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Tests and checks

Antenatal care in Belgium is very thorough with a range of checks and tests offered throughout your pregnancy. 

Informed consent 

Under the Belgian Law of 22 August 2002 on Patients' Rights, midwives and physicians must have your free and informed consent before beginning any intervention or procedure. They should therefore be explaining the purpose and urgency of any intervention or procedure, what is involved, as well as any potential risks or side-effects.

Early ultrasound

Below you can find out more about:

Note: on this page you will find links to external sites (e.g. www.babycentre.co.uk, NHS choices) that give you more information about various topics. These are generally UK sites that may not always reflect practices in Belgium. If you have any questions about any of the tests or checks that are offered to you in Belgium, ask your care provider. 

 


Confirming the pregnancy

Once you suspect that you are pregnant, you might like to visit your family doctor or independent midwife who can organise a blood test to confirm the pregnancy and to check hormone levels such as human chorionic gondatrophin (hCG).  

Many women then go on to see a gynaecologist / obstetrician between 6 – 8 weeks pregnant (so from around 15 days after a missed period), who may suggest an initial ultrasound scan to:  

    • confirm the pregnancy and see if there is more than one embryo;
    • to date the pregnancy, i.e. give an estimated due date; and
    • to rule out an ectopic pregnancy (where the embryo has implanted outside the uterus).  

At this early scan it is often – though not always – possible to see/hear the baby’s heartbeat. 

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Regular checks by your care provider

Your care provider (typically your gynaecologist or midwife) usually sees you once a month for the first 28 weeks of pregnancy, every fortnight until 36 weeks, and then every week until the birth.

He/she can carry out or organise all the tests and checks during your pregnancy. At your regular check-ups, your care provider will typically be checking:

    • your blood pressure
    • your weight
    • your baby's heartbeat (either with a doppler alone or by doing an ultrasound scan)
    • your fundal height (i.e. measuring the size of your uterus to assess how your baby is growing)

He/she may also suggest regular blood tests - you may have to go to a separate laboratory to have the blood test, but your care provider will give you the prescription.  If you see a gynaecologist and he/she has the necessary equipment and training, your gynaecologist may perform all your ultrasounds - if not, he/she will provide you with the necessary paperwork to have the three 'official' ultrasounds done by a sonographer. 

With your agreement, vaginal exams are also common during check-ups, especially as the pregnancy progresses. 

While in theory check-ups are also a chance for you to ask any questions you may have about the birth of your baby, time pressure during appointments may make this difficult. In this case, you may like to consider attending antenatal/birth preparation classes where you will have a chance to discuss labour and birth in a group setting with a qualified childbirth educator/antenatal teacher.

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Blood tests

During your pregnancy your care provider may suggest regular blood tests. Some of the things that are checked in Belgium are:

    • your blood group and whether you are rhesus positive or negative - your care provider will check this once early in your pregnancy. Read more about the importance of knowing if you are rhesus positive or negative

    • iron levels - often checked at the beginning of pregnancy, and again at the beginning of the third trimester. Read more about anaemia in pregnancy

    • immunity to toxoplasmosis - if you do not have immunity to toxoplasmosis (an infection caused by a parasite that can cause serious problems for an unborn baby, and may lead to miscarriage or stillbirth) your care provider may suggest monthly testing. Read more about toxoplasmosis in pregnancy

    • immunity to cytomegalovirus (CMV) - if you do not have immunity to CMV (a herpes-like virus that can cause serious problems for an unborn baby) your care provider may suggest monthly testing. Read more about cytomegalovirus in pregnancy

Note: care providers often only contact you about blood test results if there is a reason for concern. No news is usually good news.

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Ultrasounds

Most women have a minimum of three utrasounds during pregnancy - and only three are officially reimbursed by your 'mutuelle' / 'ziekenfonds'. Many gynaecologists have ultrasound equipment in their practices, and may suggest many more than the three main scans.

If you are being looked after by an independent midwife, she will give you the necessary paperwork to arrange your scans with a sonographer. 

 

When are they and what is checked?

An early ultrasound is sometimes carried out around 6-8 weeks to confirm the pregnancy and see if there is more than one embryo, to date the pregnancy, i.e. give an estimated due date and to rule out an ectopic pregnancy (where the embryo has implanted outside the uterus). This early ultrasound is usually done with a vaginal probe (rather than through the abdomen) as this provides a better image of your baby at this stage.

The main ultrasounds are then usually carried out around:

11 - 14 weeks                                         It is at this scan that the fluid under the skin at the back of your baby's neck is measured, as this can indicate a risk of chromosomal abnormalities
20 - 22 weeks In Belgium this is known as the 'morphological' scan (sometimes called 'anomaly' scan in the UK), and is a detailed scan of your baby, checking all the organs and taking measurements.

The sonographer/your gynaecologist will also check how your placenta and umbilical cord is functioning, and may suggest a vaginal scan to look at the length of the cervix as a screening test for premature labour. 

It is usually possible to tell whether you are expecting a boy or girl at this scan. 

Read more about the 20 week scan.
32 - 34 weeks In Belgium it is quite common to have a 'growth scan' around 32 weeks. This scan checks that your baby is growing as expected and can check your baby's position (e.g. head down, breech) and the position of your placenta.

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Screening for chromosomal abnormalities

Irrespective of your age, you will be offered screening to evaluate the risk of your baby having Down's Syndrome (trisomy 21) and other chromosomal abnormalities.

For more information about the difference between screening and diagnostic tests, and support for parents who are concerned about test results, see the website of the UK charity Antenatal Results and Choice (ARC).


Tests covered by basic health insurance in Belgium

The most common test is the 'combined test'. This is performed between 11 and 14 weeks and consists of:

    • a nuchal translucency (NT) scan, which measures the fluid under the skin at the back of your baby's neck. 

    • a blood test that checks the levels of human chorionic gonadotrophin (hCG) and pregnancy-associated plasma protein A (PAPP-A).

If the combined test could not be performed between 11 and 14 weeks, a 'triple test' can be performed between 14 and 20 weeks. This blood test checks the levels of human chorionic gonadotrophin (hCG), alpha fetoprotein (AFP) and estriol (uE3).

The results of the combined test or triple test are combined with the mother's age to give a risk ratio. A ratio of less than 1/250 is considered 'positive'.


Tests not covered by basic health insurance

The Harmony prenatal test is a Non-Invasive Prenatal Test (NIPT) that "allows in nearly 100% of cases to detect trisomy 21 and to a lesser extent trisomy 18 and 13, without taking any risk of miscarriage such as following amniocentesis or CVS" (see http://www.fmfb.be/en/NIPT.html for more details). It can be performed as of 10 weeks of pregnancy. It is not reimbursed by the mutuelle and currently costs between €450 - €600.


What if my screening test is positive?

Remember that this is a screening test, not a diagnosis. An increased risk does not mean your baby is affected. However, your gynaecologist or independent midwife will discuss with you the possibility of having a diagnostic test which can confirm whether or not your baby is affected.

For more information about the difference between screening and diagnostic tests, and support for parents who are concerned about test results, see the website of the UK charity Antenatal Results and Choice (ARC).

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Diagnostic tests

If your screening test gave a positive result, or if there is a fear that your unborn baby may be affected by an infection such as toxoplasmosis, your care provider will discuss with you the possibility of having a diagnostic test. The tests that are currently available in Belgium are:

    • chorionic villus sampling (CVS) - this involves taking chorionic villi cells from the placenta, and can be done by inserting either:

      -  a fine needle through the mother's abdomen; or
      -  a fine tube through the vagina.

      The cells are then analysed for abnormalities, infection etc. CVS can be carried out between weeks 10 to 13 and carries a small risk of miscarriage. CVS is partially reimbursed by your mutuelle. Read more about chorionic villus sampling (CVS)  
    • amniocentesis - this involves taking a sample of fluid from the amniotic sac surrounding your baby using a fine needle that is passed through the mother's abdomen. The fluid is then analysed for abnormalities, infection etc.

      It can be carried out between weeks 15 to 20 and carries a small risk of miscarriage. Amniocentesis is partially reimbursed by your mutuelle. Read more about amniocentesis

Your care provider should be able to answer any questions you may have about these tests.


What if tests show my baby is impacted?

Your own doctor, or specialist counsellors, will be able to explain to you the full details of any results found, and will be able to advise you on the options open to you.

The UK charity Antenatal Results and Choice (ARC) offers information and support to parents who are concerned about test results.

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Gestational diabetes

Towards the end of the second trimester (typically between 24 and 28 weeks) your care provider will probably suggest that you be tested for gestational diabetes. This is a kind of diabetes that begins during pregnancy (and usually disappears after the birth), which in some cases can cause your unborn baby to become very large, or to have issues with hypoglycaemia or jaundice after birth.

The test is called an oral glucose tolerance test (OGTT), and it shows how your body manages its glucose levels. It is usually carried out in hospital or at a laboratory, and you usually have to fast (i.e. not eat anything) from the night before. On the day of the test:

    • a first blood sample will be taken to establish a baseline for the amount of sugar in your blood

    • you will then be asked to drink a sugary drink (it is important to drink the whole amount) and advised to rest until the next blood test

    • further blood samples will be taken at one hour and two hours afterwards

Your care provider should have the results of your test within a few days. Unless the results are concerning, your care provider may not contact you. Read more about gestational diabetes and the oral glucose tolerance test.

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Group B streptococcus (GBS)

Towards the end of your pregnancy (typically between 35 and 37 weeks) your care provider will offer to test you for group B streptococcus - this screening is routinely offered to all pregnant women in Belgium. Group B streptococcus (also known as group B strep or GBS) is a bacteria that many people have in their body without even knowing it, and with no symptoms. About 25% of women have the bacteria in their vagina, and it can be passed to the baby during the birth. For some babies who become infected, GBS can be life-threatening.

The test is performed by taking a swab of your vagina and rectum to check for the bacteria.

If the sample shows that the GBS infection is present, you will be advised to have IV antibiotics (i.e. via a needle in your hand/arm) during labour. This may prevent your baby from catching the infection from you. Unfortunately, antibiotics taken before labour will not protect your baby. Read more about group B strep in pregnancy.

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References

Belgian Healthcare Knowledge Centre Guideline relative to low risk birth (in English)

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