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  #21  
Old 24.03.2015, 17:02
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Re: no more screening for Down syndrome?

There is a new non-invasive trisomy test. I cannot imagine it would be as expensive as any of the older options as it is simply a blood test and easy lab assay.

http://lifecodexx.com/press.html

I have not had the test but have worked on the science behind it. I notice in the link it mentioned it becoming available in CH too.
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  #22  
Old 24.03.2015, 17:21
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Re: no more screening for Down syndrome?

Yes, this lifecodex test was the blood test recommended to me that isn't covered by insurance. The cost I was quoted by my doctor was 1500CHF, but perhaps it would be cheaper taken in Germany?
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  #23  
Old 24.03.2015, 17:41
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Re: no more screening for Down syndrome?

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So my questions to the forum are:
No screening for Down Syndrome? Weird or not?
Abortion - the law in Switzerland says no abortions past 12 weeks? What about after a positive outcome for a trisomy?
PraenaTest - has anyone used it recently? Is the cost about right? Maybe I should just skip the screening and go straight to the blood test?

hello and congratulations on your baby!!

it is correct what your doctor told you, since some months now the legislation changed in CH and the Down Syndrome screening is not anymore covered by the Health Insurance. The test would only be covered by the insurance if you meet certain criteria: family history, age, etc...

There is a timeframe to make the test for Down Syndrome, either with a invasive or non-invasive method, so you should make sure to check with your doctor on whether you are still within the timeframe, as otherwise regardless of the result you might not be able to opt for abortion.

You should perhaps check with your Health insurance the criteria to qualify for the test....otherwise if you do not mind about money, then you should try the test "Amniocentesis", it has 99% accuracy and it will also check for other problems on your baby. I did go through this test when pregnant and everything worked fine...

In any case wish you only the best of the luck and hope you'll find the way to approach this important topic!
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Old 24.03.2015, 18:03
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Interesting - I didn't realize it was no longer covered. But given that the risk hasn't disappeared it seems unlikely that people shouldn't be screened any more right?

And wouldn't being >35 be a risk factor?

Sorry, I re-read your post about checking health insurance criteria for finding out if I qualify for testing for Down Syndrome.

It just seems odd to me to quit the screening they used to include, I wonder why they did that. New information about the inaccuracy of the testing? Moving a public cost onto the private person? Hmmm.

Last edited by 3Wishes; 24.03.2015 at 19:50. Reason: merging successive posts
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  #25  
Old 24.03.2015, 18:18
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Re: no more screening for Down syndrome?

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Interesting - I didn't realize it was no longer covered. But given that the risk hasn't disappeared it seems unlikely that people shouldn't be screened any more right?

And wouldn't being >35 be a risk factor?

Well, it is just a fact that it is no longer covered by the Health Insurance, as said before just check with your insurance cover what is the inclusion criteria.

You can argue on whether the criteria makes sense or not, but fact is that there is a timeframe to opt for abortion and therefore if you feel that you need to know this then better sooner than later...

I'd recommend you in any case to have a test where you have a high accuracy rate and that also checks for other complications on the baby, this will give you some peace of mind and you'll truly enjoy the 9 months ahead of you
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  #26  
Old 24.03.2015, 18:31
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Re: no more screening for Down syndrome?

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Interesting - I didn't realize it was no longer covered. But given that the risk hasn't disappeared it seems unlikely that people shouldn't be screened any more right?

And wouldn't being >35 be a risk factor?
This is just an "off the top of my head" response - I am not sure about CH, but in Sweden there has been quite a lot in the news recently about the increase in the number of abortions/year following ever increased screening that is now covered by the system, but screening previously only available if obtained privately. The number of babies born/yr with Down's syndrome is now quite low.

I don't have time now to expand on how the plusses/minuses of that reality plays in my mind (have a concert at daughter's school to get to), but I think as a society with ever increasing options to make choices previously left to nature, it is important to consider that maybe "perfect" isn't always desirable.

This is not meant as a judgement in relation to OP's desire for screening (I've done it myself w/more than one pregnancy). Health care systems and professionals likely have other criteria for making decisions than individuals.
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  #27  
Old 24.03.2015, 22:24
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Re: no more screening for Down syndrome?

I had 2 babies in my 40s, over 5 years ago, in Zurich. I chose CVS testing. I think I did it very early, ca 8 weeks. It was not pleasant but we wanted a definitive result, which came very quickly, after ca 2 days ( and we found out sex, which was fab). It was carried out by a specialist doctor, and was covered by my insurance. I would have chosen the blood test but it was not available then.

You have clearly thought in depth about this. Don't worry about cost, take the test if you want peace of mind asap.

Good luck!
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  #28  
Old 24.03.2015, 22:47
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Re: no more screening for Down syndrome?

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There was always a risk of spontaneous abortion from either test, (although I never saw one case of this in 7 years)
My first wife had one after an amniocentesis.

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Abortion - the law in Switzerland says no abortions past 12 weeks?
No, it doesn't.

Abortions are freely available during the first trimester, after that, you need a medical reason, but there is no time limit in such cases.

http://www.swissinfo.ch/eng/the-secr...-rate/33585760

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fact is that there is a timeframe to opt for abortion
No, there isn't, it can be done at any time with doctor approval.

Tom
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  #29  
Old 24.03.2015, 22:49
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Re: no more screening for Down syndrome?

Medical termination.
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  #30  
Old 24.03.2015, 22:57
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Re: no more screening for Down syndrome?

From memory, here's how the screening works:

The neuchal translucency is an ultrasound test. It measures the folds at the back of the embryo/foetus - Down Syndrome babies tend to have a different thickness of fold. It used to be done around 14 weeks, but I think it can be done between 10-14 weeks (I had an ultrasound done at estimated 9 weeks due to another reason and it was not 'late enough' to check the neuchal fold...) - so they will probably say 10-14 weeks to make sure it's not too early and you aren't wasting your time.

They do a blood screening test with this, and a calculation (which is based a lot on the age of the parents!) - to decide whether the baby is at a higher risk or not...it does not confirm down syndrome, it only give you a calculated risk percentage. It's up to you and your doctor to then decide, if it comes back as a high risk (and remember, the calculation is based a lot on age anyway)... then you will be asked to decide whether to go for a proper test.

Once you have that 'risk number' you can decide whether to request an amniocentesis/cvs (chorionic villi sampling) which involves putting a tiny needle into the uterus and taking a sample of amniotic fluid and they will get skin cells from the foetus which can then be genetically tested.

The main risk of this procedure is (a small possibility) of miscarriage.

Assuming you are over 35, your risk factor for down syndrome does increase, but most babies with down syndrome are born to younger mothers (under 35), as younger women generally have a lot more babies...

Medical termination is definitely allowed a long way past 12 weeks. It is handled differently to a general request for termination of pregnancy which is available in Switzerland by law to all women until 12 weeks...
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  #31  
Old 25.03.2015, 00:01
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Re: no more screening for Down syndrome?

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My first wife had one after an amniocentesis.



No, it doesn't.

Abortions are freely available during the first trimester, after that, you need a medical reason, but there is no time limit in such cases.

http://www.swissinfo.ch/eng/the-secr...-rate/33585760



No, there isn't, it can be done at any time with doctor approval.

Tom
Clarification for horsesibiris and coffeeandtea:

Art. 119

Legal abortion
1 The termination of a pregnancy is exempt from penalty in the event that the termination is, in the judgment of a physician, necessary in order to be able to prevent the pregnant woman from sustaining serious physical injury or serious psychological distress. The risk must be greater the more advanced the pregnancy is.
2 The termination of a pregnancy is likewise exempt from penalty if, at the written request of a pregnant woman, who claims that she is in a state of distress, it is performed within twelve weeks of the start of the pregnant woman's last period by a physician who is licensed to practise his profession. The physician must have a detailed consultation with the woman prior to the termination and provide her with appropriate counselling.
3 If the woman is incapable of judgement, the consent of her legal representative is required.
4 The cantons designate the medical practices and hospitals that fulfil the requirements for the professional conduct of procedures to terminate pregnancy and for the provision of counselling.
5 An abortion is reported for statistical purposes to the competent health authority, whereby the anonymity of the woman concerned is guaranteed and medical confidentiality is preserved.

So:
Before 12th week ends: Woman's request is the only thing necessary
After 12th week: Woman's request and licensed doctor's judgement are necessary

Last edited by glowjupiter; 25.03.2015 at 00:27. Reason: tl:dr added
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  #32  
Old 25.03.2015, 10:30
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Re: no more screening for Down syndrome?

I am currently pregnant (22 weeks), I had the standard triple test covered by my insurance (I am 36). My Dr explained this was a standard test covered due to medical need given my age. Any follow up tests (e.g. Amnio testing) would also have been covered by insurance - although in my case this was not necessary.

I am having monthly ultrasounds and checkups all covered by insurance as the Dr keeps stamping things medical need - I have also had physio, an offer of acupuncture, and a selection of supplements etc all covered as medical need.
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  #33  
Old 25.03.2015, 11:11
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Re: no more screening for Down syndrome?

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From memory, here's how the screening works:

The neuchal translucency is an ultrasound test. It measures the folds at the back of the embryo/foetus - Down Syndrome babies tend to have a different thickness of fold. It used to be done around 14 weeks, but I think it can be done between 10-14 weeks (I had an ultrasound done at estimated 9 weeks due to another reason and it was not 'late enough' to check the neuchal fold...) - so they will probably say 10-14 weeks to make sure it's not too early and you aren't wasting your time.

They do a blood screening test with this, and a calculation (which is based a lot on the age of the parents!) - to decide whether the baby is at a higher risk or not...it does not confirm down syndrome, it only give you a calculated risk percentage. It's up to you and your doctor to then decide, if it comes back as a high risk (and remember, the calculation is based a lot on age anyway)... then you will be asked to decide whether to go for a proper test.

Once you have that 'risk number' you can decide whether to request an amniocentesis/cvs (chorionic villi sampling) which involves putting a tiny needle into the uterus and taking a sample of amniotic fluid and they will get skin cells from the foetus which can then be genetically tested.

The main risk of this procedure is (a small possibility) of miscarriage.

Assuming you are over 35, your risk factor for down syndrome does increase, but most babies with down syndrome are born to younger mothers (under 35), as younger women generally have a lot more babies...

Medical termination is definitely allowed a long way past 12 weeks. It is handled differently to a general request for termination of pregnancy which is available in Switzerland by law to all women until 12 weeks...
This is exactly what happened to me. I posted in another thread about genetic testing, but I'd share it again here. I have done a CVS testing about 1 month ago (when I was 13 weeks pregnant), mainly because my blood screening came out with a higher risk for the baby to have trisomy. I'm not yet 35, but my ob/gyn told me that the CVS test would still be covered by my (basic) health insurance because of the higher risk result (she told me before that the Amnio and CVS tests would be covered by insurance only if you are older than 35).
We opted for the CVS test as we didn't have to wait for few more weeks (like in the case of Amnio) and the results are more accurate than the blood test, although we are aware of the miscarriage risk. My ob/gyn told me that we do have the choice to terminate the pregnancy based on the results.
And, indeed, the blood genetical test (not the screening) is not covered by insurance. Although the test doesn't bear any miscarriage risk, the result is not as accurate as the other two tests. And my ob/gyn told me, if the parents choose to terminate the pregnancy based on the results of the blood test, the mother still has to go through either CVS or Amnio test in order to make sure about the results.
Hopefully this helps, and by the way, I am based in Thalwil, and so is my ob/gyn. I did the CVS test at UniSpital ZH.
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  #34  
Old 25.03.2015, 13:11
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Re: no more screening for Down syndrome?

Here is some info concerning the triple test which would normally be carried out at the next appointment (10-12 weeks). It would be extremely unusual for any doctor not to give information on this test especially given the OP's age. It does seem odd that the OP had to ask specifically.

http://en.m.wikipedia.org/wiki/Triple_test

This link ( in French or German only) would indicate that the triple test AFP+ is not reimbursed by the basic insurance but the simple AFP test is. The link is from 2008 though so things may have changed.

http://www.medecins-conseils.ch/manual/chapter28.html

These two links give details of exactly what is covered during pregnancy under the basic obligatory insurance. It appears to me that the triple test would be covered if deemed necessary and prescribed by the doctor. Having said that it's a fairly simple blood test and wouldn't cost much even if not reimbursed.

The nuchal scan will fall under the first ultrasound exam.

Amniocentesis and CVS are covered for women aged 35 and over and for younger women who have a high risk ( 1:380 or greater) based on the initial screening results. The newer foetal cell blood test is not covered at all at the moment.


Pregnancy cover ( in English)

http://www.bag.admin.ch/themen/krank...x.html?lang=en

General cover for everything ( French, German or Italian only)

http://www.admin.ch/opc/fr/classifie...275/index.html


As far as changing doctors is concerned it's often easier to get an appointment if you are actually pregnant so I'd suggest that the OP rings around a few in the area and enquiries whether they will accept her as a new patient. It's important to have a good relation with your doctor during pregnancy.
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