Ultrasound examinations: pregnancy

Ultrasound scan confirms pregnancy

At the beginning of a pregnancy, the first of three ultrasound scans will confirm that the embryo has implanted properly in the uterus and that there is no ectopic pregnancy . From the fifth week, a small dot shows that you are pregnant. About a week later you can even see the little heart beating. From the seventh week the embryo can be distinguished from the rest of the tissue. At nine weeks, extremities such as arms and legs are already showing. Finally, at this point in the pregnancy, the first ultrasound screening is scheduled.

1. Ultrasound examination (transvaginal ultrasound)

The first ultrasound examination usually takes place as part of a preventive examination in the 9th to 12th week. If the nuchal translucency measurement is to be carried out at the same time, the first ultrasound takes place a little later, in the 12th to 15th week. The examination is performed vaginally (transvaginal sonography) and is primarily used to determine the gestational age. Because almost all babies develop the same way in the first trimester of pregnancy, the age can be determined exactly during this time. This also enables a very precise determination of the due date.

To derive the gestational age, your doctor measures the embryo and compares the values ​​with distribution curves. With these measurements and your information about your last period, he can determine the expected date of birth and check it regularly. To do this, he measures:

• Crown-rump length (SSL) : Your doctor uses a marker to mark the distance between the highest point of the child’s head (crown) and the outermost end of the rump.
• Biparietal Diameter (BPD) and Head Circumference (KU) : Then he measures the diameter of the head at the level of the child’s temples. In addition to the diameter, the head circumference is also determined.
• Fruit Sac Diameter (FSD) or Chorionic Cavity Diameter (CHD) : Between the 5th and 10th week of pregnancy, the size of the fruit sac can also be measured.

In addition, during the first ultrasound scan of the embryo, your doctor will look for the following:

• Confirmation of cardiac activity
• Review of development and growth
• Recognizing a multiple pregnancy

All of this data will be entered into your maternity card. So you should always carry it with you. If abnormalities are observed during the ultrasound examination or the optional nuchal translucency measurement, your doctor will advise you and discuss with you which further examinations and tests could be recommended. But don’t worry: for most pregnant women, the routine examinations are sufficient.

2. Ultrasound examination

Will it be a girl or a boy? The second ultrasound examination in the 19th to 22nd week of pregnancy can perhaps already answer this question for you. At this point in time, a boy’s penis development is quite advanced. Even with a girl you can already see the clitoris, but not the labia yet. However, misdiagnoses are not uncommon at this point, since the clitoris can still resemble the penis a little on the ultrasound image. Don’t want to know the gender? Then you have to tell your doctor. He will adapt to your wishes.

It is an abdominal ultrasound. Your gynecologist spreads a cold gel over your abdominal wall. The feeling can be uncomfortable, but the procedure is completely painless. Your gynecologist will now stroke your stomach with the transducer. This is called abdominal, concerning the stomach. The gel makes it easier for the sound waves to get inside the body and provide a clearer image. In contrast to transvaginal sonography, larger distances can be seen on the monitor. During the second ultrasound examination, your baby will be literally put through its paces.

Special attention is paid to the following this time:

• Organ diagnostics of the heart, lungs, stomach, bladder and kidneys
• Confirmation of cardiac activity and verification of fetal movement
• Development and growth of your baby : measurement of the circumference of the head and abdomen as well as the length of the thigh bone
• Checking the expected date of birth
• Assessment of the placenta to ensure your baby continues to be well cared for
• Testing of amniotic fluid volume

Abnormal findings in this ultrasound examination can also lead to your doctor recommending further prenatal diagnostic examinations.

3. Ultrasound examination

Your third ultrasound examination is planned for the 29th to 32nd week of pregnancy. This ultrasound is also performed through the abdominal wall. The following is examined:

• Your doctor will examine the development and position of the child.
• He misses the child again to check the expected date of birth.
• He also checks whether all organs, such as the heart, are functional and whether the child is active.
• The amount of amniotic fluid is determined to ensure that your baby is still being properly cared for.
• The placenta is located once more and the structure of the placenta is checked.

If abnormalities are found during the third screening, further ultrasound examinations or further tests may also be necessary after the 36th week.

Midwifery ultrasound examinations

The three ultrasound screenings are the only prenatal care examinations that cannot be performed by a midwife . Women who have opted for preventive care with a midwife must consult a gynecologist. The German Association of Midwives has been criticizing for years that some doctors refuse to only carry out the ultrasound and only accept pregnant women if they take care of all the preventive care with them. They attribute this to the fact that these doctors do not want to share the budget (they are then only allowed to bill for the ultrasound screenings). The Association of Statutory Health Insurance Physicians made it clear, however, that a doctor who refuses to do so is in breach of his contract and thus risks his admission to the statutory health insurance.

Unscheduled ultrasound examinations

In addition to the three ultrasound screenings, additional ultrasound examinations are often carried out. They are medically necessary if the following suspicions exist:

• At the beginning of your pregnancy, an ectopic pregnancy is suspected.
• you have bleeding
• You are expecting multiples .
• You have had an accident or are in pain.
• It is suspected that the fetus is not developing in line with the progress of the pregnancy.
• It is suspected that you have too much or too little amniotic fluid.
• When the placenta shows unfavorable structural features, appears to be detaching, or is in an unfavorable position .
• In the weeks before birth, your baby does not want to turn his head towards the pelvis and is in a so-called breech or transverse position .
• There are other suspicions that could trigger a premature birth .
• You are showing the first signs of a disease (e.g. high blood pressure or gestational diabetes ).

Other optional ultrasound scans

In prenatal diagnostics, there are a few other ultrasound examinations in which ultrasound technology plays a role. However, these examinations are usually optional, which means that you decide together with your doctor whether they should be carried out or not. You can see exactly what the other ultrasound examinations look like in this list:

• Doppler/Duplex Ultrasonography : Performed routinely by many doctors, but definitely done when there are abnormalities with other tests. The blood flow in the arteries and veins is measured. With this ultrasound, vascular calcifications can be detected and the functionality of the child’s organs and the baby’s blood supply can be checked in the womb.
• Organ ultrasound or fine ultrasound : With the help of this ultrasound examination, malformations in your baby’s limbs and organs can be ruled out.
• 3D ultrasound : 3D ultrasound examinations have been particularly popular for a number of years, as they allow a unique view of the baby. However, they are not medically necessary and are therefore not paid for by health insurers.
• Nuchal translucency measurement : With this ultrasound examination, the so-called nuchal translucency, a collection of fluid in the neck of your baby, is measured. This allows indications of chromosomal disorders to be identified. It is not mandatory, but is recommended for many pregnant women.
• Ultrasound for control : Ultrasound is also used for amniocentesis and chorionic villus sampling . Usually it is used to control the history.

Do you feel insecure? Then ask your doctor!

Are you unsure or not feeling well? Then talk to your doctor and ask for an unscheduled check-up. He will certainly be happy to comply with your request. Because the most important thing is that you have trust and confidence and can enjoy your pregnancy in peace.