Your doctor will perform three ultrasound examinations as part of your preventive check-up. The dates fall between the 8th and 12th weeks of pregnancy, the 18th and 22nd weeks of pregnancy and between the 28th and 32nd weeks of pregnancy. During an ultrasound scan, also called a sonography, you can see images of the fetus on a screen. This experience can be a happy one and may strengthen your bond to the baby. The examinations are important from a medical point of view. Your doctor sees exactly how your pregnancy is developing and can act if something is wrong.
What happens during an ultrasound?
Sonography is painless and safe for you and the fetus. For the examination, your abdomen is coated with a special gel and a transducer is passed over your abdominal wall. This transducer emits a sound too high for your ears to hear. The computer can then calculate an image using the time interval between the sound and its echo. This allows you to see the baby in your belly for the first time. An exam conducted through the abdominal wall is done with what is known as ‘abdominal ultrasonography’. An examination in which the transducer is inserted into the vagina is vaginal ultrasonography. This method is used mainly in the early stages of pregnancy. It provides more accurate images of the embryo, which is still very small at this time.
The first ultrasound takes place between the 9th and 12th weeks of pregnancy (8+0 to 11+6)
During the first ultrasound examination, your doctor will confirm the pregnancy. The heartbeat and shape of the {embryo} can be seen. With the help of the ultrasound scanner, the length of the embryo can also be determined. The distance between the coccyx and the top of the embryo's head is measured. Your doctor will be able to estimate the real age of the embryo. It is possible that the due date in your maternity record (Mutterpass) will have to be updated again. The first ultrasound scan can also tell you if there is only one baby on the way or if you are expecting twins or more multiples.
The second ultrasound examination takes place between the 19th and 22nd weeks of pregnancy (18+0 to 21+6)
At this appointment you will have the choice between a basic ultrasound examination and an extended examination. Your health insurance should cover the cost in either case. During a basic ultrasound exam, your doctor will measure the size of the fetus's head, the circumference of its abdomen, and the length of its femur. The amount of amniotic fluid, the position and structure of the placenta, and the fetal heartbeat are also checked. Additional measurements are taken during an extended basic ultrasound examination. These include, for example, the fetus’s cerebellum, the ventricles of the brain and the ventricles of the heart. The examiners will also determine whether the fetus's abdominal wall and spine are closed. This kind of examination, which looks at the fetus’s organs, is also called obstetric ultrasonography in English. Your doctor must give you a written explanation before this extended ultrasound. That means you will get a description of how the examination works and what the procedure can and cannot determine in terms of its informative value compared to the extended basic ultrasound. If you don't understand something or have questions, speak up right away. Afterwards, your doctor will ask you whether you would like a basic ultrasound or the extended version.
The third ultrasound examination falls between the 29th and 32nd weeks of pregnancy (28+0 to 31+6)
It's only two months before delivery. Doctors therefore not only check whether the baby is developing according to its age. With the help of the ultrasound, they can also determine the baby’s position. This is important for assessing possible birth risks in good time. During this check-up the amount of amniotic fluid and the condition of the placenta are checked again.
Additional ultrasound examinations
Your health insurance only covers the costs of additional ultrasound examinations if there is an important reason, for example if there might be something wrong with the fetus. This could be the case, for example, if there is uterine bleeding, a suspicion that the fetus may have a defect or be in an unfavourable position after the 36th week of pregnancy. All abnormalities that may be cause for further testing are listed in the maternity guidelines (Mutterschaftsrichtlinien) in Appendices 1b, 1c, and 1d of the maternity guidelines. There are also special kinds of ultrasounds that are used in special medical cases. These include Doppler ultrasound and 3D ultrasound. These additional examinations are entered on pages 12 and 14 of your maternity record (Mutterpass).
Limits of ultrasound examinations
Most ultrasound examinations show a healthy baby and nothing to worry about. In cases where diseases or changes become visible, ultrasounds help to take important medical measures at an early stage. That is why this kind of examination is part of preventive care.
In principle, however, an ultrasound cannot detect all defects. They cannot detect genetic disorders, metabolic diseases or diseases that do not cause physical changes. Also, if the fetus is in an awkward position or if you have a particularly thick abdominal wall, the validity of the examination may be limited.
Abbreviations on pages 10 and 11 in the maternity record (Mutterpass)
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FS: Amniotic sac diameter
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SSL (crown-rump length): the length of the fetus from the head to the end of the rump
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BPD (Biparietal Diameter): the diameter of the head measured transversely
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FOD (fronto-occipital diameter): the longitudinal diameter of the head
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KU: head circumference
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ATD (abdominal transverse diameter): dimension of the abdomen from one side to the other
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APD (Anterior-Posterior Diameter): front-to-back measurement of the abdomen
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AU (abdominal circumference): girth of the abdomen
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FL (femur length): length of the thigh bone