In our country the right to various benefits exists during gestation, but the type of offer varies according to residence. Here’s how you can better orient yourself
The pregnant woman has the right to a path of scheduled specialist services during the nine months without having to pay the ticket. To obtain exemption from participation in healthcare costs, the general practitioner or gynecologist of a public facility (counseling center, Asl, hospital) must report on the recipe the code M followed by the number of the week of gestation. Not in all regions for the exam package offered the same.
New performances in Lea
The new services included in Lea (the Essential Levels of Assistance), introduced in 2017, such as urine culture for the detection of bacteria (to reduce the risk of premature birth associated with infections) e he Pap-test in the first quarter or the vaginal swab to detect the presence of group B strep in the third trimester, they are not guaranteed entirely free of charge for example in Abruzzo, Puglia, Sicily and Sardinia, all Regions in the repayment plan from health care debt, in Umbria, in Market o in Liguria (where among the additional services in exemption there are only gynecological checks, accompanying courses for childbirth and assistance to the puerperium). The problem there failure by the Ministry of Health to adopt the decree with the maximum tariffs for the new outpatient specialist services, still being defined but necessary for their effective delivery. Unless the single Region decides to insure them under the extra Lea regime, without state reimbursement, or toas Campania does).
The combined test
Women in pregnancy at risk for or for the fetus (in the event of a threat of abortion or previous miscarriages, diabetes, alterations in thyroid function, cancer, autoimmune disease) they are entitled to free use of all services for monitoring pregnancy (the exemption code in this case M50). Perhaps the most important inequality for health protection concerns access to the so-called combined test (or bi-test) for prenatal diagnosis, which between the eleventh and thirteenth week of pregnancy allows estimate the risk of chromosomal abnormalities in the fetus, such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13). About one child in every 700 born comes into the world with these diseases. And the odds increase with maternal age, particularly after age 35.
What does it consist of
Screening consists of a maternal blood sampling (to measure two proteins produced by the placenta: papp-a and free beta hCG) and in the ultrasound measurement of nuchal translucency (i.e. the thickness of the space between the skin and the structures of the neck and nape of the fetus). The data are combined with the age of the mother and the result is considered high risk when there is a probability in 250 to one in 385. Although this screening test is part of the birth path, which can be prescribed by the treating gynecologist, the payment of the ticket (50 euros in Lombardy, 36 in the Marche) still expected in many regions, come Lombardy, Lazio, Liguria, Molise, Abruzzo, Puglia, Umbria, Marche, Sicily and Sardinia. And the exemption is not always guaranteed even for women with high-risk pregnancy.
Reduces the use of CVS and amniocentesis
The combined test indicated for all pregnant women, non-invasive and unlike the old maternal age criterion, if we rely on the risk identified by this test invasive diagnostic interventions such as CVS and amniocentesis are reduced (currently excluded from the ticket only in situations of procreative risk predictable a priori, as it is related to a family pathology, or fetal defects highlighted by ultrasound). About 20 samples are enough to have a positive diagnosis. Before, however, an average of 300 CVS and amniocentesis were needed, but with these invasive procedures, which carry a greater risk of abortion, to diagnose an affected fetus I kill a healthy one, he comments Enrico Ferrazzi, full professor of Gynecology at the University of Milan and director of the Mangiagalli obstetrics clinic. Only when the probability of developing a chromosomal abnormality is greater than one in 250 – explains the doctor – it is recommended to perform the villocentesis or amniocentesis to ascertain the diagnosis. it is desirable that the bi-test will soon become free in all regions in order to reduce the inappropriate use of invasive tests.
Non-invasive investigations
Among the non-invasive tests there is that of Fetal DNA circulating in the blood of the future mother (nipt test). Through a normal blood sample (around the tenth week of gestation) the presence of chromosome fragments coming from the placenta is detected and the risk of alterations in the number of chromosomes 21, 13 and 18 of the fetus is assessed. Unfortunately at the moment this examination, already widespread abroad, is not included in the Lea (because equipped laboratories would be needed throughout the national territory) and at the total expense of the patients. The price varies from 200 to 500 euros in the public up to over a thousand euros in private laboratories. recommended by many international guidelines when combined screening provides an intermediate result to avoid the use of invasive tests, explains Ferrazzi. But the cost is not affordable for all families. Yet, concludes the doctor, if the genetic analysis of free fetal DNA were added to the Lea’s it would lead to a 70 percent reduction in invasive procedures and therefore to savings of between 16 and 19 million euros for the National Health Service.
Only Emilia Romagna offers free nipt test to all pregnant women since 2020, regardless of age and risk factors. While in Tuscany the full exemption applies to unemployed or destitute mothers with a combined test report in the risk range between 1/200 and 1/1000. All the others, with the same risk report, benefit from the half price rate: 200 euros, instead of 400. Finally, in the autonomous provinces of Trento and Bolzano the nipt test in exemption for pregnancies with intermediate risk between 1/100 and 1/500, e in Puglia it was introduced on an experimental basis for two years for pregnant women over 40 and those with a bi-test result between 1/301 and 1/1000.
December 19, 2021 (change December 19, 2021 | 18:56)
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