Prenatal Tests, Scans and Screening in Spain

During pregnancy, you will be making lots of decisions, many concerning tests and scans. These are tools designed to provide information and support, not to cause unnecessary stress or anxiety.

Even in a healthy pregnancy, it is considered normal to have lots of check-ups. It can be a bit overwhelming at times, and although offered to everyone, not all tests and scans are valid or useful for everyone. So be critical and ask yourself if you really feel all the tests are fitting for you and your partner, your situation and your life values. Also, I speak of them being offered to you, but sometimes it can feel like you have no choice in the matter. That is a misunderstanding. You can always say no and/or ask for more information.

Throughout this article, I provide simplified explanations of tests and screenings. I've done my utmost best to make it clear and correct, but if you have any more questions, please consult your doctor. This article is purely for informational purposes and by no means personal or medical advice.

7 questions to ask before agreeing to a prenatal test or scan

It's essential to approach each prenatal check-up, examination, or imaging session with a thorough grasp of its objectives, reliability, and potential consequences for both you and your little one. Equally important is discussing these aspects with your partner to ensure you're aligned in your understanding and decisions. If you have any doubts or concerns, don't hesitate to voice them, request further explanations, and make choices that resonate with your personal beliefs and situation. By making well-informed decisions together with your partner, you will feel more confident and autonomous about your pregnancy and birth experience.

Here are 7 questions you can ask yourselves to come to a decision about doing or not doing an exam, test or scan during your pregnancy:

1. Why am I doing this scan, test, or diagnosis? 
2. How accurate is it? 
3. Do I have a high risk for what we're testing? 
4. Is the risk percentage acceptable to me? 
5. Will the information bring stress or comfort? 
6. Is it acceptable not to have this information? 
7. What will I do with the results?

For instance; what will a positive test for Down syndrome mean for you? Will you do more tests? Will you end the pregnancy? Will you prepare differently for birth and postpartum? Will it make no difference? 

Don't hesitate to ask questions and discuss your concerns with your healthcare provider. They should be able to provide personalised advice based on your individual circumstances and help you make informed decisions.

If you have any questions on how to speak to your doctor and what questions to ask, you can always contact me for a 1:1 consult and I will help you out with this.

What tests are done for prenatal screening in Spain?

In Spain, prenatal appointments typically begin as soon as you know you're pregnant. Generally, these appointments occur every four weeks until you reach 32 weeks of pregnancy, after which they increase to every two weeks. However, this schedule can vary depending on your health, your baby's health, and whether you're privately insured or using the public healthcare system. To learn more about what to expect during your prenatal visits in the public system during the first trimester, check out this article.

In this blog post, I will explain the various tests, scans, and screenings you might encounter during your prenatal care. 

Ultrasound Scans - Ecografía 

Ultrasound scans are a common to monitor your baby's development throughout pregnancy. Let's explore the different types of scans you might be offered. In Spain, it depends on the type of insurance how many tests and scans are covered. For the standard care in the Andalusian healthcare system, check this article. Depending on whether you are privately insured or in the public healthcare system, you will get more or fewer scans. These are the scans you could possibly qualify for:

• Early pregnancy scan at 8 to 11 weeks

To confirm pregnancy and set the estimated due date

• Nuchal translucency scan at 11 to 14 weeks

Amongst other things, here they will check how high the chance is of being affected with common chromosomal problems

• Early anomaly scan at 14 to 18 weeks

Same as anomaly scan, but earlier, even less precise than the next scan. The sex of the baby can be scanned for at this stage too

• Anomaly scan at 19 to 23 weeks

This is normally the first test where there is a scan for anomalies

• Growth scan after 24 weeks

Measurements of head, abdominal and thigh for estimated foetal weight

Bear in mind that the ultrasound is not a very precise measurement to determine if your baby will or will not have anomalies, nor to determine your baby's weight. When during the scan a chance of an anomaly is found, more tests are necessary to make a diagnosis. In estimated high or low birth weight, this estimation can be off by as much as 10%! This can be the difference between a recommendation for an induction of labour or natural labour. It´s good to ask yourself the question if this scan will give you stress or peace of mind. 

Prenatal Diagnosis of Congenital Anomalies - Análisis cromosómico

As part of prenatal care, you may be offered tests to screen for potential chromosomal conditions. These tests aim to provide information about your baby's health early in the pregnancy. The chromosomal screening is called 'cribado' in Spanish and is meant to rule out any anomalies in your baby.

The best-known test is the combined screening test which can identify a pregnancy with an increased chance of Down syndrome (trisomy 21) and Edwards syndrome (trisomy 18). This test involves the pregnant woman having a blood test between 9 and 13 weeks gestation, and an ultrasound between 11 and 13 weeks gestation.

The Andalusian Health Service (SAS) has incorporated prenatal blood testing into the Congenital Anomalies Screening Programme, which will avoid in many cases the need for more invasive techniques, which until now were necessary to confirm the diagnosis of foetal chromosomopathies. The chromosomal abnormalities tested for are: trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome) and trisomy 13 (Patau syndrome). Specifically, it will apply to women who are found to have a risk of 1/50 to 1/280 in first trimester combined screening and those who have a previous child with a chromosomopathy. Read more about it in this link, this is the source I used. Or you can check this document when you want to look into it even more. It is in Spanish, so you might need to translate since it's not so easy to read.

Blood Sugar Test for gestational diabetes screening - Curva de azúcar 

Gestational diabetes is a condition that can develop during pregnancy. To screen for this, you'll likely be offered a blood sugar test. This test will be offered in your first trimester when you are identified as being part of the at-risk population. If you are not considered high risk, the test will be offered to you later on in pregnancy.

This blood sugar test determines the amount of glucose in the blood after ingesting 50 grams of sugar. The test shows how effectively your body deals with sugar intake. This is done by drawing your blood and giving you a sugar drink on an empty stomach. After an hour, your blood will be drawn again, and this will be repeated 2 or 3 times. You should not eat or smoke during this time.

Foetal Heart Monitoring CTG Monitoring - La cardiotocografía or monitores

Monitoring your baby's heartbeat is common part of prenatal care, especially as you approach your due date you can be asked to do the monitoring. CTG is also used during labour, or if there are concerns about the baby's movement or growth. The CTG helps assess your baby's well-being by tracking how their heart rate responds to movements and contractions. Two sensors are placed on your abdomen - one to measure the baby's heart rate and another to monitor contractions. Normally this takes 20 to 30 minutes, but it can be longer. While CTG can provide valuable information, it's not always conclusive and may sometimes lead to unnecessary interventions. You can read more about this in this blog article. 

Strep B Culture - Grupo B de estreptococos

Group B streptococcus is one of the many bacteria that we have in our body; this is not abnormal. It is usually a harmless bacteria, but very occasionally can cause disease in newborns because sometimes one can pass the bacteria on to the baby at birth. For the test, a sample is taken with a swab from your vagina and rectum. When you test positive, the doctor will prescribe antibiotics and advise having antibiotics during labour. This too is your choice to take it or not.

There is many research done and Sara Wickham wrote a whole book about it. For more critical research, check out her articles on GBS screening here.

Testing for GBS is often part of late-pregnancy care, though practices can vary. In Spain, when you have a private doctor you will not be offered a strep B test as part of routine prenatal care, but in the public hospital it is part of the routine prenatal care. 

My experience of prenatal screening in Malaga

During my first pregnancy in Spain with my youngest daughter, I underwent prenatal screening tests in Malaga Province. As I was privately insured, I visited a gynaecologist in Rincón de la Victoria. She performed the ultrasounds and exams, while I went to Vithas San Anton and Vithas in Rincón de la Victoria for my blood work. I also had an ultrasound at Vithas once (for a different pregnancy) and took a hospital tour to see the birth spaces at Vithas San Anton. The staff was very friendly, although they didn't speak English. Vithas San Anton is a pleasant, luminous hospital with beautiful rooms. The downside is the lack of easily accessible parking nearby. However, these wouldn't be my main or only criteria for choosing a hospital or birthplace. I plan to write another blog post on that topic in the future.

I was generally satisfied with my gynaecologist, but her approach was very different from what I was accustomed to in The Netherlands. She expected me to follow her instructions blindly, and before I knew it, she was examining me and conducting tests without explanation or asking for my consent. This was shocking for me at first. After that initial experience, I became more cautious and started asking for more explanations. I also refused some of the tests she wanted me to undergo. This was a new experience for her, and she seemed a bit uncomfortable with it. Fortunately, I could attribute my behaviour to being a foreigner in Spain. Being able to say, "We do things differently in The Netherlands," helped me stand my ground.

Support groups for pregnant women in Malaga

If you want to know more about the experiences of other moms in Malaga join the support group Mums of Malaga on Facebook. This group is especially for pregnant women and moms of young children in Malaga. Online you can post your questions and we also come together in Malaga to have face-to-face contact and build stronger relationships and support. 

Conclusion

All the doctors appointments, prenatal tests and scans can be overwhelming, but you can use them as tools for gathering of information on the health of you and your baby. You can decide if it is important for you in your situation and with your life values to have the appointment, test or scan or that you trust in the process and only go to a doctor when something is wrong. This is also a valid option.

It is crucial to approach each appointment, test or scan with a clear understanding of its purpose, accuracy, and implications for you and your baby. Don't hesitate to ask questions, seek clarification, and make decisions that align with your values and circumstances. Ultimately, you are the expert on your own body and pregnancy, and with informed choices, you can feel empowered throughout your pregnancy and birth experience.

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Want to delve into the material yourself? Good idea! Here are my sources