federal Committee of Doctors and Statutory Health Insurance Funds in the so-called . These specify the scope of legally required prenatal examinations and the physician's duty to provide advice and information to expectant parents. If you are employed, you are also entitled to time off from work for the examinations. If you have private insurance, the prenatal care offered during pregnancy may differ from that of statutory health insurance. It is best to inquire directly with your insurance company.
Individuelle Gesundheitsleistungen (IGeL):
In addition to these basic preventive examinations, which are available to every insured person, there are various individual health services, short IGeL. They are performed either for medical reasons, such as a high-risk pregnancy or certain pre-existing conditions, or at the patient's request. If the additional examinations are medically necessary, they are also covered by the health insurance. However, if you choose to have them done at your own request, you will have to cover the costs yourself. An example of an individual health service is testing for specific immune antibodies. This examination is not relevant for every pregnant woman, but it can be useful for women in certain professions, such as in the medical field.
Prenatal diagnostic examinations, which specifically look for indications of possible malformations, chromosomal abnormalities, and hereditary diseases, are also considered individual health services. As part of statutory preventive care, they are only performed if the likelihood of a chromosomal abnormality is increased due to the mother's age, if there is an abnormal medical or family history, or if abnormalities are detected in the child during ultrasound examination. Some prenatal diagnostic procedures are viewed critically due to their invasive techniques and uncertain detection rates, and they carry certain risks. Therefore, your doctor is in any case obliged to inform you in advance about the purpose, scope, and consequences of the examinations, about possible psychological stress caused by the findings, and about these risks of the procedure.
What happens during the legally mandated examinations?
For each woman, approximately ten occur during pregnancy Preventive examinations planned. Regular check-ups provide the opportunity to detect potential risks for you or your child early on and, if necessary, to take appropriate measures. At the beginning of your pregnancy, the prenatal appointments include three Ultrasound examinations monthly from, then biweekly starting from the 32nd week of pregnancy. Some doctors also examine their patients in the first few weeks of pregnancy initially on a biweekly basis. If you are expecting multiples, the development of your babies will be monitored more closely throughout the entire pregnancy. All prenatal check-ups can also be performed by your midwife, only if you want to have ultrasound examinations done, your doctor must do them. A combination of both is also possible, so you can alternate between being examined by your midwife and your doctor. Especially in a high-risk pregnancy, regular examinations with your doctor in addition to ultrasound may be particularly advisable.
If you choose to have the examinations with your doctor, some things will be done. examined during each check-up :
Monitoring of blood pressure and weight
Urinalysis for bacteria, protein, and sugar content
Palpation of the uterus position
Monitoring the position of the child and its heartbeat
Blood tests at regular intervals
The results of all examinations are documented in the document.
All preventive examinations at a glance
1. Vorsorgeuntersuchung (nach dem positiven Schwangerschaftstest):
Confirmation of pregnancy (usually by ultrasound, which is not included in the three ultrasound examinations)
Determine your current week of pregnancy and calculation of the due date (since the exact time of fertilization cannot always be determined precisely, the estimated delivery date may be adjusted later in the pregnancy)
Detailed consultation regarding your overall health, possible pre-existing conditions, and, if applicable, findings from previous pregnancies
Clarification of your vaccination status
Blood sample collection and determination of blood type and Rhesus factor
Antibody test for specific infectious diseases, urine test (test for syphilis infection), hemoglobin determination to detect iron deficiency, and urine examination for chlamydia
Advice on behavior, nutrition and stress during pregnancy, behavior in the workplace, and an opportunity for you to ask questions (information about work-related risks and any potential work bans must be clarified with your employer or a company doctor)
Individual health services:
Blood test for toxoplasmosis, listeriosis, cytomegalovirus, and rubella (viral or bacterial diseases that can cause damage to the child)
Just before the first check-up, you might have some questions about the general process. In the video, our LILLYDOO gynecologist Christian explains exactly what to expect:
2. Vorsorgeuntersuchung (1. Trimester):
First ultrasound examination: If this was not possible during the initial check-up, your doctor will examine whether the embryo has implanted in your uterus. This confirms the pregnancy with certainty. Your doctor can also determine if you are expecting multiples.
Exhibition of your maternity record
3. Vorsorgeuntersuchung (2. Trimester):
Listening to your baby's heartbeat with a Dopton device (ultrasound), possible from the 13th week of pregnancy at the earliest
Individual health services:
Various prenatal examinations such as blood tests to determine the likelihood of different chromosomal abnormalities. Your doctor can provide more detailed information about the options and risks of the different tests.
4. Vorsorgeuntersuchung (2. Trimester):
Regular examinations that take place at all appointments
Individual health services:
Monitoring of placental position by ultrasound
5. Vorsorgeuntersuchung (2. Trimester):
Second ultrasound: The doctor checks whether all organs are correctly formed. Additionally, the position and structure of the placenta are examined, the amount of amniotic fluid is measured, and your baby is assessed. Usually, you can also now find out the biological sex of your child.
Individual health services:
3D/4D Ultrasound*, second Toxoplasmosis and Listeriosis test
6. Vorsorgeuntersuchung (2./3. Trimester):
Regular examinations that take place at all appointments
7. Vorsorgeuntersuchung (3. Trimester):
Oral glucose tolerance test for gestational diabetes: You should not eat or drink anything about an hour before the examination and will be given a glucose solution to drink. An hour later, a blood sample will be taken to measure how well your body processes the sugar.
8. Vorsorgeuntersuchung (3. Trimester):
Third ultrasound to monitor the baby's growth and heart function and the location of the placenta
From the 32nd week of pregnancy, prenatal check-ups will be every two weeks
Paid additional service:
3D/4D Ultrasound*
9. Vorsorgeuntersuchung (3. Trimester):
Blood test for hepatitis B antigen detection (HBsAg): This checks whether you carry the hepatitis B virus and if there is a risk of transmitting it to your baby. In this case, your baby can be immunized immediately after birth.
10. Vorsorgeuntersuchung (3. Trimester):
Regular examinations that take place at all appointments
Individual health services:
B-Streptococcus test (GBS screening, possible from the 35th week of pregnancy): B-Streptococcus bacteria can occur in the vagina or intestines, so your baby can become infected during birth if you carry them. The bacteria are harmless to you, but in newborns, they can cause infections such as meningitis or pneumonia. If the test is positive, you will receive antibiotics during labor to prevent your baby from becoming infected. Although the test is not part of the statutory prenatal checkups, it is recommended.
Ab dem errechneten Geburtstermin:
Every two days check-up with CTG
The statutory preventive examinations offer the opportunity to regularly monitor your own health and that of your baby and to ensure that the pregnancy proceeds without complications. Many expectant mothers also appreciate the chance to discuss questions and concerns with their doctor or midwife during scheduled appointments. On the other hand, the individual health guidelines and the question of which ones you follow and which you do not can quickly lead to uncertainty. In addition to the expert advice of your doctor or midwife, your own intuition also plays an important role in deciding which examinations you consider useful and which you do not.
We hope that your pregnancy proceeds as smoothly as possible and wish you that you can fully enjoy the anticipation of your baby!
*The performance of ultrasound examinations that go beyond the three scheduled examinations and are not medically necessary, as well as examinations with CTG before the estimated due date, are currently classified as individual health services and are legally prohibited from 2021. The reason for this is the unclear effect of sound exposure on cells and tissues and the potential danger of cell changes and damage to the unborn child.