Top NYC Doctor Explains Your 20 Week Anatomy Scan

I fell in love with my daughter during her 20 week ultrasound.

It was the first time I saw her and when she began to twist and turn, I knew my life would never be the same.

But as the ultrasound technician continued her scan, I started stressing over what the possible negative outcomes were for this test. I wondered what were they looking for, or when I would find out the results. These thoughts lead me to spend the remainder of the scan worrying about what they might find.

Thankfully, the scan showed that my daughter Annabell was healthy, but I couldn’t shake the idea that I wasted the majority of the time I had to see my baby that day, anxious out about everything I didn’t know about the test.

Looking back, what would have really helped me is knowing more about why I was getting this test, if it was necessary, whether ultrasounds could harm my baby or not and when I could expect my results. Having this knowledge could have helped me be more present with my baby at this special moment in my pregnancy.

In speaking with women on Expectful’s platform I’ve found that I’m not alone and that there’s a lot of uncertainty when it comes to the 20 week scan. Many women don’t know why they have to get it, if it’s safe, and what they can expect on the day of the test.

That’s why I sat down with the Head Of Obstetrics at Mount Sinai Hospital in New York City, Dr. Keith Eddleman – to learn everything there is to know about your 20 week scan so you can feel confident, informed and empowered during your experience.

Can you give us a brief description of what the 20-week anatomy scan is?

In short, it’s a scan where we can get the most information about your baby’s anatomy. It’s done right in the middle of the pregnancy because at that point most babies are large enough that you can see all of the structures that you need to see.

Expectful Tip:

What to do the day before the scan? Nourish Your Mind.

One of the best things you can do leading up to the day of your scan is to connect with your growing baby. Try setting time aside the night before your appointment to listen to the Being With Your Baby meditation in the Expectful app. This meditation is designed to allow you and your baby to have a moment of presence with one another, so you can find relaxation and gratitude for this special time in your pregnancy.

When a woman comes in for a 20-week scan, what can she expect?

When you arrive in the waiting room you’ll get some written information about the scan and what we’ll be looking for. In the ultrasound room, you’ll be lying on a bed and you’ll have a screen above you where you’ll be able to watch your baby as they look at the anatomy.

Expectful Tip:

What to do before your appointment? Take Three Minutes.

One of the best ways to find some calm before your scan is through a quick three minute meditation. On the day of the scan, arrive to your appointment with a few minutes to spare in the parking lot or waiting room. Pull out your Expectful app, go to the Urgent Care meditation library and select our three minute Body Scan meditation. This meditation will allow you to relax both your body and mind so you can feel more at ease before your appointment.

What are you specifically looking for in the scan? What are the indicators of a healthy pregnancy that you’re testing for?

The first thing we do is look for a heartbeat to make sure it’s a viable pregnancy. Then we look at how much amniotic fluid is around the baby because if there is a good amount of fluid it’s an indirect sign of fetal health.

Next, we look at how the baby is positioned in the uterus. Since the baby is in a bag of water it can swim around and where the baby is is important. Then the second part of the scan is when we do different measurements like the head circumference, the femur length, and the circumference of the abdomen to name a few. Those parameters help us determine the size of the baby and the age of the baby.

After all that, we turn to the anatomy – starting from the head to the toes. We look at the brain, the face, the heart, lungs, diaphragm, stomach, intestines, kidneys and the bladder. Then we scan the extremities – hands, feet, fingers, toes. Lastly we look at the spine to make sure it’s closed on every level. This part takes a while because we’re looking so thoroughly through the whole body.

The third part of the scan is when we look at where the placenta is located to make sure it’s not in an area where it could jeopardize a safe delivery. Then we look at where the umbilical cord goes into the placenta and the baby to make sure they are inserted properly. Then we look at the maternal structures like the wall of the uterus to make sure there aren’t any extra fibroids, the ovaries to make sure there aren’t any cysts or masses, and the cervix (the opening to the uterus) to make sure it’s closed and has significant length to hold the remainder of the pregnancy.

Expectful Tip:

What to do during your scan? Come Back To Your Breath.

If you find your mind beginning to focus on worrisome thoughts during your scan, try bringing your attention back to your breath. With every inhale, say internally to yourself “I am present for this inhale” and with every exhale, “I am present for this exhale.” By doing this, you help your mind to stay in the moment rather than getting lost in what could or could not be in the future. Be gentle with yourself and if you find your mind starts to wonder again, simply come back to repeating being present with each breath.

What are the top three complications that you could find during ultrasounds?

First would be that there is no heartbeat which is more common early in the pregnancy and begins to decrease further towards the end of the first trimester.

Number two would be finding a complication that’s not compatible with life. 3 to 6% of all births have a noticeable heart issue, however most are not life threatening.

Examples of complications are: missing major parts of the brain, skull, or scalp which happens in the US about 3 times every 10,000 pregnancies. Another is when both kidneys fail to develop, something that occurs about 1 in 3000 pregnancies.

The third would be a rarity where the outcome isn’t clear – where it could be something that could lead to living a normal life or it could be a much bigger issue. Finding a irregularity that has a range of outcomes, from mild disability to severe mental disability. For example, something known as a Dandy-Walker (the names of the two people who first described it) variant, occurs when part of the back of the brain doesn’t form.

How much this disability will affect the baby depends on how much of the brain is missing, which is often very difficult to determine during pregnancy. In these children, the disabilities can range from mild problems with balance to severe mental challenges, developmental delay and an inability to walk. This is a rare disorder, occurring in about 1 in every 30,000 pregnancies to 1 in every 50,000 pregnancies.

Expectful Tip:

What to do if you worry about this during your scan? Start A Conversation.

If you find yourself beginning to worry about how this scan could affect your baby, begin speaking with the technician about your concerns and explain that you are asking because you are feeling uneasy about it. Often times, when we open up a dialogue and express our fears out loud we can find comfort and support in the people around us.

When do you find out the results to your test?

You find out the results immediately.

Some of our users are concerned about the negative effects that ultrasounds might have on a fetus. Can you speak to that concern and if there are any negative side effects?

There are several different levels of ultrasounds. Ultrasound means outside of the range of human hearing. There are different wavelengths of ultrasounds. Some wavelengths are intended to break up tissue, but the wavelengths that we use for diagnostics imaging are not at all in the ranges that could cause significant tissue damage.

Our machines have restraints on them so that they can’t go to that level of frequency that could cause damage. We constantly have our machines calibrated to make sure it can’t go into that range.

Ultrasounds have been used Diagnostically for over 50 years now and there have been numerous studies done and none have shown that there is any effect to diagnostic ultrasound.

Why do they do the early anatomy ultrasound before the 20 week one? Is that one necessary?

No, it’s not really necessary, but let me explain why we do it. There are certain things that we can see at 16 weeks and if we could diagnose a fatal anomaly at 16 weeks ultrasound, wouldn’t you want to know that earlier than later? Unfortunately, we can’t see everything, which is why you have the 20-week scan, but we want women to have information sooner rather than later.

How often common is it to identify the baby’s sex incorrectly during the 20-week anatomy scan?

If the baby is positioned in a way where it’s difficult for us to see than the gender might be more difficult to determine. In that case, we’ll tell the woman our estimated that we aren’t 100% sure but we think it’s this or that.

Expectful Tip:

What to do after your scan? Sleep well.

After the excitement from your scan has settled and your day has began to come to a close, allow your body and mind to ease into sleep. You could do this by listening to our Preparing For Sleep meditation or by trying our Waves Of Breath Exercise below.

Waves Of Breath Exercise:

Water has often been revered for its calm and healing properties. As another tool for drifting back to sleep, imagine that your in-breath is a wave floating into shore, and your out-breath is a wave slipping back into the ocean. Think of the ocean as sleep, and with every exhale you submerge deeper into rest. Repeating that continuously, feeling the flow of both wave and breath effortlessly moving as one.