20 Week Ultrasound

Ultrasound at the 20th week of pregnancy is called level 2 ultrasound, mid-pregnancy, anatomy, morphology or structural scan as well as anomaly scan because fetal abnormalities are searched for since they are visible at this stage. Thus, we can conclude that this ultrasound examines anatomical and morphological characteristics of the baby’s body.

This scan is not necessarily essential, but it can determine if all looks normal of the fetus´s anatomy. At this week, all the baby’s organs are formed and visible on the scan.  Although they are still immature, if there is any failure in some of the organs, this ultrasound can show it. The procedure of the examination is usual.

For Whom a Level 2 Ultrasound Is For?

If you had an ultrasound during the first trimester of your pregnancy, or the first-trimester screening test, regardless, your doctor will recommend the level 2 sonogram. It is important examination because of all the additional details that give your doctor the necessary information about your baby’s development. It means that, regardless of your pregnancy development, you will have the level 2 sonogram.

What Can You See on the Scan?

Your baby´s spine is formed by the little tiny bones in line. It may look like a string of pearls to you. You can see other big bones too because the tissues around the bones are still tin. Black area around the baby is amniotic fluid. Now you can see a sex organ of the baby pretty well, although ultrasound examination is never 100% accurate at determining the fetal sex. There are three lines if it is a girl or a little penis if it is a boy. The face of your baby will be the most interesting for you, especially if he/she is sucking his/her thumb, making grimaces or yawing. During the examination, your baby may move around, play with umbilical cord or stretch and extend his/her legs and arms, while you enjoy looking at him/her.

What Can the Sonographer See on the Scan?

The sonographer can see much more details about your baby’s anatomy. He will inspect all the baby’s organs. First in a row, he will look at the baby’s head, its structure, symmetry, and shape. He will check for a cleft lip on the baby’s face.  He will also measure the fetal size, look at the baby’s spine while checking that the skin covers the spine at the back. The measurements that should be taken are head circumference (HC), abdominal circumference (AC) and length of the thigh bone (FL).

Your sonographer will confirm that the fetal heart is beating as well as the two chambers are in proper size, so as that the valves open and close with each heartbeat. Major veins and arteries of your baby will be examined too, as well as the placenta, umbilical cord, and the amniotic fluid. If the placenta is on the back wall of your uterus, it is called – posterior, while if it is on the front wall, it is called – anterior, or the placenta near the top which is called – fundal. The placenta may cover the cervix (the neck of your uterus). Due to its position, you’ll have another scan in the third trimester. Placenta usually moves away from your cervix during the last weeks.

The sonographer will check also that the abdominal wall covers all the internal organs at the front as well as the baby’s kidneys, bladder. He will check baby’s fingers, toes, arms, legs, hands, and feet.

Which Abnormalities Can Be Detected?

Sonographers know in advance, conditions that they must look out for. Some conditions are hard to see, so as most of them are very rare. It is very important to know if the condition is treatable so the doctor can make sure your baby has the right care after he/she is born. Some conditions are very serious, which may mean that the baby’s life is in danger.

Here are congenital abnormalities, and how likely is to identify each problem with scanning:



  • Spina bifida – seen like an open spinal cord;
  • Hydrocephalus – seen like an excess fluid within the brain;
  • Anencephaly – seen like the absence of the top head;
  • Omphalocele – seen as ventral body wall defects;
  • Mayor kidney problems – seen as an abnormal structure or missing of kidney;
  • Mayor limbs abnormalities – very short limbs or missing some of the bones.

Chance for detecting these malformations is 99% to 85%, while the chance to detect Down syndrome by this ultrasound examination is only 40%. Cerebral palsy (spastic paralysis) or Autism is never seen by this way.

Are There Any Risks For Your Health Associated With Ultrasound?

Ultrasound is a safe method of scanning of the internal organs, so as scanning of the fetus during the pregnancy. You should not be concern about the risks associated with ultrasounds. Ultrasound waves aren’t radioactive so they don’t make any damage passing through your or the baby’s organs. Therefore, examination by an ultrasound is recommended during the pregnancy. At the same time, ultrasound images allow very good visibility of the details which is important for assessing the health of a fetus.

After the Ultrasound Examination

The result of an ultrasound examination will be referred to your doctor, and after that, he will explain to you about the current condition and the development of your baby. If there are signs of some malformation, you might consult a genetic counselor, obstetrician or pediatrician. They can discuss with you about the possible problem as well as make a decision about further intervention. Some of them may be a decision to continue or abort the pregnancy. Such serious problems are rare. Other problems may be healed by surgery treatment after birth, or even during the pregnancy.


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