Down test pregnancy

Prenatal Testing for Down Syndrome | Patient Education

Age-Related Risks

Generally, the chance of having a Down syndrome birth is related to the mother's age. Under age 25, the odds of having a child with Down syndrome are about 1 in 1,400. At age 35, the odds are about 1 in 350. At age 40, the odds are about 1 in 100.

Causes of Down Syndrome

There are three causes of Down syndrome:

Trisomy 21

An estimated 95 percent of people with Down syndrome have trisomy 21, meaning they have three number 21 chromosomes instead of two. We normally have 23 pairs of chromosomes, each made up of genes. During the formation of the egg and the sperm, a woman's or a man's pair of chromosomes normally split so that only one chromosome is in each egg or sperm. In trisomy 21, the 21st chromosome pair does not split and a double dose goes to the egg or sperm. An estimated 95 to 97 percent of the extra chromosome is of maternal origin.

Translocation

Translocation occurs in about 3 to 4 percent of people with Down syndrome. In this type, an extra part of the 21st chromosome gets stuck onto another chromosome. In about half of these situations, one parent carries the extra 21st chromosome material in a "balanced" or hidden form.

Mosaicism

In mosaicism, the person with Down syndrome has an extra 21st chromosome in some of the cells but not all of them. The other cells have the usual pair of 21st chromosomes. About 1 to 2 percent of people with Down syndrome have this type.

Prenatal Testing

Screening tests can identify women at increased risk of having a baby with Down syndrome. These tests have no risks of miscarriage, but can't determine with certainty whether a fetus is affected. Diagnostic tests, on the other hand, are extremely accurate at identifying certain abnormalities in the fetus, but carry a small — generally less than 1 percent — risk of miscarriage. We offer options for both screening and diagnostic testing.

Screening Tests

Sequential Integrated Screening — Sequential integrated screening is offered to all pregnant women by the state of California. This non-invasive screening is performed in two steps.

In the first step, which is performed between 10 and 14 weeks of pregnancy, a blood sample is taken from the mother and a nuchal translucency ultrasound is performed to measure the amount of fluid at the back of the baby's neck. If the blood test is scheduled prior to the ultrasound, we can provide the results at the end of the ultrasound appointment. The results of the blood test, the nuchal translucency measurement and the mother's age are used to estimate the risk for Down syndrome and trisomy 18.

The second step is a maternal blood test between 15 to 20 weeks of pregnancy. When the results of this blood test are combined with the results from the first trimester blood test and nuchal translucency ultrasound, the detection rate for Down syndrome increases. This test also provides a personal risk assessment for having a fetus with trisomy 18, Smith-Lemli-Opitz syndrome, an open neural tube defect or an abdominal wall defect.

Diagnostic Tests

Amniocentesis, chorionic villus sampling (CVS) and ultrasound are the three primary procedures for diagnostic testing.

Amniocentesis — Amniocentesis is used most commonly to identify chromosomal problems such as Down syndrome. When the fetus is known to be at risk, it can detect other genetic diseases like cystic fibrosis, Tay-Sachs disease and sickle cell disease.

An amniocentesis procedure for genetic testing is typically performed between 15 and 20 weeks of pregnancy. Under ultrasound guidance, a needle is inserted through the abdomen to remove a small amount of amniotic fluid. The cells from the fluid are then cultured and a karyotype analysis — an analysis of the chromosomal make-up of the cells — is performed. It takes about two weeks to receive the results of the test.

Amniocentesis detects most chromosomal disorders, such as Down syndrome, with a high degree of accuracy. Testing for other genetic diseases, such as Tay-Sachs disease, is not routinely performed but can be detected through specialized testing if your fetus is known to be at risk. Testing for neural tube defects, such as spina bifida, also can be performed.

There is a small risk of miscarriage as a result of amniocentesis — about 1 in 100 or less. Miscarriage rates for procedures performed at UCSF Medical Center are less than 1 in 350.

Chorionic Villus Sampling (CVS) — Like amniocentesis, chorionic villus sampling is used most commonly to identify chromosomal problems such as Down syndrome. It can detect other genetic diseases like cystic fibrosis, Tay-Sachs disease and sickle cell disease in at-risk fetuses. The main advantage of CVS over amniocentesis is that it is done much earlier in pregnancy, at 10 to 12 weeks rather than 15 to 20 weeks.

CVS involves removing a tiny piece of tissue from the placenta. Under ultrasound guidance, the tissue is obtained either with a needle inserted through the abdomen or a catheter inserted through the cervix. The tissue is then cultured and a karyotype analysis of the chromosomal make-up of the cells is performed. It takes about two weeks to receive the results.

The advantage of CVS over amniocentesis is that the test is performed much earlier in pregnancy, so results are typically available by the end of the third month. A disadvantage is that spinal cord defects cannot be detected. Expanded alpha fetoprotein (AFP) blood testing or ultrasound can be performed later in the pregnancy to screen for spinal cord defects.

There is a small risk of miscarriage as a result of CVS — 1 in 100 or less. Miscarriage rates for procedures performed at UCSF Medical Center are less than 1 in 350.

Ultrasound — The primary purpose of ultrasound is to determine the status of a pregnancy — the due date, size of the fetus and if the mother is carrying multiples. Ultrasound also can provide some information about possible birth defects in a fetus. All patients at UCSF Medical Center undergo a comprehensive ultrasound examination before any invasive tests are performed. Results of the ultrasound are explained at the time of the visit.

In some patients, an ultrasound raises concern of a possible abnormality in the fetus. We have extensive experience in performing and interpreting ultrasounds in pregnancy.

If You Receive a Positive Result

If you receive positive results on a screening test, we recommend that you discuss this with your doctor and a genetic counselor. Options for further diagnostic testing will be explained. The decision as to whether to have invasive genetic testing is up to you.

If a diagnostic test finds a genetic abnormality, the significance of such results should be discussed with experts familiar with the condition, including a medical geneticist and a genetic counselor, as well as your own doctor.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

Related clinic

Prenatal Diagnostic Center

1825 Fourth St., Third Floor
San Francisco, CA 94158

(415) 476-4080

M-F, 8 a.m. - 5 p.m.

Down syndrome - Diagnosis and treatment

Diagnosis

The American College of Obstetricians and Gynecologists recommends offering the option of screening tests and diagnostic tests for Down syndrome to all pregnant women, regardless of age.

Screening tests can indicate the likelihood or chances that a mother is carrying a baby with Down syndrome. But these tests can't tell for sure or diagnose whether the baby has Down syndrome.
Diagnostic tests can identify or diagnose whether your baby has Down syndrome.

Your health care provider can discuss the types of tests, advantages and disadvantages, benefits and risks, and the meaning of your results. If appropriate, your provider may recommend that you talk to a genetics counselor.

Screening tests during pregnancy

Screening for Down syndrome is offered as a routine part of prenatal care. Although screening tests can only identify your risk of carrying a baby with Down syndrome, they can help you make decisions about more-specific diagnostic tests.

Screening tests include the first trimester combined test and the integrated screening test.

The first trimester combined test

The first trimester combined test, which is done in two steps, includes:

Blood test. This blood test measures the levels of pregnancy-associated plasma protein-A (PAPP-A) and the pregnancy hormone known as human chorionic gonadotropin (HCG). Abnormal levels of PAPP-A and HCG may indicate a problem with the baby.
Nuchal translucency test. During this test, an ultrasound is used to measure a specific area on the back of your baby's neck. This is known as a nuchal translucency screening test. When abnormalities are present, more fluid than usual tends to collect in this neck tissue.

Using your age and the results of the blood test and the ultrasound, your doctor or genetic counselor can estimate your risk of having a baby with Down syndrome.

Integrated screening test

The integrated screening test is done in two parts during the first and second trimesters of pregnancy. The results are combined to estimate the risk that your baby has Down syndrome.

First trimester. Part one includes a blood test to measure PAPP-A and an ultrasound to measure nuchal translucency.
Second trimester. The quad screen measures your blood level of four pregnancy-associated substances: alpha fetoprotein, estriol, HCG and inhibin A.

Diagnostic tests during pregnancy

If your screening test results are positive or worrisome, or you're at high risk of having a baby with Down syndrome, you might consider more testing to confirm the diagnosis. Your health care provider can help you weigh the pros and cons of these tests.

Diagnostic tests that can identify Down syndrome include:

Chorionic villus sampling (CVS). In CVS, cells are taken from the placenta and used to analyze the fetal chromosomes. This test is typically performed in the first trimester, between 10 and 13 weeks of pregnancy. The risk of pregnancy loss (miscarriage) from a CVS is very low.
Amniocentesis. A sample of the amniotic fluid surrounding the fetus is withdrawn through a needle inserted into the mother's uterus. This sample is then used to analyze the chromosomes of the fetus. Doctors usually perform this test in the second trimester, after 15 weeks of pregnancy. This test also carries a very low risk of miscarriage.

Preimplantation genetic diagnosis is an option for couples undergoing in vitro fertilization who are at increased risk of passing along certain genetic conditions. The embryo is tested for genetic abnormalities before it's implanted in the womb.

Diagnostic tests for newborns

After birth, the initial diagnosis of Down syndrome is often based on the baby's appearance. But the features associated with Down syndrome can be found in babies without Down syndrome, so your health care provider will likely order a test called a chromosomal karyotype to confirm diagnosis. Using a sample of blood, this test analyzes your child's chromosomes. If there's an extra chromosome 21 in all or some cells, the diagnosis is Down syndrome.

More Information

Amniocentesis
Genetic testing
Ultrasound

Treatment

Early intervention for infants and children with Down syndrome can make a major difference in improving their quality of life. Because each child with Down syndrome is unique, treatment will depend on individual needs. Also, different stages of life may require different services.

Team care

If your child has Down syndrome, you'll likely rely on a team of specialists that can provide medical care and help him or her develop skills as fully as possible. Depending on your child's particular needs, your team may include some of these experts:

Primary care pediatrician to coordinate and provide routine childhood care
Pediatric cardiologist
Pediatric gastroenterologist
Pediatric endocrinologist
Developmental pediatrician
Pediatric neurologist
Pediatric ear, nose and throat (ENT) specialist
Pediatric eye doctor (ophthalmologist)
Audiologist
Speech pathologist
Physical therapist
Occupational therapist

You'll need to make important decisions about your child's treatment and education. Build a team of health care providers, teachers and therapists you trust. These professionals can help evaluate the resources in your area and explain state and federal programs for children and adults with disabilities.

Request an Appointment at Mayo Clinic

Coping and support

When you learn your child has Down syndrome, you may experience a range of emotions, including anger, fear, worry and sorrow. You may not know what to expect, and you may worry about your ability to care for a child with a disability. The best antidote for fear and worry is information and support.

Consider these steps to prepare yourself and to care for your child:

Ask your health care provider about early intervention programs in your area. Available in most states, these special programs offer infants and young children with Down syndrome stimulation at an early age (typically until age 3) to help develop motor, language, social and self-help skills.
Learn about educational options for school. Depending on your child's needs, that may mean attending regular classes (mainstreaming), special education classes or both. With your health care team's recommendations, work with the school to understand and choose appropriate options.
Seek out other families who are dealing with the same issues. Most communities have support groups for parents of children with Down syndrome. You can also find internet support groups. Family and friends can also be a source of understanding and support.
Participate in social and leisure activities. Take time for family outings and look in your community for social activities such as park district programs, sports teams or ballet classes. Although some adaptations may be required, children and adults with Down syndrome can enjoy social and leisure activities.
Encourage independence. Your child's abilities may be different from other children's abilities, but with your support and some practice your child may be able to perform tasks such as packing lunch, managing hygiene and dressing, and doing light cooking and laundry.
Prepare for the transition to adulthood. Opportunities for living, working, and social and leisure activities can be explored before your child leaves school. Community living or group homes, and community employment, day programs or workshops after high school require some advance planning. Ask about opportunities and support in your area.

Expect a bright future. Most people with Down syndrome live with their families or independently, go to mainstream schools, read and write, participate in the community, and have jobs. People with Down syndrome can live fulfilling lives.

By Mayo Clinic Staff

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Obstetrician-gynecologist Natalya Bakhmetyeva talks to the patient Nefedova lying under a dropper: the dynamics worsened, let's discuss the options, I called the urologist. Nefedova: if he removes my second kidney, it will make some sense. Bakhmetyeva: it's risky to wait, I suggest delivery at 31 weeks. Nefedova refuses: Kolmogorov said that I could hold out for another 3-4 weeks, I want to give birth to a healthy child. I knew what I was getting into - the only kidney, chronic pyelonephritis. I decided everything - I want to convey. Did Kolmogorov guide you from the very beginning of your pregnancy? Yes, I chose the best doctor. When he sent me to you, he said that I could decide for myself if there were options. And they are. nine0003

Bakhmetyeva unsuccessfully tries to get through to Kolmogorov. Bakhmetyeva approaches the head physician of the clinic, Ilya Yakovlevich, and says that Nefedov needs to be operated on urgently. What about Kolmogorov? Not available. The head physician says that with such urgency, Bakhmetyeva, instead of pulling him, could take the initiative into her own hands. At this moment, Bakhmeteva is summoned to Nefedova. The patient has stopped breathing. The resuscitator does her intubation and chest compressions. Nefedova is taken to the operating room. But, despite all the efforts of Bakhmetyeva and her colleagues, the patient dies on the operating table. The child is saved. nine0003

Bakhmetyeva drives up to the RAMS building. She leaves Kolmogorov a message on the answering machine: come down, I'm downstairs. But then she sees Kolmogorov leaving the building. Bakhmetyeva tells him: if you are interested, Yuri Alekseevich, then Nefedova Nadezhda Grigorievna died during the operation. Kolmogorov told her that at 46 years old with one kidney, you can give birth to a hero and a genius on the 40th week. Yura, I called you a hundred times... Kolmogorov says: stop acting like a quivering student, it's time for you to make your own decisions, it's time to grow up. Understand! Leaving Natalya, Kolmogorov heads to his wife, who meets him near the car. She asks her husband: who is this? My student. Kolmogorov kisses his wife, they get into the car and drive away. nine0003

Bakhmetyeva submits a letter of resignation of her own free will. Ilya Yakovlevich: you're not to blame, don't punish yourself. Losing a patient on the operating table is always a tragedy, but it happens. Bakhmetyeva: don't comfort me, just sign the application, I won't change my mind. Ilya Yakovlevich: But you understand that without Kolmogorov's blessing they won't let you into any shop in Moscow now. Bakhmeteva: fortunately, there are shops not only in Moscow. Having signed the application, Ilya Yakovlevich reports: a couple of weeks ago, an old acquaintance, the head doctor of a clinic in a northern city, called me, he was looking for the head of the observation - young, promising. nine0003

Late in the evening, Bakhmetyeva is loading things into the trunk of her car. Kolmogorov arrives: Natasha, what's going on? Why do you need to drop everything at once - a clinic, a dissertation? Running away in the middle of the night, not answering my calls - what kind of kindergarten? Bakhmetyeva: Don't you understand? The man is dead. Kolmogorov: Yes, sometimes patients die. So what? Analyzed, saddened - we go further. Bakhmetyeva: Here I am going. Kolmogorov: to whom and what are you proving? What can you do without me? You lived with me for ten years. Yura, to live is when under one roof. So you wanted a simple philistine happiness? I know too little about him to want. But I know exactly what I don't want anymore. Thinking you have a man when you don't. Telling yourself that working around the clock and seeing you once a week is okay. Thanks for reminding me how old I am. I'm going to grow up and find out what I want. nine0003

Bakhmetyeva arrives in St. Petersburg.

Obstetrician-gynecologist Alla V. Kashina sleeps in her office after celebrating her anniversary with her colleagues the day before. Kashina is 50 years old. She is awakened by a phone call: another patient has been brought to the clinic. Kashina puts himself in order and goes to the emergency department. She asks: what do we have here? The waters broke forty hours ago. Kashina examines the patient, commands: a gurney! In her operblock, quickly! The husband of the woman in labor remains in the ward, he is dressed in a Hare Krishna outfit, reciting mantras. nine0003

Bakhmetyeva drives up to the clinic building where she will now work. The security guard refuses to let her into the parking lot. He refers to the instructions: your car is not on the list, I don't know you, no one warned me about you, you don't have a pass either. Bakhmetyeva says she can call the head physician. The guard declares that he has his own superiors, to whom he submits. Bakhmetyeva leaves her passport as a pledge so that they let her through.

Midwife Evgenia Efimovna Mishina, known by her colleagues as Misha, is trying to hear the heartbeat of a Hare Krishna patient's fetus using a wooden tube. A young obstetrician-gynecologist is interested in: what is there, Misha? If I can't hear it with my ear, then it doesn't exist. Kashina enters the operative block, reports: the head physician is unavailable. Mishina turns to Kashina: the fetus is dead, it is necessary to do a fruit-destroying one. Leave her uterus, fool, because the first child does not need to be the last. Irritated Kashina pulls the midwife: Evgenia Efimovna, mind your own business. The offended Mishina departs. Appears anesthesiologist Alexander Anatolyevich Dontsov: well, what do we have here? Kashin: supravaginal amputation, due to prolonged anhydrous. Dontsov sighs: it means that her fate is to be childless. Kashina: I would like children, I would not give birth at home. nine0003

In the corridor, intern Pavel Samoryadov fills in the case history of a newly admitted patient. Misha is standing nearby, she grumbles: why immediately shred the table and the uterus? Previously, a dead fetus was pulled out through a certain place, and the uterus was left in place. Bakhmetyeva comes up, says hello, looks into the medical history, is horrified and runs to the operating room. Mishina: what was that now? Paul: I don't understand.

Kashina lifts the scalpel over the patient's abdomen. Bakhmetyeva bursts into the operating room, she throws the surgical instruments prepared for the operation onto the floor. Kashina is indignant: why are outsiders in the operating block? Call security! Bakhmetyeva introduces herself, says that from today she is the head of the observation department. Then she commands: the patient to the delivery room, quickly! nine0003

Mishina helps Bakhmetyeva remove the dead fetus. Pavel faints during this procedure. Dontsov brings the intern to his senses and puts him out into the corridor.

After a successful operation, Bakhmetyeva tells Pavel to leave his sensitivity for dates in the operating room - this is an unaffordable luxury. Bakhmetyeva is called by the head physician. When she leaves, Pavel asks Dontsov: who was right - Bakhmetyev or Kashin? He says: Kashina did what she was supposed to, but Bakhmetyeva swung at more. So you are for Bakhmeteva? No, I'm for mine. Kashina and I gave birth to half a division of children together, and I never liked doctors with God's syndrome. nine0003

Kashina reprimands the head physician of the clinic, Oleg Evgenievich Samoryadov (Pasha's father): well, you gave me a present for my anniversary. Couldn't you have at least warned me ahead of time? Samoryadov: Bakhmetyeva acted boldly and professionally, and she kept the uterus, which you wanted to cut into pieces, so as not to risk it. Yeah, and now the temperature will rise, and the uterus will still have to be removed, but only a septic one. You're screwing up! Go to work and don't disturb her. I will follow.

Bakhmetyeva enters the office. Kashina, pursing her lips, is removed. Samoryadov congratulates the new head of the observatory on her military entry into office. Just keep in mind for the future: such decisions are made by the council. Bakhmetiev: which still needs to be collected, and the risk of infectious complications increases. Samoryadov: I have no doubt that you are a good doctor, but what kind of head you will be is still unknown. You need to be able to build relationships with subordinates. nine0003

After the round, Bakhmetyev scolds Pavel. Why did you blurt out the patient about placental abruption? If the next time something seems to you, be patient until the corridor, take pity on the patient. Have you read her medical history? She had eight miscarriages! She has never made it past 30 weeks. Then Bakhmetyeva switches to Sechenov: I asked you to do an ultrasound, where is it? Sechenov is silent. Bakhmeteva leaves. Pavel: Does she even know how to talk normally? Sechenov: I'm worried about something else. I brought her cards half an hour before the round. How did she manage to study everything about 12 patients? I feel, Pasha, our free life is over. Kashina will be remembered later as a good king. nine0003

IVF specialist Ruslan Bazanov enters the clinic building. Head nurse Dina Rafailovna shares with him the latest gossip about the new head of the observation. Having learned her last name, Bazanov drops a cup of coffee from his hands.

A patient comes to see Bazanov, who has been trying to get pregnant for 15 years. She underwent IVF 25 times, but to no avail. Bazanov assures that there are still chances of success. He sees no reason to refuse a woman who so wants to become a mother. nine0003

At lunchtime, Bakhmetyeva is relaxing on a bench in the clinic's yard. A Hare Krishna approaches her: why didn't you save my child? Because you marinated your wife at home for two days. The Krishnaite is crying: do you also think that only obscurantists give birth at home? But after all, you can’t tear the child from the mother when he was born, the umbilical cord must not be cut, and the placenta must be buried. We wanted children so much. My wife couldn't get pregnant for two years. Then we went to India, and a miracle happened. Why didn't you save the child? nine0003

Neonatologist Andrei Lazarev enters the yard. He turns to the Hare Krishna: what is your name? Andrey. Listen, namesake, is your beloved woman still alive? Yes. This is the main thing. She can still give birth - also not bad. Let's go to her now, you will say that you love her. Lazarev leads the Krishnaite away.

Bakhmetyeva sees Bazanov getting out of the car that has driven up to the clinic. She recognizes her classmate, sneaks up behind him, closes her eyes with her hands: Ruslanchik-Bazanchik, a sunny boy. Bakhmetiev! Natalya hangs on Ruslan's neck. He says you haven't changed at all. And you grew up and became even more beautiful, aren't you ashamed? Bakhmetyeva asks: where is the buffet? I haven't seen food in days. Bazanov: buffet is not food. And you are still the same snob. A long-legged brown-haired woman in a medical gown comes out of the clinic building, greets Bazanov, and passes by. Bakhmetyeva: Is that sister Nicole Kidman? Bazanov: he is lying that he is the head of the laboratory. This is Olga Olshanskaya, a great clever girl. In love? But not in me. Bazanchik, well, can there really be someone who is not in love with you? You seem to be hungry, let's go eat. nine0003

Lazarev comes to the laboratory and asks Olshanskaya to do one analysis. Olshanskaya asks Lazarev about Bakhmeteva. He says that he saw her briefly, but already on the first occasion it is clear that she is a maximalist, it is difficult with such people. Olshanskaya: see you on Friday? Lazarev: I have children on Friday. On Saturday? Olshanskaya: I don't know. I have a sports club, a massage, then a meeting with a childhood friend. If, of course, you squeeze in... Lazarev kisses Olshanskaya: I'm compact.

In the dining room, Bazanov and Bakhmetyeva ask each other what has happened in the seven years they have not seen each other. Bakhmetyeva answers questions about her personal life and reasons for leaving Moscow evasively. Her phone rings. There was an accident, eight cars. A pregnant woman is among the victims. nine0003

At the emergency department, Pavel and Sechenov are waiting for the arrival of a patient injured in an accident. Suitable couple. A pregnant woman says that her five-year-old daughter kicked her in the stomach last night: it hurts very badly. Sechenov instructs Pavel to do an ultrasound. Kashina, walking towards him, says that Pavel should start the inspection, she will come later.

A patient is brought in after an accident, she is 40 weeks pregnant, has a hip injury and is bleeding. Kashina believes that the placenta has exfoliated. Bakhmetyeva gives her an order: take her to the operating unit, first a caesarean section, then a hip, call a traumatologist. Pavel approaches Kashina: what to do with the woman whom her daughter kicked in the stomach? Oh, I totally forgot. What is an ultrasound? I did, nothing is visible, but it seems that something is wrong. She complains of pain. Bakhmetyeva decides to deal with the patient. On examination, the woman grimaces in sharp pain. Is that a caesarean scar? Yes. Were there other surgeries? Myoma was cut out. nine0003

Bakhmetyeva and Pavel drive the patient to the operating room. Near it is another gurney with a woman after the accident. Bakhmetyeva asks Kashina: why haven't they started yet? All the anesthesiologists are in surgery now, in an accident. Mishina: will be in 20 minutes, if they don't lie. Bakhmetyeva: we urgently need an operating room, her condition is critical. Kashina: We can't do two caesareans at the same time, the patient has a lot of blood loss. Bakhmeteva: yours can wait, she has a lot of damage, but the child is out of danger, and here we can lose both. nine0003

Bakhmetyeva believes that her patient had a uterine rupture. She performs a C-section on her under local anesthesia. As a result, both the child and the woman in labor remain alive. Mishina is delighted with the actions of Bakhmetyeva. Kashina believes that she was just lucky.

Bazanov helps Bakhmeteva find an apartment in St. Petersburg. On the way to work, Bakhmetyeva asks him about her subordinates: which of them should I be afraid of? You can handle the rest yourself.

The pop diva Meridian (her real name is Marina) is brought to the clinic. At the appointment with Bakhmetyeva, she says that already in the late stages of pregnancy, the fetus was diagnosed with Down syndrome. The husband of the pop diva is an oligarch, he is waiting for a normal heir. Therefore, Marina hid the diagnosis from him. And now she doesn't want the baby to be born alive. Bakhmetyeva says that no doctor would agree to kill a child with a pathology. Marina intends to leave the clinic, but at the door she faints. Bakhmetyeva insists on the hospitalization of a VIP patient who has a fetal presentation. nine0003

Bazanov is trying to convince a patient who was undergoing IVF by his colleagues from another clinic to get rid of at least two out of four embryos. Giving birth to a healthy quadruple is very unlikely. The woman straightens up.

A prisoner from a pre-trial detention center is brought to the clinic. A woman (Anastasia) killed her husband - exceeding self-defense, he beat her. She has already started contractions. Despite the protests of Dina Rafailovna, Bakhmetyeva gives the order to register the patient and issue gowns to the guards accompanying her. nine0003

At the end of the working day, Samoryadov calls Bakhmetyeva and tells her to inform the management of her decisions in extraordinary situations.

Late in the evening, Meridian begins to bleed vaginally. She is rushed to the operating room.

Bakhmetyeva accepts Bazanov's invitation to dine at a restaurant. He orders champagne, expresses the hope that their relationship will become more than friendly. Bakhmetyeva flirts and laughs off.

Misha sees that Kashina cannot cope with Meridian's bleeding. She calls the head nurse and demands that she call Bakhmetyeva: otherwise we will have two VIP corpses. nine0003

Saying goodbye to Bazanov, Bakhmetyeva answers Diana Rafailovna's call and rushes to the clinic. She replaces Kashina and finishes the operation started by that one. The child is born premature. They are engaged in Lazarev. In the morning he tells Meridiana: your child is alive, a boy, genetic analysis has come, your son has Down syndrome. Thanks, I'm aware.

Meridian is visited by her producer Vladik. He says that a child down with a star can be a reason for crazy PR: everyone just swears. Meridiana declares: you would not go to the forest with such PR. nine0003

Bakhmetyeva delivers Anastasia. Pavel arrives. Bakhmetyeva smells a strong smell of fumes from the intern. She declares that Pavel has been demoted to the orderlies for three days, and drives him away.

A husband comes to Meridiana. Upon learning that the child was born with an incurable pathology, the oligarch declares: we are breaking up, you will receive everything that is written in the contract. And the child? We have a healthy child in the contract. The oligarch leaves.

Anastasia gives birth to a healthy boy. But prisoners do not have the opportunity to raise their children. nine0003

Meridiana decides to abandon her child. She asks Bakhmetyeva and Lazarev to invite a lawyer to her.

Bazanov speaks at a medical conference at the institute where his late father taught. He tells the interns about modern IVF methods. After the lecture, graduate student Inga Elizarova meets him.

Samoryadov tells Bakhmetyeva that usually a lot of things are forgiven to the children of the authorities. But she did the right thing with Pavel: I still hope that a real doctor will come out of him. Therefore, do not forgive him for anything like this in the future. nine0003

At night, Meridiana comes to the neonatology department. She cries near the box for premature babies, asks her son for forgiveness.

90,000 series pregnancy test 3 watch all series online in good quality

3 season

0. Trailer

2 minutes

1. Series 1

51 minutes

2. Series 2

49 minutes

3 Series 3

50 minutes

4. Series 4

51 minutes

5. Series 5

48 minutes

6. Series 6

50 minutes

December 21,

7. Series 7

28 December

8. Series 8

28 December

Natalya Bakhmetyeva - Natalia Bakhmetyev a brilliant surgeon, able to make difficult choices without hesitation. Her determination, which has always served as a reliable support, leads the heroine to a career dead end: Natalya comes into conflict with the hospital administration, loses her position as a leading doctor and makes a fatal mistake.